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Sample records for advanced surgical techniques

  1. Advances in Surgical Reconstructive Techniques in the Management of Penile, Urethral, and Scrotal Cancer.

    PubMed

    Bickell, Michael; Beilan, Jonathan; Wallen, Jared; Wiegand, Lucas; Carrion, Rafael

    2016-11-01

    This article reviews the most up-to-date surgical treatment options for the reconstructive management of patients with penile, urethral, and scrotal cancer. Each organ system is examined individually. Techniques and discussion for penile cancer reconstruction include Mohs surgery, glans resurfacing, partial and total glansectomy, and phalloplasty. Included in the penile cancer reconstruction section is the use of penile prosthesis in phalloplasty patients after penectomy, tissue engineering in phallic regeneration, and penile transplantation. Reconstruction following treatment of primary urethral carcinoma and current techniques for scrotal cancer reconstruction using split-thickness skin grafts and flaps are described.

  2. Results of two different surgical techniques in the treatment of advanced-stage Freiberg's disease

    PubMed Central

    Özkul, Emin; Gem, Mehmet; Alemdar, Celil; Arslan, Hüseyin; Boğatekin, Ferit; Kişin, Bülent

    2016-01-01

    Background: Freiberg's disease is an osteochondrosis most commonly seen in adolescent women and characterized by pain, swelling and motion restriction in the second metatarsal. The early stages of this disease can be managed with semirigid orthoses, metatarsal bars and short leg walking cast. Number of operative methods are suggested which can be used depending on the pathophysiology of the disease, including abnormal biomechanics, joint congruence and degenerative process. We evaluated the outcomes of the patients with Freiberg's disease who were treated with dorsal closing-wedge osteotomy and resection of the metatarsal head. Patients and Methods: 16 patients (11 female, 5 male) with a mean age of 24.5 (range 13–49 years) years who underwent dorsal closing wedge osteotomy or resection of the metatarsal head were included in this retrospective study. Second metatarsal was affected in 13 and third metatarsal in three patients. According to the Smillie's classification system, ten patients had type IV osteonecrosis and six patients had type V. The results of the patients were evaluated using the lesser metatarsophalangeal-interphalangeal (LMPI) scale. Results: According to the LMPI scale, the postoperative scores for the osteotomy and excision groups were 86 (range 64–100) and 72.6 (range 60–85), respectively. In the osteotomy group, mean passive flexion restriction was 18° (range 0°–35°) and mean passive extension restriction was 12° (range 0°–25°). Mean metatarsal shortening was 2.2 mm (range 2–4 mm) in the osteotomy group as opposed to 9.8 mm (range 7–14 mm) in the excision group. Significant pain relief was obtained in both groups following the surgery. Conclusions: The decision of performing osteotomy or resection arthroplasty in the patients with advanced-stage Freiberg's disease should be based on the joint injury and the patients should be informed about the cosmetic problems like shortening which may arise from resection. PMID:26955180

  3. Minimally invasive surgical technique for tethered surgical drains

    PubMed Central

    Hess, Shane R; Satpathy, Jibanananda; Waligora, Andrew C; Ugwu-Oju, Obinna

    2017-01-01

    A feared complication of temporary surgical drain placement is from the technical error of accidentally suturing the surgical drain into the wound. Postoperative discovery of a tethered drain can frequently necessitate return to the operating room if it cannot be successfully removed with nonoperative techniques. Formal wound exploration increases anesthesia and infection risk as well as cost and is best avoided if possible. We present a minimally invasive surgical technique that can avoid the morbidity associated with a full surgical wound exploration to remove a tethered drain when other nonoperative techniques fail.

  4. [Surgical techniques of organ transplants].

    PubMed

    Froněk, Jiří

    2015-01-01

    The list of surgical procedures of solid organ transplantations appears very interesting and colorful, even with overlap among techniques. Liver transplantation is a life-saving procedure in a majority of cases, the liver can be transplanted as a full or partial graft. The liver graft can be split for two recipients; it can also be reduced for a small recipient if splitting is not indicated. Kidney transplantation is the most common solid organ transplant procedure, the majority of kidney grafts come from brain-dead donors whereas the number of live donor transplants is increasing, also thanks to paired donation and blood group incompatible transplantation methods. The small bowel and multivisceral transplantation are rare procedures; they serve selected patients with short bowel syndrome, some patients with retroperitoneal tumors or with extensive visceral thrombosis. Solid organ transplants are well established treatment methods with good and proven outcomes. A majority of patients can return to a normal life after their transplants.

  5. Surgical Techniques to Increase Bone Augmentation Success.

    PubMed

    Resnik, Randy R

    2015-11-01

    Oral implantology has grown into awidely acceptedand ever expanding discipline. Due to this phenomenon, more and more clinicians are offering dental implant surgery in their respective practices. As the discipline of implantology grows, the prevalence of bone grafting will become more significant. Restoring the lost hard-tissue volume to allow ideal implant placement. is crucial to decrease the Morbidity of implants and the restorations they support. Bone augmentation comprises a wide range of materials, donor sites, and surgical approaches, with new advances arriving at a staggering rate. With all of the materials and varying techniques available today, the practitioner must have a solid understanding of adjunct techniques to increase the success of bone grafting.

  6. Advanced echocardiographic techniques

    PubMed Central

    Perry, Rebecca

    2015-01-01

    Abstract Echocardiography has advanced significantly since its first clinical use. The move towards more accurate imaging and quantification has driven this advancement. In this review, we will briefly focus on three distinct but important recent advances, three‐dimensional (3D) echocardiography, contrast echocardiography and myocardial tissue imaging. The basic principles of these techniques will be discussed as well as current and future clinical applications. PMID:28191159

  7. Cochlear implant simulator for surgical technique analysis

    NASA Astrophysics Data System (ADS)

    Turok, Rebecca L.; Labadie, Robert F.; Wanna, George B.; Dawant, Benoit M.; Noble, Jack H.

    2014-03-01

    Cochlear Implant (CI) surgery is a procedure in which an electrode array is inserted into the cochlea. The electrode array is used to stimulate auditory nerve fibers and restore hearing for people with severe to profound hearing loss. The primary goals when placing the electrode array are to fully insert the array into the cochlea while minimizing trauma to the cochlea. Studying the relationship between surgical outcome and various surgical techniques has been difficult since trauma and electrode placement are generally unknown without histology. Our group has created a CI placement simulator that combines an interactive 3D visualization environment with a haptic-feedback-enabled controller. Surgical techniques and patient anatomy can be varied between simulations so that outcomes can be studied under varied conditions. With this system, we envision that through numerous trials we will be able to statistically analyze how outcomes relate to surgical techniques. As a first test of this system, in this work, we have designed an experiment in which we compare the spatial distribution of forces imparted to the cochlea in the array insertion procedure when using two different but commonly used surgical techniques for cochlear access, called round window and cochleostomy access. Our results suggest that CIs implanted using round window access may cause less trauma to deeper intracochlear structures than cochleostomy techniques. This result is of interest because it challenges traditional thinking in the otological community but might offer an explanation for recent anecdotal evidence that suggests that round window access techniques lead to better outcomes.

  8. [Surgical renal biopsies: technique, effectiveness and complications].

    PubMed

    Pinsach Elías, L; Blasco Casares, F J; Ibarz Servió, L; Valero Milián, J; Areal Calama, J; Bucar Terrades, S; Saladié Roig, J M

    1991-01-01

    Retrospective study made on 140 renal surgical biopsies (RSB) performed throughout the past 4 years in our Unit. The technique's effectiveness and morbidity are emphasized and the surgical technique and type of anaesthesia described. The sample obtained was enough to perform an essay in 100% cases, and a diagnosis was reached in 98.5%. Thirty-nine patients (27.8%) presented complications, 13 (9.2%) of which were directly related to the surgical technique. No case required blood transfusion and no deaths were reported. The type of anaesthesia used was: local plus sedation in 104 (74.2%) cases, rachianaesthesia in 10 (7.1%) and general in 26 (18.5%). The same approach was used in all patients: minimal subcostal lumbotomy, using Wilde's forceps to obtain the samples. It is believed that RSB is a highly effective, low mortality procedure, easy and quick to perform, and suitable for selected patients.

  9. Rhinoplasty: surface aesthetics and surgical techniques.

    PubMed

    Çakir, Bariş; Doğan, Teoman; Öreroğlu, Ali Riza; Daniel, Rollin K

    2013-03-01

    Surface aesthetics of the attractive nose are created by certain lines, shadows, and highlights, with specific proportions and breakpoints. Our evaluation of the nasal surface aesthetics is achieved using the concept of geometric polygons as aesthetic subunits, both to define the existing deformity and the aesthetic goals. Surgical techniques have been developed and modified to achieve the desired surface appearance, and those are detailed in this article. The principles of geometric polygons allow the surgeon to analyze the deformities of the nose, to define an operative plan to achieve specific goals, and to select the appropriate operative technique. These aesthetic concepts and surgical techniques were used in 257 consecutive rhinoplasties performed in the past 3 years by the principal author (B.Ç.).

  10. The transcaruncular approach: surgical anatomy and technique.

    PubMed

    Goldberg, Robert A; Mancini, Ronald; Demer, Joseph L

    2007-01-01

    With a detailed understanding of the pertinent surgical anatomy, the transcaruncular approach provides safe access and excellent exposure of the medial orbit and orbital apex. We herein describe our technique of the transcaruncular approach and delineate the pertinent associated surgical anatomy via dissection, magnetic resonance imaging, and histologic examination. The isolated transcaruncular approach provides exposure of the medial orbital floor from the region of the maxilloethmoidal strut to the orbital roof area superior to the frontoethmoidal suture. When combined with an inferior fornix incision, the transcaruncular approach allows for continuous exposure from the frontozygomatic suture laterally to the frontoethmoidal suture medially. Attention to anatomical details promotes creation of an effective and safe caruncular incision. The conjunctival incision should be ample. The orbital septum should be carefully dissected from the posterior surface of the Horner muscle to minimize fat spillage, and the periosteum should be opened widely at the beginning of surgery.

  11. Post-traumatic knee stiffness: surgical techniques.

    PubMed

    Pujol, N; Boisrenoult, P; Beaufils, P

    2015-02-01

    Post-traumatic knee stiffness and loss of range of motion is a common complication of injuries to the knee area. The causes of post-traumatic knee stiffness can be divided into flexion contractures, extension contractures, and combined contractures. Post-traumatic stiffness can be due to the presence of dense intra-articular adhesions and/or fibrotic transformation of peri-articular structures. Various open and arthroscopic surgical treatments are possible. A precise diagnosis and understanding of the pathology is mandatory prior to any surgical treatment. Failure is imminent if all pathologies are not addressed correctly. From a general point of view, a flexion contracture is due to posterior adhesions and/or anterior impingement. On the other hand, extension contractures are due to anterior adhesions and/or posterior impingement. This overview will describe the different modern surgical techniques for treating post-traumatic knee stiffness. Any bony impingements must be treated before soft tissue release is performed. Intra-articular stiff knees with a loss of flexion can be treated by an anterior arthroscopic arthrolysis. Extra-articular pathology causing a flexion contracture can be treated by open or endoscopic quadriceps release. Extension contractures can be treated by arthroscopic or open posterior arthrolysis. Postoperative care (analgesia, rehabilitation) is essential to maintaining the range of motion obtained intra-operatively.

  12. Cephalometric evaluation of surgical mandibular advancement.

    PubMed

    Boeck, Eloísa Marcantônio; Kuramae, Mayury; Lunardi, Nádia; Santos-Pinto, Ary dos; Mazzonetto, Renato

    2010-01-01

    The treatment of Class II adult individuals with mandibular deficiency has been the combination of orthodontic treatment and orthognathic surgery. Therefore, a study was conducted in which cephalometric analysis was used to evaluate the influence of dentoalveolar decompensation in Class II patients submitted to orthodontic and surgical treatment for mandibular advancement, by bilateral osteotomy of the mandibular ramus. A sample of 15 leukoderma adult female patients were selected and three cephalometric radiographs of each patient, taken before the orthodontic treatment, before surgery and after at least 6 months postoperatively, were analyzed in a total of 45 roentgenograms. The tracings were made by the manual method and the points were digitalized using software. The results showed that values of SNB increased from 75.6 to 78.6 degrees. The measures BNP and PGNP were reduced from -12.7 to -7.7 mm and -12.7 to -6.6 mm, respectively. For ANB there was a reduction of 3.23 degrees (from 8.1 degrees to 4.9 degrees). Likewise, the values of AOBO were diminished by 6.3 mm (from 7.6 to 1.3 mm), and in the values of OJ there was a reduction of 5.7 mm (from 9 to 3.3 mm). It was concluded that the pre-surgical orthodontic treatment promoted minimal and variable dental and skeletal changes in the final result. The surgical treatment caused significant skeletal changes, especially in the measurements related to the mandible (SNB, BNP, PGNP and SNPM) or indirectly to it (ANB, AOBO and OJ).

  13. [Evidence-based surgical techniques for caesarean section].

    PubMed

    Aabakke, Anna J M; Secher, Niels Jørgen; Krebs, Lone

    2014-02-10

    Caesarean section (CS) is a common surgical procedure, and in Denmark 21% of deliveries is by CS. There is an increasing amount of scientific evidence to support the different surgical techniques used at CS. This article reviews the literature regarding CS techniques. There is still a lack of evidence especially about the long-term consequences of the surgical techniques.

  14. Endoscopic quadricepsplasty: A new surgical technique.

    PubMed

    Blanco, C E; Leon, H O; Guthrie, T B

    2001-05-01

    We present a new surgical subperiosteal endoscopic technique for the release of fibrosis of the quadriceps to the femur caused by gunshot injuries, postsurgical scarring, and fractures, that was developed at the Arthroscopy Group at Hospital Hermanos Ameijeiras in Havana, Cuba. The technique used is a proximal endoscopic subperiosteal extension of the usual arthroscopic intra-articular release of adhesions, using periosteal elevators and arthroscopic scissors placed through medial and lateral superior knee portals to release adhesions and bands of scar tissue beneath the quadriceps mechanism. The technique was used in a prospective case series of 26 male patients aged 19 to 22 years between February 1997 and March 1998 who presented with clinically and ultrasonically documented extra-articular fibrosis resulting in ankylosis of the knee in extension. Only patients who had reached a plateau in their aggressive physiotherapy program with no further progression in knee flexion for 3 months were selected. Those with joint instability, motion-limiting articular surface pathology, and muscle or neurologic injury were excluded. All patients had obtained satisfactory results at 2-year follow-up. The extra-articular release gained at final follow-up was between 30 degrees and 90 degrees of flexion in addition to that obtained at the completion of the standard intra-articular release. Complications included 1 case of deep vein thrombosis, 2 cases of scrotal edema, 5 cases of hemarthrosis, and 2 cases of reflex sympathetic dystrophy. We have found this technique useful in obtaining additional flexion and improved function in a difficult class of patients with ankylosis caused by extra-articular fibrosis of the quadriceps to the femur, allowing immediate aggressive rehabilitation and presenting a useful outpatient alternative with fewer and less severe complications than described with the classic open Thompson's quadricepsplasty.

  15. Sternoclavicular dislocation: case report and surgical technique.

    PubMed

    Terra, Bernardo Barcellos; Rodrigues, Leandro Marano; Pádua, David Victoria Hoffmann; Martins, Marcelo Giovanini; Teixeira, João Carlos de Medeiros; De Nadai, Anderson

    2015-01-01

    Sternoclavicular dislocations account for less than 5% of all dislocations of the scapular belt. Most cases of anterior dislocation of the sternoclavicular joint do not present symptoms. However, some patients may develop chronic anterior instability and remain symptomatic, and surgical treatment is indicated in these cases. There is a scarcity of reports in the literature relating to reconstruction using the long palmar tendon in cases of traumatic anterior instability. Although rare, these injuries deserve rapid diagnosis and efficient treatment in order to avoid future complications. The aim of this report was to report on a case of a motocross competitor who developed chronic traumatic anterior instability of the sternoclavicular joint and underwent surgical reconstruction using the autogenous long palmar tendon. The patient was a 33-year-old man with a history of anterior dislocation of the sternoclavicular subsequent to a fall during a maneuver in a motocross competition. Conservative treatment was instituted initially, consisting of use of a functional sling to treat the symptoms for 3 weeks, along with physiotherapeutic rehabilitation for 3 months. We chose to use a modification of the "figure of eight" technique based on the studies by Spencer and Kuhn. A longitudinal incision of approximately 10 cm was made at the level of the sternoclavicular joint. The graft from the ipsilateral long palmar tendon was passed through the orifices in the form of a modified "figure of eight" and its ends were sutured together. The patient was immobilized using an American sling for 4 weeks. After 6 months of follow-up, the patient no longer presented pain or instability when movement of the sternoclavicular joint was required. Minor discomfort and slight prominence of the sternoclavicular joint continued to be present but did not affect the patient's activities. Thus, the patient was able to return to racing 6 months after the operation. Our study presented a case of

  16. Advancement on Visualization Techniques

    DTIC Science & Technology

    1980-10-01

    Aeroa and As ronautics Massachusetts Institute of Technology Cambridge, MA 02139 USA I !ii 1 I This AGARDograph was prepared at the request of the...the fields of science § and technology relating to aerospace for the following purposes: - Exchanging of scientific and technical information...Techniques for providing the pilot visualization have grown rapidly. Technology has developed fron mechanical gauges through electro-mechanical

  17. Advanced Coating Removal Techniques

    NASA Technical Reports Server (NTRS)

    Seibert, Jon

    2006-01-01

    An important step in the repair and protection against corrosion damage is the safe removal of the oxidation and protective coatings without further damaging the integrity of the substrate. Two such methods that are proving to be safe and effective in this task are liquid nitrogen and laser removal operations. Laser technology used for the removal of protective coatings is currently being researched and implemented in various areas of the aerospace industry. Delivering thousands of focused energy pulses, the laser ablates the coating surface by heating and dissolving the material applied to the substrate. The metal substrate will reflect the laser and redirect the energy to any remaining protective coating, thus preventing any collateral damage the substrate may suffer throughout the process. Liquid nitrogen jets are comparable to blasting with an ultra high-pressure water jet but without the residual liquid that requires collection and removal .As the liquid nitrogen reaches the surface it is transformed into gaseous nitrogen and reenters the atmosphere without any contamination to surrounding hardware. These innovative technologies simplify corrosion repair by eliminating hazardous chemicals and repetitive manual labor from the coating removal process. One very significant advantage is the reduction of particulate contamination exposure to personnel. With the removal of coatings adjacent to sensitive flight hardware, a benefit of each technique for the space program is that no contamination such as beads, water, or sanding residue is left behind when the job is finished. One primary concern is the safe removal of coatings from thin aluminum honeycomb face sheet. NASA recently conducted thermal testing on liquid nitrogen systems and found that no damage occurred on 1/6", aluminum substrates. Wright Patterson Air Force Base in conjunction with Boeing and NASA is currently testing the laser remOval technique for process qualification. Other applications of liquid

  18. Evolving Educational Techniques in Surgical Training.

    PubMed

    Evans, Charity H; Schenarts, Kimberly D

    2016-02-01

    Training competent and professional surgeons efficiently and effectively requires innovation and modernization of educational methods. Today's medical learner is quite adept at using multiple platforms to gain information, providing surgical educators with numerous innovative avenues to promote learning. With the growth of technology, and the restriction of work hours in surgical education, there has been an increase in use of simulation, including virtual reality, robotics, telemedicine, and gaming. The use of simulation has shifted the learning of basic surgical skills to the laboratory, reserving limited time in the operating room for the acquisition of complex surgical skills".

  19. Advanced Wavefront Control Techniques

    SciTech Connect

    Olivier, S S; Brase, J M; Avicola, K; Thompson, C A; Kartz, M W; Winters, S; Hartley, R; Wihelmsen, J; Dowla, F V; Carrano, C J; Bauman, B J; Pennington, D M; Lande, D; Sawvel, R M; Silva, D A; Cooke, J B; Brown, C G

    2001-02-21

    this project, work was performed in four areas (1) advanced modeling tools for deformable mirrors (2) low-order wavefront correctors with Alvarez lenses, (3) a direct phase measuring heterdyne wavefront sensor, and (4) high-spatial-frequency wavefront control using spatial light modulators.

  20. Preoperative Diagnostic Angiogram and Endovascular Aortic Stent Placement for Appleby Resection Candidates: A Novel Surgical Technique in the Management of Locally Advanced Pancreatic Cancer

    PubMed Central

    Trabulsi, N.; Pelletier, J. S.; Abraham, C.; Vanounou, T.

    2015-01-01

    Background. Pancreatic adenocarcinoma of the body and tail usually presents late and is typically unresectable. The modified Appleby procedure allows resection of pancreatic body carcinoma with celiac axis (CA) invasion. Given that the feasibility of this technique is based on the presence of collateral circulation, it is crucial to confirm the presence of an anatomical and functional collateral system. Methods. We here describe a novel technique used in two patients who were candidates for Appleby resection. We present their clinical scenario, imaging, operative findings, and postoperative course. Results. Both patients had a preoperative angiogram for assessment of anatomical circulation and placement of an endovascular stent to cover the CA. We hypothesize that this new technique allows enhancement of collateral circulation and helps minimize intraoperative blood loss when transecting the CA at its takeoff. Moreover, extra length on the CA margin may be gained, as the artery can be transected at its origin without the need for vascular clamp placement. Conclusion. We propose this novel technique in the preoperative management of patients who are undergoing a modified Appleby procedure. While further experience with this technique is required, we believe that it confers significant advantages to the current standard of care. PMID:26491217

  1. Advanced qualification techniques

    SciTech Connect

    Winokur, P.S; Shaneyfelt, M.R.; Meisenheimer, T.L.; Fleetwood, D.M.

    1993-12-01

    This paper demonstrates use of the Qualified Manufacturers List (QML) methodology to qualify commercial and military microelectronics for use in space applications. QML ``builds in`` the hardness of product through statistical process control (SPC) of technology parameters relevant to the radiation response, test structure to integrated circuit (IC) correlations, and techniques for extrapolating laboratory test results to low-dose-rate space scenarios. Each of these elements is demonstrated and shown to be a cost-effective alternative to expensive end-of-line IC testing. Several examples of test structured-IC correlations are provided and recent work on complications arising from transistor scaling and geometry is discussed. The use of a 10-keV x-ray wafer-level test system to support SPC and establish ``process capability`` is illustrated and a comparison of 10-keV x-ray and Co{sup 60} gamma irradiations is provided for a wide range of CMOS technologies. The x-ray tester is shown to be cost-effective and its use in lot acceptance/qualification is recommended. Finally, a comparison is provided between MIL-STD-883D, Test Method 1019.4, which governs the testing of packaged semiconductor microcircuits in the DoD, and ESA/SSC Basic Specification No. 22900, Europe`s Total Dose Steady-State Irradiation Test Method. Test Method 1019.4 focuses on conservative estimates of MOS hardness for space and tactical applications, while Basic Specification 22900 focuses on improved simulation of low-dose-rate space environments.

  2. Techniques in Advanced Language Teaching.

    ERIC Educational Resources Information Center

    Ager, D. E.

    1967-01-01

    For ease of presentation, advanced grammar teaching techniques are briefly considered under the headings of structuralism (belief in the effectiveness of presenting grammar rules) and contextualism (belief in the maximum use by students of what they know in the target language). The structuralist's problem of establishing a syllabus is discussed…

  3. Computer-Assisted Technique for Surgical Tooth Extraction

    PubMed Central

    Hamza, Hosamuddin

    2016-01-01

    Introduction. Surgical tooth extraction is a common procedure in dentistry. However, numerous extraction cases show a high level of difficulty in practice. This difficulty is usually related to inadequate visualization, improper instrumentation, or other factors related to the targeted tooth (e.g., ankyloses or presence of bony undercut). Methods. In this work, the author presents a new technique for surgical tooth extraction based on 3D imaging, computer planning, and a new concept of computer-assisted manufacturing. Results. The outcome of this work is a surgical guide made by 3D printing of plastics and CNC of metals (hybrid outcome). In addition, the conventional surgical cutting tools (surgical burs) are modified with a number of stoppers adjusted to avoid any excessive drilling that could harm bone or other vital structures. Conclusion. The present outcome could provide a minimally invasive technique to overcome the routine complications facing dental surgeons in surgical extraction procedures. PMID:27127510

  4. Computer-Assisted Technique for Surgical Tooth Extraction.

    PubMed

    Hamza, Hosamuddin

    2016-01-01

    Introduction. Surgical tooth extraction is a common procedure in dentistry. However, numerous extraction cases show a high level of difficulty in practice. This difficulty is usually related to inadequate visualization, improper instrumentation, or other factors related to the targeted tooth (e.g., ankyloses or presence of bony undercut). Methods. In this work, the author presents a new technique for surgical tooth extraction based on 3D imaging, computer planning, and a new concept of computer-assisted manufacturing. Results. The outcome of this work is a surgical guide made by 3D printing of plastics and CNC of metals (hybrid outcome). In addition, the conventional surgical cutting tools (surgical burs) are modified with a number of stoppers adjusted to avoid any excessive drilling that could harm bone or other vital structures. Conclusion. The present outcome could provide a minimally invasive technique to overcome the routine complications facing dental surgeons in surgical extraction procedures.

  5. Surgical therapy in advanced heart failure.

    PubMed

    Vitali, Ettore; Colombo, Tiziano; Fratto, Pasquale; Russo, Claudio; Bruschi, Giuseppe; Frigerio, Maria

    2003-05-08

    Congestive heart failure (CHF) affects about 1% of adults in the United States and is a contributing factor in >250,000 deaths per year. In an increasingly elderly population, the surgical treatment of CHF made great progress during the past 3 decades, consuming enormous health care resources. Heart transplantation is still the most effective therapy for end-stage heart disease, with the 10-year survival rate after transplantation approaching 50%. Efforts to increase the supply of donor organs have failed to improve the shortage, underscoring the crucial need for alternatives to cardiac allotransplantation. Alternative surgical options to end-stage heart transplantation are rapidly evolving. Left ventricular assist devices have been used as a bridge to heart transplantation for patients who otherwise might die awaiting a new heart. There is also continued interest in the use of these devices either to bridge patients to full recovery or to destination therapy, without the need for heart replacement. Left ventricular reconstruction, including the Batista and Dor procedures, along with mitral valve repair, cardiomyoplasty, and extreme coronary artery bypass graft surgery, are now being increasingly performed as alternative options. The history, status, and personal experience of surgical treatment of end-stage heart disease are discussed.

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

    PubMed Central

    Leppäniemi, Ari

    2009-01-01

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

  7. [Recent advances in medical and surgical treatment of ulcerative colitis].

    PubMed

    Sugita, Akira; Koganei, Kazutaka; Tatsumi, Kenji; Futatsuki, Ryo; Kuroki, Hirosuke; Yamada, Kyoko; Arai, Katsuhiko; Fukushima, Tsuneo

    2015-03-01

    Recent advances in both medical and surgical treatment of ulcerative colitis have been remarkable. Changes in medical treatment are mainly good results of therapy with the anti-TNF-α antibody, tacrolimus, and those in surgical treatment are an expansion of the surgical indications to include patients with intractable disease, such as treatment refractoriness and chronic corticosteroid dependence, by a better postoperative clinical course after pouch surgery, improred selection of surgical procedures and the timing of surgery in elderly patients. To offer the optimal treatment for patients with ulcerative colitis, new medical therapies should be analyzed from the standpoint of the efficacy and limitations of effect. Long postoperative clinical course of surgical patients including colitic cancer, prevention of postoperative complications should be also analyzed.

  8. Minimally invasive surgical techniques in periodontal regeneration.

    PubMed

    Cortellini, Pierpaolo

    2012-09-01

    A review of the current scientific literature was undertaken to evaluate the efficacy of minimally invasive periodontal regenerative surgery in the treatment of periodontal defects. The impact on clinical outcomes, surgical chair-time, side effects and patient morbidity were evaluated. An electronic search of PUBMED database from January 1987 to December 2011 was undertaken on dental journals using the key-word "minimally invasive surgery". Cohort studies, retrospective studies and randomized controlled clinical trials referring to treatment of periodontal defects with at least 6 months of follow-up were selected. Quality assessment of the selected studies was done through the Strength of Recommendation Taxonomy Grading (SORT) System. Ten studies (1 retrospective, 5 cohorts and 4 RCTs) were included. All the studies consistently support the efficacy of minimally invasive surgery in the treatment of periodontal defects in terms of clinical attachment level gain, probing pocket depth reduction and minimal gingival recession. Six studies reporting on side effects and patient morbidity consistently indicate very low levels of pain and discomfort during and after surgery resulting in a reduced intake of pain-killers and very limited interference with daily activities in the post-operative period. Minimally invasive surgery might be considered a true reality in the field of periodontal regeneration. The observed clinical improvements are consistently associated with very limited morbidity to the patient during the surgical procedure as well as in the post-operative period. Minimally invasive surgery, however, cannot be applied at all cases. A stepwise decisional algorithm should support clinicians in choosing the treatment approach.

  9. [Objective surgery -- advanced robotic devices and simulators used for surgical skill assessment].

    PubMed

    Suhánszki, Norbert; Haidegger, Tamás

    2014-12-01

    Robotic assistance became a leading trend in minimally invasive surgery, which is based on the global success of laparoscopic surgery. Manual laparoscopy requires advanced skills and capabilities, which is acquired through tedious learning procedure, while da Vinci type surgical systems offer intuitive control and advanced ergonomics. Nevertheless, in either case, the key issue is to be able to assess objectively the surgeons' skills and capabilities. Robotic devices offer radically new way to collect data during surgical procedures, opening the space for new ways of skill parameterization. This may be revolutionary in MIS training, given the new and objective surgical curriculum and examination methods. The article reviews currently developed skill assessment techniques for robotic surgery and simulators, thoroughly inspecting their validation procedure and utility. In the coming years, these methods will become the mainstream of Western surgical education.

  10. Recent advances in the surgical management of rhinosinusitis

    PubMed Central

    Jaksha, Alexandria F.; Weitzel, Erik K.; Laury, Adrienne M.

    2016-01-01

    Rhinosinusitis affects a significant portion of the US population, and its management imposes a substantial burden on the healthcare system. The treatment of chronic rhinosinusitis includes initial medical management prior to consideration of surgical intervention. However, if surgery does become necessary, several factors must be considered in order to optimize outcomes. This review evaluates surgical patient selection, perioperative medical management, and the extent of operative intervention, with the goal of improving surgical results, decreasing the need for revision surgery, and enhancing the patient’s quality of life. Specific variations in patient genotypes and phenotypes will be further explored with regard to their implications on surgical outcomes. Additionally, the evidence behind pre- and post-operative antibiotic and steroid use will be evaluated. Finally, we will review evolving surgical tools and techniques that are currently being utilized for the treatment of specific subsets of rhinosinusitis. PMID:27746900

  11. LHC Olympics: Advanced Analysis Techniques

    NASA Astrophysics Data System (ADS)

    Armour, Kyle; Larkoski, Andrew; Gray, Amanda; Ventura, Dan; Walsh, Jon; Schabinger, Rob

    2006-05-01

    The LHC Olympics is a series of workshop aimed at encouraging theorists and experimentalists to prepare for the soon-to-be-online Large Hadron Collider in Geneva, Switzerland. One aspect of the LHC Olympics program consists of the study of simulated data sets which represent various possible new physics signals as they would be seen in LHC detectors. Through this exercise, LHC Olympians learn the phenomenology of possible new physics models and gain experience in analyzing LHC data. Additionally, the LHC Olympics encourages discussion between theorists and experimentalists, and through this collaboration new techniques could be developed. The University of Washington LHC Olympics group consists of several first-year graduate and senior undergraduate students, in both theoretical and experimental particle physics. Presented here is a discussion of some of the more advanced techniques used and the recent results of one such LHC Olympics study.

  12. Equine thoracoscopy: normal anatomy and surgical technique.

    PubMed

    Peroni, J F; Horner, N T; Robinson, N E; Stick, J A

    2001-05-01

    Six normal, healthy horses age 3-10 years underwent left and right thoracoscopic examination using a rigid telescope. A minimum of 30 days was allowed between procedures. Horses were restrained in stocks and sedated with a continuous detomidine infusion. After surgical preparation of the hemithorax elected for surgery, and administration of local or regional anaesthesia of the surgery sites, thoracoscopy was completed during two 15 min pneumothorax periods. During the procedures, the thoracic structures were viewed using a 57 cm, 10 mm diameter, 30 degrees rigid telescope connected to a digital camcorder to allow computer capture of digital images. The telescope was inserted into the thoracic cavity via 3 different intercostal spaces. The 8th, 10th and 12th intercostal spaces were randomly selected and used among horses. The exploration of each hemithorax started from the dorsal-caudal quadrant continued toward the cranial thorax and was completed by observing the diaphragmatic and caudal pulmonary region. Collapsed lung, aorta, oesophagus and diaphragm were viewed readily in either hemithorax. On exploration of the right hemithorax, the azygos vein, thoracic duct and pulmonary veins were also identified. Horses tolerated thoracoscopy well. Signs of discomfort, such as increased respiratory rate, coughing and decreased level of sedation, were associated with lung collapse in one horse, with pneumothorax on 2 occasions, and when the thorax was approached through the 8th intercostal space. Surgery performed via the 8th intercostal space was hindered by the rigidity of the 8th and 9th ribs, and by the presence of a greater musculature, which did not allow easy cranial and caudal movements of the telescope.

  13. Invasive and minimally invasive surgical techniques for back pain conditions.

    PubMed

    Lavelle, William; Carl, Allen; Lavelle, Elizabeth Demers

    2007-12-01

    This article summarizes current issues related to invasive and minimally invasive surgical techniques for back pain conditions. It describes pain generators and explains theories about how discs fail. The article discusses techniques for treating painful sciatica, painful motion segments, and spinal stenosis. Problems related to current imaging are also presented. The article concludes with a discussion about physical therapy.

  14. Surgical Techniques Used for the Treatment of Atrial Fibrillation

    PubMed Central

    Robertson, Jason O.; Lawrance, Christopher P.; Maniar, Hersh S.; Damiano, Ralph J.

    2015-01-01

    The use of surgical lesion sets for the treatment of atrial fibrillation has been increasing, particularly in patients with complicated anatomical substrates and those undergoing concomitant surgery. Preferences in terms of lesion set, surgical approach and ablation technology vary by center. This review discusses both the surgical techniques and the outcomes for the most commonly performed procedures in the context of recent consensus guidelines. The Cox-Maze IV, pulmonary vein isolation, extended left atrial lesion sets, the hybrid approach and ganglionated plexus ablation are each reviewed in an attempt to provide insight into current clinical practice and patient selection PMID:23823731

  15. Gonioscopically Guided Nonpenetrating Cyclodialysis Cleft Repair: A Novel Surgical Technique

    PubMed Central

    Rodrigues, Ian AS; Shah, Brinda; Goyal, Saurabh

    2017-01-01

    ABSTRACT Aim We present a novel surgical technique for repair of persistent and symptomatic cyclodialysis clefts refractory to conservative or minimally invasive treatment. Background Numerous surgical techniques have been described to close cyclodialysis clefts. The current standard approach involves intraocular repair of cyclodialysis clefts underneath a full-thickness scleral flap. Technique Our technique employs intraoperative use of a direct gonioscope to guide a nonpenetrating surgical repair. Subsequently, a significantly less invasive, nonpenetrating technique utilizing a partial-thickness scleral flap can be performed that reduces potential risks associated with intraocular surgery. The direct gonioscope is also used for confirmation of adequate surgical closure of the cyclodialysis cleft prior to completion of surgery. This technique has been successfully carried out to repair traumatic chronic cyclodialysis clefts associated with hypotony in two patients. There were no significant adverse events as a result of using this technique. Conclusion The novel technique described increases the likelihood of successful and permanent repair of cyclodialysis clefts with resolution of symptoms associated with hypotony, through direct intraoperative visualization of the cleft. Clinical significance Gonioscopically guided nonpenetrating cyclodialysis cleft repair offers significant benefits over previously described techniques. Advantages of our technique include gonioscopic cleft visualization, enabling accurate localization of the area requiring repair, and subsequent confirmation of adequate closure of the cleft. Using a partial-thickness scleral flap is also less invasive and reduces risks associated with treatment of this potentially challenging complication of ocular trauma. How to cite this article Rodrigues IAS, Shah B, Goyal S, Lim S. Gonioscopically Guided Nonpenetrating Cyclodialysis Cleft Repair: A Novel Surgical Technique. J Curr Glaucoma Pract 2017

  16. Surgical techniques for lumbo-sacral fusion.

    PubMed

    Tropiano, P; Giorgi, H; Faure, A; Blondel, B

    2017-02-01

    Lumbo-sacral (L5-S1) fusion is a widely performed procedure that has become the reference standard treatment for refractory low back pain. L5-S1 is a complex transition zone between the mobile lordotic distal lumbar spine and the fixed sacral region. The goal is to immobilise the lumbo-sacral junction in order to relieve pain originating from this site. Apart from achieving inter-vertebral fusion, the main challenge lies in the preoperative determination of the fixed L5-S1 position that will be optimal for the patient. Many lumbo-sacral fusion techniques are available. Stabilisation can be achieved using various methods. An anterior, posterior, or combined approach may be used. Recently developed minimally invasive techniques are gaining in popularity based on their good clinical outcomes and high fusion rates. The objective of this conference is to resolve the main issues faced by spinal surgeons in their everyday practice.

  17. Surgical technique refinements in head and neck oncologic surgery.

    PubMed

    Liu, Jeffrey C; Shah, Jatin P

    2010-06-15

    The head and neck region poses a challenging arena for oncologic surgery. Diseases and their treatment can affect a myriad of functions, including sight, hearing, taste, smell, breathing, speaking, swallowing, facial expression, and appearance. This review discusses several areas where refinements in surgical techniques have led to improved patient outcomes. This includes surgical incisions, neck lymphadenectomy, transoral laser microsurgery, minimally invasive thyroid surgery, and the use of vascularized free flaps for oromandibular reconstruction.

  18. The alexander surgical technique for the treatment of severe burns

    PubMed Central

    Gasperoni, M.; Neri, R.; Carboni, A.; Purpura, V.; Morselli, P.G.; Melandri, D.

    2016-01-01

    Summary The extensive loss of skin in burned patients is a critical clinical condition, and the choice of an effective technique to cover and protect the damaged area has always been a challenge in the surgical field. Despite its wide clinical use, there is little data in the literature on using the Alexander technique to treat severe burns, while several studies have focused on alternative approaches. The present study aims to evaluate the effectiveness of the Alexander surgical technique on 117 patients with severe burns. The characteristics of the burned patients, factors related to etiology of burns as well as adverse prognostic factors and their incidence in discharged versus deceased patients were also taken into account. Finally, a comparison is made with an alternative surgical procedure described in the literature. Our results show a satisfactory level of survival for patients with severe burns surgically treated with the Alexander technique, accounting for 63% of all clinical cases reported here. This treatment is also less expensive and more rapid than the alternative approach we compared it with. The Alexander technique is a lifesaving method for the treatment of severe burns that provides a satisfactory chance of survival at lower cost than the alternative surgical procedure examined. PMID:28289363

  19. Surgical Treatment of Epiphrenic Diverticulum: Technique and Controversies.

    PubMed

    Andolfi, Ciro; Wiesel, Ory; Fisichella, P Marco

    2016-11-01

    The goal of this article is to illustrate the current minimal invasive approaches to patients with epiphrenic diverticulum in terms of preoperative evaluation, surgical technique, and outcomes. Two techniques will be presented: a laparoscopic and a video-assisted thoracic repair. Indications for each technique will be discussed as well as proper patient selection and management. Current controversies in the treatment of patients with this rare disease will be addressed.

  20. Using biomechanics to improve the surgical technique for internal fixation of intracapsular femoral neck fractures.

    PubMed

    Wu, Chi-Chuan

    2010-01-01

    Despite advances in science and technology, the success rate for the treatment of displaced intracapsular femoral neck fractures in high-energy injuries remains disappointing. The blood supply system in the femoral head of humans does not favor recovery from these fractures. Once these fractures occur, osteonecrosis and nonunion rates may be as high as 30%, even if the newest technique is used. There are some surgical techniques used to supplement internal fixation to reestablish the blood supply in the femoral head, but none have been evidently successful. After analysis of related studies, the author concludes that immediate surgical treatment using improved techniques incorporating the principles of biomechanics can improve the success rate of treatment of these fractures. Using these principles, the fracture site can achieve sufficient stability. Consequently, the blood supply in the femoral head and neck can be reestablished earlier and loss of reduction of fragments during treatment can be minimized. Thus, the chance of full recovery from these complicated fractures can be maximized. In this study, the biomechanical characteristics of these fractures and the principles associated with the surgical techniques used for treating them are reviewed and clarified. Finally, a surgical technique which is ideal from the author's viewpoint is presented. The author believes that the recommended surgical technique may become the best method for treating these complicated fractures.

  1. HOSPITALIZATION TIME AFTER OPEN APPENDECTOMY BY THREE DIFFERENT SURGICAL TECHNIQUES

    PubMed Central

    XIMENES, Agláia Moreira Garcia; MELLO, Fernando Salvo Torres; de LIMA-JÚNIOR, Zailton Bezerra; FERREIRA, Cícero Faustino; CAVALCANTI, Amanda Dantas Ferreira; DIAS-FILHO, Adalberto Vieira

    2014-01-01

    Background The choice of surgical technique to approach the appendicular stump depends mostly on skill and personal preference of the surgeon or on the protocol used in the service, and the influence of this choice in hospitalization time is not evaluated. Aim To evaluate the relation between surgical technique and postoperative hospitalization time in patients presenting with acute appendicitis. Methods Retrospective analysis of 180 patients who underwent open appendectomy. These where divided into three groups according to surgical technique: conventional appendectomy (simple ligation of the stump), tobacco pouch suture and Parker-Kerr suture. Data where crossed with hospitalization time (until three days, from four to six days and over seven days). Results A hundred and eighty patients with age from 15 to 85 years where included. From these, 95 underwent conventional technique, had an average hospitalization time of 3,9 days and seven had complications (surgical site infection, seroma, suture dehiscence and evisceration). In 67 patients, tobacco pouch suture was chosen and had average hospitalization time of 3,7 days and two complications (infection and seroma). In 18 Parker-Kerr suture was made, with average hospitalization time of 2,6 days, with no complication. Contingency coefficient between the variables hospitalization time and technique was 0,255 and Cramér's V was 0,186. Conclusion There was tendency to larger hospitalization time and larger number of complications in conventional appendectomy, whereas in patients where Parker-Kerr suture was performed, hospitalization time was significantly smaller. PMID:25184769

  2. Computer-assisted virtual planning and surgical template fabrication for frontoorbital advancement.

    PubMed

    Soleman, Jehuda; Thieringer, Florian; Beinemann, Joerg; Kunz, Christoph; Guzman, Raphael

    2015-05-01

    OBJECT The authors describe a novel technique using computer-assisted design (CAD) and computed-assisted manufacturing (CAM) for the fabrication of individualized 3D printed surgical templates for frontoorbital advancement surgery. METHODS Two patients underwent frontoorbital advancement surgery for unilateral coronal synostosis. Virtual surgical planning (SurgiCase-CMF, version 5.0, Materialise) was done by virtual mirroring techniques and superposition of an age-matched normative 3D pediatric skull model. Based on these measurements, surgical templates were fabricated using a 3D printer. Bifrontal craniotomy and the osteotomies for the orbital bandeau were performed based on the sterilized 3D templates. The remodeling was then done placing the bone plates within the negative 3D templates and fixing them using absorbable poly-dl-lactic acid plates and screws. RESULTS Both patients exhibited a satisfying head shape postoperatively and at follow-up. No surgery-related complications occurred. The cutting and positioning of the 3D surgical templates proved to be very accurate and easy to use as well as reproducible and efficient. CONCLUSIONS Computer-assisted virtual planning and 3D template fabrication for frontoorbital advancement surgery leads to reconstructions based on standardizedmeasurements, precludes subjective remodeling, and seems to be overall safe and feasible. A larger series of patients with long-term follow-up is needed for further evaluation of this novel technique.

  3. Surgical technique for revision surgery of cervical artificial disc replacements.

    PubMed

    Onken, Julia; Meyer, Bernhard; Vajkoczy, Peter

    2017-01-01

    OBJECTIVE Cervical artificial disc replacement (C-ADR) is a widely used procedure with low risk at implantation. Few cases have been reported about the surgical techniques of C-ADR revision. The authors describe their surgical experience with the explantation of a Galileo C-ADR. METHODS Revision surgery was performed in a 58-year-old patient. Patient positioning and surgical opening techniques were performed as appropriate for anterior cervical decompression. RESULTS Revision surgery via the initial anterior approach was successful following an atraumatic removal of the implant. Fusion of the C5-6 segment was performed without complications. CONCLUSIONS In general, the authors observed recurrent nerve palsy and malpositioning of the revised implant in C-ADR revision surgery. Problems with implant removal did not occur because the fusion rate was low due to the short time between initial surgery and C-ADR revision surgery. The video can be found here: https://youtu.be/32CUEDquinc .

  4. Surgical implantation techniques for electronic tags in fish

    SciTech Connect

    Wagner, Glenn N.; Cooke, Steven J.; Brown, Richard S.; Deters, Katherine A.

    2011-01-01

    Intracoelomic implantation of transmitters into fish requires making a surgical incision, incision closure, and other surgery related techniques; however, the tools and techniques used in the surgical process vary widely. We review the available literature and focus on tools and techniques used for conducting surgery on juvenile salmonids because of the large amount of research that is conducted on them. The use of sterilized surgical instruments properly selected for a given size of fish will minimize tissue damage and infection rates, and speed the wound healing of fish implanted with transmitters. For the implantation of transmitters into small fish, the optimal surgical methods include making an incision on the ventral midline along the linea alba (for studies under 1 month), protecting the viscera (by lifting the skin with forceps while creating the incision), and using absorbable monofilament suture with a small-swaged-on swaged-on tapered or reverse-cutting needle. Standardizing the implantation techniques to be used in a study involving particular species and age classes of fish will improve survival and transmitter retention while allowing for comparisons to be made among studies and across multiple years. This review should be useful for researchers working on juvenile salmonids and other sizes and species of fish.

  5. Some Observations on Veterinary Undergraduate Training in Surgical Techniques.

    ERIC Educational Resources Information Center

    Whittick, William G.

    1978-01-01

    The undergraduate surgery course of the Faculty of Veterinary Medicine and Animal Science, Universiti Pertanian Malaysia, is described with focus on its experential method of teaching surgical techniques. Also discussed are the benefits of veterinary school cooperation with a large city Society for the Prevention of Cruelty to Animals (SPCA). (JMD)

  6. Cartilage repair: synthetics and scaffolds: basic science, surgical techniques, and clinical outcomes.

    PubMed

    Kerker, Jordan T; Leo, Andrew J; Sgaglione, Nicholas A

    2008-12-01

    Symptomatic articular cartilage lesions have gained attention and clinical interest in recent years and can be difficult to treat. Historically, various biologic surgical treatment options have yielded inconsistent results because of the inferior biomechanical properties associated with a variable healing response. Improving technology and surgical advances has generated considerable research in cartilage resurfacing and optimizing hyaline tissue restoration. Biologic innovation and tissue engineering in cartilage repair have used matrix scaffolds, autologous and allogenic chondrocytes, cartilage grafts, growth factors, stem cells, and genetic engineering. Numerous evolving technologies and surgical approaches have been introduced into the clinical setting. This review will discuss the basic science, surgical techniques, and clinical outcomes of novel synthetic materials and scaffolds for articular cartilage repair.

  7. Surgical advances in bone and soft tissue sarcoma: 50 years of progress.

    PubMed

    Henshaw, Robert M

    2014-01-01

    As the American Society of Clinical Oncology celebrates its 50th anniversary, physicians can appreciate the significant advances made in the treatment of patients with sarcoma. Historically, these rare tumors have garnered great interest in the medical profession, due to their ability to reach extraordinary size, resulting in substantial deformities and disabilities. Fortunately, advances in surgical management, which have occurred concurrently with advances in imaging, diagnostic techniques, and both local and systemic adjuvant treatments, offer patients diagnosed with sarcoma significant hope for successful treatment and the expectation of a meaningful quality of life.

  8. The posterolateral corner: surgical approach and technique overview.

    PubMed

    Dickens, Jonathan F; Kilcoyne, Kelly; Kluk, Matthew; Rue, John-Paul

    2011-09-01

    Injuries to the posterolateral corner (PLC) of the knee can lead to profound knee instability, especially when combined with anterior cruciate or posterior cruciate ligament injury. With increased recognition of this injury, as well as improved understanding of the pathoanatomy, surgical treatment of these injuries has evolved in favor of acute treatment including reconstructive techniques to minimize recurrent laxity and allow for early rehabilitation. This article describes the approach to the PLC and the technique for figure of 8 reconstruction.

  9. A Novel Surgical Technique to Correct Intrareolar Polythelia

    PubMed Central

    Cherubino, Mario; Pellegatta, Igor; Frigo, Claudia; Scamoni, Stefano; Taibi, Dominic; Maggiulli, Francesca; Valdatta, Luigi

    2014-01-01

    Polythelia is a rare congenital malformation that occurs in 1–2% of the population. Intra-areolar polythelia is the presence of one or more supernumerary nipples located within the areola. This is extremely rare. This article presents 3 cases of intra-areolar polythelia treated at our Department. These cases did not present other associated malformation. Surgical correction was performed for psychological and cosmetic reasons using advancement flaps. The aesthetic and functional results were satisfactory.

  10. Restoring accommodation: surgical technique and preliminary evaluation in rabbits

    NASA Astrophysics Data System (ADS)

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

    1999-06-01

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

  11. [Intestinal stomas--indications, stoma types, surgical technique].

    PubMed

    Renzulli, P; Candinas, D

    2007-09-01

    The formation of an intestinal stoma is one of the most frequent operations in visceral surgery. Despite new operative techniques and a more restrictive use of the stoma, the stoma formation remains an often necessary surgical procedure, which results to a dramatic change in the patients' life. The stoma formation and its later closure are associated with a high morbidity. Many complications, such as stoma necrosis, stoma retraction or stoma prolapse, are related to surgical mistakes made during stoma formation. These complications are therefore largely avoidable. The stoma formation needs careful planning together with a professional stoma nursing team. Moreover, it is mandatory that the stoma formation is made with great care and that it meticulously follows the well established surgical principles. A perfectly placed, technically correctly fashioned and easy to care for stoma is essential for a good patients'quality of life.

  12. Advanced techniques for microwave reflectometry

    SciTech Connect

    Sanchez, J.; Branas, B.; Luna, E. de la; Estrada, T.; Zhuravlev, V. |; Hartfuss, H.J.; Hirsch, M.; Geist, T.; Segovia, J.; Oramas, J.L.

    1994-12-31

    Microwave reflectometry has been applied during the last years as a plasma diagnostic of increasing interest, mainly due to its simplicity, no need for large access ports and low radiation damage of exposed components. Those characteristics make reflectometry an attractive diagnostic for the next generation devices. Systems used either for density profile or density fluctuations have also shown great development, from the original single channel heterodyne to the multichannel homodyne receivers. In the present work we discuss three different advanced reflectometer systems developed by CIEMAT members in collaboration with different institutions. The first one is the broadband heterodyne reflectometer installed on W7AS for density fluctuations measurements. The decoupling of the phase and amplitude of the reflected beam allows for quantitative analysis of the fluctuations. Recent results showing the behavior of the density turbulence during the L-H transition on W7AS are shown. The second system shows how the effect of the turbulence can be used for density profile measurements by reflectometry in situations where the complicated geometry of the waveguides cannot avoid many parasitic reflections. Experiments from the TJ-I tokamak will be shown. Finally, a reflectometer system based on the Amplitude Modulation (AM) technique for density profile measurements is discussed and experimental results from the TJ-I tokamak are shown. The AM system offers the advantage of being almost insensitive to the effect of fluctuations. It is able to take a direct measurement of the time delay of the microwave pulse which propagates to the reflecting layer and is reflected back. In order to achieve fast reconstruction for real time monitoring of the density profile application of Neural Networks algorithms will be presented the method can reduce the computing times by about three orders of magnitude. 10 refs., 10 figs.

  13. Advances in Procedural Techniques - Antegrade

    PubMed Central

    Wilson, William; Spratt, James C.

    2014-01-01

    There have been many technological advances in antegrade CTO PCI, but perhaps most importantly has been the evolution of the “hybrid’ approach where ideally there exists a seamless interplay of antegrade wiring, antegrade dissection re-entry and retrograde approaches as dictated by procedural factors. Antegrade wire escalation with intimal tracking remains the preferred initial strategy in short CTOs without proximal cap ambiguity. More complex CTOs, however, usually require either a retrograde or an antegrade dissection re-entry approach, or both. Antegrade dissection re-entry is well suited to long occlusions where there is a healthy distal vessel and limited “interventional” collaterals. Early use of a dissection re-entry strategy will increase success rates, reduce complications, and minimise radiation exposure, contrast use as well as procedural times. Antegrade dissection can be achieved with a knuckle wire technique or the CrossBoss catheter whilst re-entry will be achieved in the most reproducible and reliable fashion by the Stingray balloon/wire. It should be avoided where there is potential for loss of large side branches. It remains to be seen whether use of newer dissection re-entry strategies will be associated with lower restenosis rates compared with the more uncontrolled subintimal tracking strategies such as STAR and whether stent insertion in the subintimal space is associated with higher rates of late stent malapposition and stent thrombosis. It is to be hoped that the algorithms, which have been developed to guide CTO operators, allow for a better transfer of knowledge and skills to increase uptake and acceptance of CTO PCI as a whole. PMID:24694104

  14. Metacarpal Neck Fractures: A Review of Surgical Indications and Techniques

    PubMed Central

    Padegimas, Eric M.; Warrender, William J.; Jones, Christopher M.; Ilyas, Asif M.

    2016-01-01

    Context Hand injuries are a common emergency department presentation. Metacarpal fractures account for 40% of all hand fractures and can be seen in the setting of low or high energy trauma. The most common injury pattern is a metacarpal neck fracture. In this study, the authors aim to review the surgical indications for metacarpal neck fractures, the fixation options available along with the risk and benefits of each. Evidence Acquisition Literature review of the different treatment modalities for metacarpal neck fractures. Review focuses on surgical indications and the risks and benefits of different operative techniques. Results The indications for surgery are based on the amount of dorsal angulation of the distal fragment. The ulnar digits can tolerate greater angulation as the radial digits more easily lose grip strength. The most widely utilized fixation techniques are pinning with k-wires, dorsal plating, or intramedullary fixation. There is currently no consensus on an optimal fixation technique as surgical management has been found to have a complication rate up to 36%. Plate and screw fixation demonstrated especially high complication rates. Conclusions Metacarpal neck fractures are a common injury in young and active patients that results in substantial missed time from work. While the surgical indications are well-described, there is no consensus on the optimal treatment modality because of high complication rates. Dorsal plating has higher complication rates than closed reduction and percutaneous pinning, but is necessary in comminuted fractures. The lack of an ideal fixation construct suggests that further study of the commonly utilized techniques as well as novel techniques is necessary. PMID:27800460

  15. Modified Surgical Techniques for Managing Intraoperative Floppy Iris Syndrome

    PubMed Central

    Charukamnoetkanok, Puwat

    2016-01-01

    Purpose. To report a modified surgical strategy in the management of intraoperative floppy iris syndrome-associated iris prolapse. Methods. Prolapsed iris is left as is and a new corneal incision near the original wound but at a different site is created. Depending on the location of the original incision and the surgeon's preference, this additional incision can be used as a new port for phacoemulsification tip or can be the new site for the iris to securely prolapse, allowing for the surgery to proceed safely. Results. We present 2 cases of iris prolapse and inadequate pupil dilation in patients with IFIS. Along with our modified technique, additional iris retractors were placed to increase the workspace for the phacoemulsification tip. The cataract surgery was performed successfully without further complications in both cases. Conclusion. This surgical technique could be an adjunct to allow the surgeons to expand the armamentarium for the management of IFIS-associated iris prolapse. PMID:27999697

  16. Safe surgical technique: intramedullary nail fixation of tibial shaft fractures.

    PubMed

    Zelle, Boris A; Boni, Guilherme

    2015-01-01

    Statically locked, reamed intramedullary nailing remains the standard treatment for displaced tibial shaft fractures. Establishing an appropriate starting point is a crucial part of the surgical procedure. Recently, suprapatellar nailing in the semi-extended position has been suggested as a safe and effective surgical technique. Numerous reduction techiques are available to achieve an anatomic fracture alignment and the treating surgeon should be familiar with these maneuvers. Open reduction techniques should be considered if anatomic fracture alignment cannot be achieved by closed means. Favorable union rates above 90 % can be achieved by both reamed and unreamed intramedullary nailing. Despite favorable union rates, patients continue to have functional long-term impairments. In particular, anterior knee pain remains a common complaint following intramedullary tibial nailing. Malrotation remains a commonly reported complication after tibial nailing. The effect of postoperative tibial malalignment on the clinical and radiographic outcome requires further investigation.

  17. Cardiac advanced life support-surgical guideline: overview and implementation.

    PubMed

    Herrmann, Cheryl

    2014-01-01

    Cardiac arrest in the immediate postoperative recovery period in a patient who underwent cardiac surgery is typically related to reversible causes-tamponade, bleeding, ventricular arrhythmias, or heart blocks associated with conduction problems. When treated promptly, 17% to 79% of patients who experience cardiac arrest after cardiac surgery survive to discharge. The Cardiac Advanced Life Support-Surgical (CALS-S) guideline provides a standardized algorithm approach to resuscitation of patients who experience cardiac arrest after cardiac surgery. The purpose of this article is to discuss the CALS-S guideline and how to implement it.

  18. Hemorrhage after tonsillectomy: does the surgical technique really matter?

    PubMed

    Gysin, Claudine; Dulguerov, Pavel

    2013-01-01

    A thorough review of the publications on surgical techniques used for tonsillectomy is provided, emphasizing randomized studies and meta-analysis. In the assessment of the data it is important to clearly define and categorize the types of posttonsillectomy bleeding (PTB), as well as the various factors that have been associated with increased PTB. In recent audits of a large number of tonsillectomies, the PTB rates seem to concur: 1% early and 2.5% delayed PTB; 10% anamnestic, 2% objective, and 2% re-operation PTB. Objective PTB rates beyond 10% should require an audit. The bipolar technique seems associated with the least early PTB, while the cold technique is associated with the least delayed PTB. Because of the lack of large well-conducted randomized trials, it is difficult to conclude which technique is the best. With electrocautery techniques, the current power should be adjusted to the minimal level providing hemostasis. Surgical techniques for tonsillectomy that should probably be abandoned include monopolar electrocautery, Coblation, various lasers, and the harmonic scalpel. Vessel-sealing systems might hold promise and deserve further evaluation. Tonsillotomy might be associated with less postoperative pain, but the hemorrhagic advantage in randomized studies is not obvious. Tonsil regrowth rates and efficacy to treat obstruction need also further evaluation.

  19. Surgical Treatment of Tennis Elbow; Minimal Incision Technique

    PubMed Central

    Amroodi, Morteza Nakhaei; Mahmuudi, Ali; Salariyeh, Mostafa; Amiri, Arash

    2016-01-01

    Background: When non-operative treatment of tennis elbow fails; a surgical procedure can be performed to improve the associated symptoms. Different surgical techniques for treatment of lateral epicondylitis are prescribed. The purpose of this study was to evaluate the clinical outcomes of surgical treatment for tennis elbow based on small incision techniques. Methods: This technique was performed on 24 consecutive patients between June 2011 and July 2013. Outcomes were assessed using the Patient-Rated Tennis Elbow Evaluation (PRTEE), Nirschl’s staging system and visual analog scale (VAS) for pain and satisfaction criteria. Results: There were 15 female and 9 male patients in the study. The mean duration of symptoms before surgery was 3.7 years. The average duration of follow-up was 34.8 months. The post-operative outcome was good to excellent in most patients. The mean VAS score improved from 7.2 to 3.5 points. The total PRTEE improved from 68.7 to 15.8 points. Conclusion: This procedure provides a low complication rate which is associated with a high rate of patient satisfaction. Therefore, we suggest this option after failed conservative management of tennis elbow. PMID:27847851

  20. Surgical ablation for atrial fibrillation: techniques, indications, and results

    PubMed Central

    Lawrance, Christopher P.; Henn, Matthew C.; Damiano, Ralph J.

    2015-01-01

    Purpose of review The aim of this review is to focus specifically on the indications, evolution of technique, and results of surgical ablation for atrial fibrillation. Recent findings With the introduction of the Cox-Maze IV procedure utilizing bipolar radiofrequency ablation and cryoablation, long-term studies have demonstrated a significant decrease in aortic cross-clamp times and major complications with a comparable rate of restoration of sinus rhythm. New hybrid approaches utilizing both catheter-based ablation and minimally invasive surgical approaches have been developed, but have not been standardized. Early studies have demonstrated reasonable success rates of hybrid procedures, with advantages that include confirmation of conduction block, decreased surgical morbidity, and possibly reduced morbidity. However, hybrid approaches have the disadvantage of significantly increased operative times. Summary The Cox-Maze IV is currently the gold standard for surgical treatment of atrial fibrillation. New hybrid approaches have potential advantages with promising early results, but a standard lesion set, improvement in operative times, and long-term results still need to be evaluated. PMID:25389650

  1. The Kock pouch reconsidered: an alternative surgical technique.

    PubMed

    Crawshaw, Alison; Williams, Julia; Woodhouse, Fran

    The psychological impact stoma surgery can have on an individual is well documented within the literature (White and Hunt, 1997; Borwell, 2009; Williams, 2005; Brown, 2005). For many years, surgeons have explored and developed innovations in surgical techniques, in particular restorative procedures with a view of preventing permanent stoma formation; ileal anal pouch (IAP) now being the surgical procedure of choice for treatment of ulcerative colitis (UC) and familial adenomatous polyposis (FAP). However, high morbidity rates are associated with pouch longevity (Castillo et al 2005; Nessar and Wu, 2012) and once removed can lead to a high-output ileostomy with risks of electrolyte imbalance and malabsorption. This then creates the dilemma of whether the Kock pouch (KP) should be offered as a surgical option. This article offers a historical perspective of the KP and its place in the surgical management of UC and FAP. This article also presents results from a recent audit funded by the Ileostomy Association (IA), highlighting how patients manage their KP and the importance of maintaining bowel control and being free of an incontinent stoma as a means of coming to terms with their condition.

  2. AUDIOVISUAL RESOURCES ON THE TEACHING PROCESS IN SURGICAL TECHNIQUE

    PubMed Central

    PUPULIM, Guilherme Luiz Lenzi; IORIS, Rafael Augusto; GAMA, Ricardo Ribeiro; RIBAS, Carmen Australia Paredes Marcondes; MALAFAIA, Osvaldo; GAMA, Mirnaluci

    2015-01-01

    Background: The development of didactic means to create opportunities to permit complete and repetitive viewing of surgical procedures is of great importance nowadays due to the increasing difficulty of doing in vivo training. Thus, audiovisual resources favor the maximization of living resources used in education, and minimize problems arising only with verbalism. Aim: To evaluate the use of digital video as a pedagogical strategy in surgical technique teaching in medical education. Methods: Cross-sectional study with 48 students of the third year of medicine, when studying in the surgical technique discipline. They were divided into two groups with 12 in pairs, both subject to the conventional method of teaching, and one of them also exposed to alternative method (video) showing the technical details. All students did phlebotomy in the experimental laboratory, with evaluation and assistance of the teacher/monitor while running. Finally, they answered a self-administered questionnaire related to teaching method when performing the operation. Results: Most of those who did not watch the video took longer time to execute the procedure, did more questions and needed more faculty assistance. The total exposed to video followed the chronology of implementation and approved the new method; 95.83% felt able to repeat the procedure by themselves, and 62.5% of those students that only had the conventional method reported having regular capacity of technique assimilation. In both groups mentioned having regular difficulty, but those who have not seen the video had more difficulty in performing the technique. Conclusion: The traditional method of teaching associated with the video favored the ability to understand and transmitted safety, particularly because it is activity that requires technical skill. The technique with video visualization motivated and arouse interest, facilitated the understanding and memorization of the steps for procedure implementation, benefiting the

  3. Surgical technique for allogeneic uterus transplantation in macaques

    PubMed Central

    Obara, Hideaki; Kisu, Iori; Kato, Yojiro; Yamada, Yohei; Matsubara, Kentaro; Emoto, Katsura; Adachi, Masataka; Matoba, Yusuke; Umene, Kiyoko; Nogami, Yuya; Banno, Kouji; Tsuchiya, Hideaki; Itagaki, Iori; Kawamoto, Ikuo; Nakagawa, Takahiro; Ishigaki, Hirohito; Itoh, Yasushi; Ogasawara, Kazumasa; Saiki, Yoko; Sato, Shin-ichi; Nakagawa, Kenshi; Shiina, Takashi; Aoki, Daisuke; Kitagawa, Yuko

    2016-01-01

    No study has reported an animal model of uterus transplantation (UTx) using cynomolgus macaques. We aimed to establish a surgical technique of allogeneic UTx assuming the recovery of a uterus from a deceased donor in cynomolgus macaques. Four allogeneic UTxs were performed in female cynomolgus macaques. Donor surgeries comprised en bloc recovery of organs with iliac vessels on both sides, and/or abdominal aorta/vena cava after sufficient perfusion from one femoral artery or external iliac artery. Before perfusion, 150 mL of whole blood was obtained from the donor for subsequent blood transfusion to the recipient. Four uterine grafts were orthotopically transplanted to recipients. End-to-side anastomosis was performed to the iliac vessels on one side in case 1 and iliac vessels on both sides in case 2; aorto-aorto/cavo-caval anastomosis was performed in cases 3 and 4. Arterial blood flow of the uterine grafts was determined by intraoperative indocyanine green (ICG) angiography. ICG angiography results showed sufficient blood flow to all uterine grafts, and anaemia did not progress. Under appropriate immune suppression, all recipients survived for more than 90 days post-transplantation, without any surgical complications. We describe a surgical technique for allogeneic UTx in cynomolgus macaques. PMID:27786258

  4. Surgical Tips in Frozen Abdomen Management: Application of Coliseum Technique.

    PubMed

    Kyriazanos, Ioannis D; Manatakis, Dimitrios K; Stamos, Nikolaos; Stoidis, Christos

    2015-01-01

    Wound dehiscence is a serious postoperative complication, with an incidence of 0.5-3% after primary closure of a laparotomy incision, and represents an acute mechanical failure of wound healing. Relatively recently the concept of "intentional open abdomen" was described and both clinical entities share common pathophysiological and clinical pathways ("postoperative open abdominal wall"). Although early reconstruction is the target, a significant proportion of patients will develop adhesions between abdominal viscera and the anterolateral abdominal wall, a condition widely recognized as "frozen abdomen," where delayed wound closure appears as the only realistic alternative. We report our experience with a patient who presented with frozen abdomen after wound dehiscence due to surgical site infection and application of the "Coliseum technique" for its definitive surgical management. This novel technique represents an innovative alternative to abdominal exploration, for cases of "malignant" frozen abdomen due to peritoneal carcinomatosis. Lifting the edges of the surgical wound upwards and suspending them under traction by threads from a retractor positioned above the abdomen facilitates approach to the peritoneal cavity, optimizes exposure of intra-abdominal organs, and prevents operative injury to the innervation and blood supply of abdominal wall musculature, a crucial step for subsequent hernia repair.

  5. Ahmed glaucoma valve implant: surgical technique and complications

    PubMed Central

    Riva, Ivano; Roberti, Gloria; Oddone, Francesco; Konstas, Anastasios GP; Quaranta, Luciano

    2017-01-01

    Implantation of Ahmed glaucoma valve is an effective surgical technique to reduce intraocular pressure in patients affected with glaucoma. While in the past, the use of this device was reserved to glaucoma refractory to multiple filtration surgical procedures, up-to-date mounting experience has encouraged its use also as a primary surgery for selected cases. Implantation of Ahmed glaucoma valve can be challenging for the surgeon, especially in patients who already underwent previous multiple surgeries. Several tips have to be acquired by the surgeon, and a long learning curve is always needed. Although the valve mechanism embedded in the Ahmed glaucoma valve decreases the risk of postoperative hypotony-related complications, it does not avoid the need of a careful follow-up. Complications related to this type of surgery include early and late postoperative hypotony, excessive capsule fibrosis around the plate, erosion of the tube or plate edge, and very rarely infection. The aim of this review is to describe surgical technique for Ahmed glaucoma valve implantation and to report related complications. PMID:28255226

  6. Surgical techniques and radiological findings of meniscus allograft transplantation.

    PubMed

    Lee, Hoseok; Lee, Sang Yub; Na, Young Gon; Kim, Sung Kwan; Yi, Jae Hyuck; Lim, Jae Kwang; Lee, So Mi

    2016-08-01

    Meniscus allograft transplantation has been performed over the past 25 years to relieve knee pain and improve knee function in patients with an irreparable meniscus injury. The efficacy and safety of meniscus allograft transplantation have been established in numerous experimental and clinical researches. However, there is a lack of reviews to aid radiologists who are routinely interpreting images and evaluating the outcome of the procedures, and also meniscus allograft transplantation is not widely performed in most hospitals. This review focuses on the indications of the procedure, the different surgical techniques used for meniscus allograft transplantation according to the involvement of the lateral and medial meniscus, and the associated procedures. The postoperative radiological findings and surgical complications of the meniscus allograft transplantation are also described in detail.

  7. [Surgical reconstruction of maxillary defects using computer-assisted techniques].

    PubMed

    Zhang, W B; Yu, Y; Wang, Y; Liu, X J; Mao, C; Guo, C B; Yu, G Y; Peng, X

    2017-02-18

    The maxilla is the most important bony support of the mid-face skeleton and is critical for both esthetics and function. Maxillary defects, resulting from tumor resection, can cause severe functional and cosmetic deformities. Furthermore, maxillary reconstruction presents a great challenge for oral and maxillofacial surgeons. Nowadays, vascularized composite bone flap transfer has been widely used for functional maxillary reconstruction. In the last decade, we have performed a comprehensive research on functional maxillary reconstruction with free fibula flap and reported excellent functional and acceptable esthetic results. However, this experience based clinical procedure still remainssome problems in accuracy and efficiency. In recent years, computer assisted techniques are now widely used in oral and maxillofacial surgery. We have performed a series of study on maxillary reconstruction with computer assisted techniques. The computer assisted techniques used for maxillary reconstruction mainly include: (1) Three dimensional (3D) reconstruction and tumor mapping: providing a 3D view of maxillary tumor and adjacent structures and helping to make the diagnosis of maxillary tumor accurate and objective; (2) Virtual planning: simulating tumor resection and maxillectomy as well as fibula reconstruction on the computer, so that to make an ideal surgical plan; (3) 3D printing: producing a 3D stereo model for prebending individualized titanium mesh and also providing template or cutting guide for the surgery; (4) Surgical navigation: the bridge between virtual plan and real surgery, confirming the virtual plan during the surgery and guarantee the accuracy; (5) Computer assisted analyzing and evaluating: making a quantitative and objective of the final result and evaluating the outcome. We also performed a series of studies to evaluate the application of computer assisted techniques used for maxillary reconstruction, including: (1) 3D tumor mapping technique for accurate

  8. Genioglossus muscle advancement: A modification of the conventional technique.

    PubMed

    García Vega, José Ramón; de la Plata, María Mancha; Galindo, Néstor; Navarro, Miriam; Díez, Daniel; Láncara, Fernando

    2014-04-01

    Obstructive sleep apnoea syndrome (OSAS) is a pathophysiologic condition associated with fragmented sleep and arousals caused by nocturnal mechanical obstruction of the upper airway. This results in behavioural derangements, such as excessive daytime sleepiness and fatigue, and pathophysiologic derangements that cause morbidities and mortality including hypertension, arrhythmias, myocardial infarction, stroke and sudden death. The genioglossus advancement is a proven technique for the treatment of mild to moderate obstructive sleep apnoea syndrome by relieving airway obstruction at the hypopharyngeal level. In this article, we report a modification of the conventional genioglossus advancement described by Riley and Powell. The modification we describe replaces the bone segment at the mandibular basal bone rather than at the mid area of the symphysis. This means a linear movement that allows a greater advancement and avoids the rotation of the genioglossus muscle. Through this article we will describe the advantages of the surgical technique such as greater effectiveness, stability, more pleasing aesthetic outcome and the reduction of potential complications.

  9. Advances in the surgical treatment of fecal incontinence.

    PubMed

    Person, Benjamin; Wexner, Steven D

    2005-03-01

    Although surgery for fecal incontinence has been shown to be effective, it is still very challenging and sometimes frustrating. Overlapping sphincteroplasty, by far the most common procedure, is effective in patients with sphincter defects; however, recent data suggest that success rates tend to deteriorate over time. A thorough preoperative evaluation incorporates numerous factors, including patient characteristics, severity of incontinence, type and size of the sphincter defect as assessed by physical examination, anal ultrasound, and anorectal physiology studies including anal manometry, electromyography, and pudendal nerve terminal motor latency assessment. The use of these evaluation methods has allowed better patient assignment for a variety of new alternative treatment options. Innovations in the surgical treatment of fecal incontinence range from simple, office-based sphincter augmentation techniques to surgical implantation of mechanical devices. This article reviews 5 alternative surgical treatment options for fecal incontinence: injection of carbon-coated beads in the submucosa of the anal canal, radiofrequency energy delivery, stimulated graciloplasty, artificial bowel sphincter, and sacral nerve stimulation.

  10. A Challenging Surgical Approach to Locally Advanced Primary Urethral Carcinoma

    PubMed Central

    Lucarelli, Giuseppe; Spilotros, Marco; Vavallo, Antonio; Palazzo, Silvano; Miacola, Carlos; Forte, Saverio; Matera, Matteo; Campagna, Marcello; Colamonico, Ottavio; Schiralli, Francesco; Sebastiani, Francesco; Di Cosmo, Federica; Bettocchi, Carlo; Di Lorenzo, Giuseppe; Buonerba, Carlo; Vincenti, Leonardo; Ludovico, Giuseppe; Ditonno, Pasquale; Battaglia, Michele

    2016-01-01

    Abstract Primary urethral carcinoma (PUC) is a rare and aggressive cancer, often underdetected and consequently unsatisfactorily treated. We report a case of advanced PUC, surgically treated with combined approaches. A 47-year-old man underwent transurethral resection of a urethral lesion with histological evidence of a poorly differentiated squamous cancer of the bulbomembranous urethra. Computed tomography (CT) and bone scans excluded metastatic spread of the disease but showed involvement of both corpora cavernosa (cT3N0M0). A radical surgical approach was advised, but the patient refused this and opted for chemotherapy. After 17 months the patient was referred to our department due to the evidence of a fistula in the scrotal area. CT scan showed bilateral metastatic disease in the inguinal, external iliac, and obturator lymph nodes as well as the involvement of both corpora cavernosa. Additionally, a fistula originating from the right corpus cavernosum extended to the scrotal skin. At this stage, the patient accepted the surgical treatment, consisting of different phases. Phase I: Radical extraperitoneal cystoprostatectomy with iliac-obturator lymph nodes dissection. Phase II: Creation of a urinary diversion through a Bricker ileal conduit. Phase III: Repositioning of the patient in lithotomic position for an overturned Y skin incision, total penectomy, fistula excision, and “en bloc” removal of surgical specimens including the bladder, through the perineal breach. Phase IV: Right inguinal lymphadenectomy. The procedure lasted 9-and-a-half hours, was complication-free, and intraoperative blood loss was 600 mL. The patient was discharged 8 days after surgery. Pathological examination documented a T4N2M0 tumor. The clinical situation was stable during the first 3 months postoperatively but then metastatic spread occurred, not responsive to adjuvant chemotherapy, which led to the patient's death 6 months after surgery. Patients with advanced stage tumors of

  11. Advanced Spectroscopy Technique for Biomedicine

    NASA Astrophysics Data System (ADS)

    Zhao, Jianhua; Zeng, Haishan

    This chapter presents an overview of the applications of optical spectroscopy in biomedicine. We focus on the optical design aspects of advanced biomedical spectroscopy systems, Raman spectroscopy system in particular. Detailed components and system integration are provided. As examples, two real-time in vivo Raman spectroscopy systems, one for skin cancer detection and the other for endoscopic lung cancer detection, and an in vivo confocal Raman spectroscopy system for skin assessment are presented. The applications of Raman spectroscopy in cancer diagnosis of the skin, lung, colon, oral cavity, gastrointestinal tract, breast, and cervix are summarized.

  12. Stitching Techniques Advance Optics Manufacturing

    NASA Technical Reports Server (NTRS)

    2010-01-01

    Because NASA depends on the fabrication and testing of large, high-quality aspheric (nonspherical) optics for applications like the James Webb Space Telescope, it sought an improved method for measuring large aspheres. Through Small Business Innovation Research (SBIR) awards from Goddard Space Flight Center, QED Technologies, of Rochester, New York, upgraded and enhanced its stitching technology for aspheres. QED developed the SSI-A, which earned the company an R&D 100 award, and also developed a breakthrough machine tool called the aspheric stitching interferometer. The equipment is applied to advanced optics in telescopes, microscopes, cameras, medical scopes, binoculars, and photolithography."

  13. Advanced Geophysical Environmental Simulation Techniques

    DTIC Science & Technology

    2007-11-02

    cloud property retrieval algorithms for processing of large multiple-satellite data sets; development and application of improved cloud -phase and... cloud optical property retrieval algorithms; investigation of techniques potentially applicable for retrieval of cloud spatial properties from very...14. SUBJECT TERMS cirrus cloud retrieval satellite meteorology polar-orbiting geostationary 15. NUMBER OF PAGES 16. PRICE CODE 17. SECURITY

  14. Surgical palliation of gastric outlet obstruction in advanced malignancy

    PubMed Central

    Potz, Brittany A; Miner, Thomas J

    2016-01-01

    Gastric outlet obstruction (GOO) is a common problem associated with advanced malignancies of the upper gastrointestinal tract. Palliative treatment of patients’ symptoms who present with GOO is an important aspect of their care. Surgical palliation of malignancy is defined as a procedure performed with the intention of relieving symptoms caused by an advanced malignancy or improving quality of life. Palliative treatment for GOO includes operative (open and laparoscopic gastrojejunostomy) and non-operative (endoscopic stenting) options. The performance status and medical condition of the patient, the extent of the cancer, the patients prognosis, the availability of a curative procedure, the natural history of symptoms of the disease (primary and secondary), the durability of the procedure, and the quality of life and life expectancy of the patient should always be considered when choosing treatment for any patient with advanced malignancy. Gastrojejunostomy appears to be associated with better long term symptom relief while stenting appears to be associated with lower immediate procedure related morbidity. PMID:27648158

  15. Medical and surgical therapy for advanced chronic venous insufficiency.

    PubMed

    Word, Ronnie

    2010-12-01

    Venous ulceration is the most serious consequence of chronic venous insufficiency. The disease has been known for more than 3.5 millennia with wound care centers established as early as 1500 bc. Unfortunately, still today it is a very poorly managed medical condition by most physicians despite that a great deal has been learned about the pathogenesis and treatment for venous ulcerations. We find that many wound care clinics treat the wound and not the cause of the problem. In this article, we review the basic pathophysiology of advanced chronic venous insufficiency and review the most up-to-date information with regard to medical therapy and different options of surgical therapy to address the underlying venous pathology responsible for chronic ulcers.

  16. Septoplasty: Basic and Advanced Techniques.

    PubMed

    Most, Sam P; Rudy, Shannon F

    2017-05-01

    Nasal septal deviation is a prevalent problem that can have significant quality of life ramifications. Septoplasty is commonly performed to provide qualitative and quantitative benefit to those with nasal obstruction owing to septal deviation. Although a standard, basic technique is often adequate for individuals with mild to moderate mid to posterior septal deviation, unique challenges arise with caudal septal deviation. Herein, multiple strategies that attempt to address anterior septal deviation are discussed. Anterior septal reconstruction has been shown to be a safe and effective means by which to address severe caudal septal deviation and long-term reduction in preoperative symptoms.

  17. Use of Performance Measures to Evaluate, Document Competence and Deterioration of Advanced Surgical Skills Exposure for Trauma (ASSET) Surgical Skills

    DTIC Science & Technology

    2015-03-01

    Skills Exposure for Trauma (ASSET) Surgical Skills ". The Title was abbreviated as Retention and Assessment of Surgical Performance (RASP) PRINCIPAL...Surgeons introduced a cadaver-based course to review the necessary surgical anatomy, procedure, skills , and techniques for rapid vascular exposure...that the objective assessment tool and “Trauma Readiness Index” metric distinguish between skill level groups, identify improvement and degradation

  18. Orthodontic microsurgery: a new surgically guided technique for dental movement.

    PubMed

    Vercellotti, Tomaso; Podesta, Andrea

    2007-08-01

    Eight patients with malocclusions were treated with a new orthodontic-surgical technique that reduces the duration of treatment compared to conventional techniques. The monocortical tooth dislocation and ligament distraction (MTDLD) technique combines two different dental movements that work separately but simultaneously on opposite root surfaces. On the root surface corresponding to the direction of movement, vertical and horizontal microsurgical corticotomies are performed around each tooth root with a piezosurgical microsaw to eliminate cortical bone resistance. The immediate application of strong biomechanical forces produces rapid dislocation of the root and the cortical bone together. On the root surface opposite the direction of movement, the force of dislocation produces rapid distraction of ligament fibers. During the osteogenic process that follows, application of normal orthodontic biomechanics achieves the final tooth movement. All eight patients underwent periodontal and radiologic examinations for more than 1 year after treatment. No periodontal defects were observed in any of the patients, including one with a severe malocclusion and a thin periodontal tissue biotype. Compared to traditional orthodontic therapy, the average treatment time with the MTDLD technique in the mandible and maxilla was reduced by 60% and 70%, respectively.

  19. Tactical and surgical techniques issues in the surgical treatment of incisional hernias

    PubMed Central

    Gangură, AG; Palade, RŞ

    2014-01-01

    Abstract Within five years, between 2006 and 2011, a total of 368 incisional hernias have been operated in the Surgery Clinic 1, University Emergency Hospital Bucharest. The study followed the morphological and biological parameters, associated pathology, tactics and surgical technique used and postoperative morbidity. The average age of patients was 61.75 years, female sex was predominant (81.25%), and incisional hernias were large and giant in a percentage of 73.37%. Locations were predominantly median (83.42%). Recurrent incisional hernias and multiple relapsed hernias represented 25.54%. Associated pathology was dominated by obesity (51,09%) and cardiovascular disease (37,77%). We have used both methods of tissue procedures (22.83%), and the prosthetic procedures (77.17%). Prosthetic techniques, retro muscle fitting mesh in the rectus abdominis muscle sheath (Rives-Stoppa technique), fitting ov er the fascia and tissue replacement techniques were performed. Immediate postoperative morbidity was represented by seroma (14.13%), prolonged postoperative ileus (8.69%), prolonged hematic drainage (6.52%), and hematoma (1.9%). Late postoperative morbidity was given by granulomas (5.7%) and recurrence of incisional hernias (4.34%). Good and very good results were obtained in the 89.96% of the operated cases. PMID:25408770

  20. Modern, multi-media, advances in surgical information.

    PubMed

    Ponsky, Todd A; Rothenberg, Steven S

    2015-06-01

    The need for education does not end with residency. Practicing surgeons must find ways to stay current. The boom in new technologic developments may significantly enhance our methods of teaching through the use of new mutli-media. Here we will explore some of the muti-media innovations that have or may have the greatest impact on surgical education. Live, interactive, and online forums have proven to be effective new methods of bringing people together to discuss and learn new concepts in medicine. These forums allow physicians to interact with key opinion leaders and flatten knowledge sharing, so that everyone may have a voice. The dynamic, fast paced, and interactive format allows for screen-based learning to be engaging and interactive. Information is now available online in multiple formats that are continuously updated, so that information is no longer outdated by the time it is published in a textbook. Multi-media is now being used to disseminate content through, archived video, live video, as well as audiocasts. All of these are creating more modern ways for physicians to stay up-to-date either at home, in the office, or when mobile. Lastly, new advanced, interactive, technology can allow experts to assist less-experienced surgeons as "virtual partners" through telementoring. With telementoring, an expert can be virtually present while another surgeon is performing a complex, new, operation, and the expert can help with voice suggestions and on-screen telestration. Pediatric surgical education has made a giant leap thanks to new developments in multi-media technology.

  1. Total hip replacement for hip fracture: Surgical techniques and concepts.

    PubMed

    Coomber, Ross; Porteous, Matthew; Hubble, Matthew J W; Parker, Martyn J

    2016-10-01

    When treating a hip fracture with a total hip replacement (THR) the surgical technique may differ in a number of aspects in comparison to elective arthroplasty. The hip fracture patient is more likely to have poor bone stock secondary to osteoporosis, be older, have a greater number of co-morbidities, and have had limited peri-operative work-up. These factors lead to a higher risk of complications, morbidity and perioperative mortality. Consideration should be made to performing the THR in a laminar flow theatre, by a surgeon experienced in total hip arthroplasty, using an anterolateral approach, cementing the implant in place, using a large head size and with repair of the joint capsule. Combined Ortho-geriatric care is recommended with similar post-operative rehabilitation to elective THR patients but with less expectation of short length of stay and consideration for fracture prevention measures.

  2. Treatment of keloid formation following syndactyly division: surgical technique.

    PubMed

    Kong, Bong Young; Baek, Goo Hyun; Gong, Hyun Sik

    2012-01-01

    A strong association has been reported between keloid formation after syndactyly reconstruction and primary digital enlargement, and methotrexate (MTX) treatment has been shown to produce promising results in a few reported cases. However, detailed surgical technique for revision of keloid formation after syndactyly division has not been well described, and there is still no standard treatment protocol regarding use of MTX in such cases. In this paper, we describe the technical details of keloid excision and full thickness skin grafting followed by MTX medication for the treatment of massive keloid formation after syndactyly division. We also describe a case of unsuccessful use of MTX, and our experience of its prophylactic use for a patient with syndactyly with primary digital enlargement.

  3. Superciliary Keyhole Approach for Unruptured Anterior Circulation Aneurysms: Surgical Technique, Indications, and Contraindications

    PubMed Central

    2014-01-01

    Neurosurgeons have been trying to reduce surgical invasiveness by applying minimally invasive keyhole approaches. Therefore, this paper clarifies the detailed surgical technique, its limitations, proper indications, and contraindications for a superciliary keyhole approach as a minimally invasive modification of a pterional approach. Successful superciliary keyhole surgery for unruptured aneurysms requires an understanding of the limitations and the use of special surgical techniques. Essentially, this means the effective selection of surgical indications, usage of the appropriate surgical instruments with a tubular shaft, and refined surgical techniques, including straightforward access to the aneurysm, clean surgical dissection, and the application of clips with an appropriate configuration. A superciliary keyhole approach allows unruptured anterior circulation aneurysms to be clipped safely, rapidly, and less invasively on the basis of appropriate surgical indications. PMID:25535512

  4. Surgical technique for repair of complex anterior skull base defects

    PubMed Central

    Reinard, Kevin; Basheer, Azam; Jones, Lamont; Standring, Robert; Lee, Ian; Rock, Jack

    2015-01-01

    Background: Modern microsurgical techniques enable en bloc resection of complex skull base tumors. Anterior cranial base surgery, particularly, has been associated with a high rate of postoperative cerebrospinal fluid (CSF) leak, meningitis, intracranial abscess, and pneumocephalus. We introduce simple modifications to already existing surgical strategies designed to minimize the incidence of postoperative CSF leak and associated morbidity and mortality. Methods: Medical records from 1995 to 2013 were reviewed in accordance with the Institutional Review Board. We identified 21 patients who underwent operations for repair of large anterior skull base defects following removal of sinonasal or intracranial pathology using standard craniofacial procedures. Patient charts were screened for CSF leak, meningitis, or intracranial abscess formation. Results: A total of 15 male and 6 female patients with an age range of 26–89 years were included. All patients were managed with the same operative technique for reconstruction of the frontal dura and skull base defect. Spinal drainage was used intraoperatively in all cases but the lumbar drain was removed at the end of each case in all patients. Only one patient required re-operation for repair of persistent CSF leak. None of the patients developed meningitis or intracranial abscess. There were no perioperative mortalities. Median follow-up was 10 months. Conclusion: The layered reconstruction of large anterior cranial fossa defects resulted in postoperative CSF leak in only 5% of the patients and represents a simple and effective closure option for skull base surgeons. PMID:25722926

  5. Through Knee Amputation: Technique Modifications and Surgical Outcomes

    PubMed Central

    Albino, Frank P; Seidel, Rachel; Brown, Benjamin J; Crone, Charles G

    2014-01-01

    Background Knee disarticulations (KD) are most commonly employed following trauma or tumor resection but represent less than 2% of all lower extremity amputations performed in the United States annually. KDs provide enhanced proprioception, a long lever arm, preservation of adductor muscle insertion, decreased metabolic cost of ambulation, and an end weight-bearing stump. The role for KDs in the setting of arterial insufficiency or overwhelming infection is less clear. The purpose of this study is to describe technique modifications and report surgical outcomes following KDs at a high-volume Limb Salvage Center. Methods A retrospective study of medical records for all patients who underwent a through-knee amputation performed by the senior author (C.E.A.) between 2004 and 2012 was completed. Medical records were reviewed to collect demographic, operative, and postoperative information for each of the patients identified. Results Between 2004 and 2012, 46 through-knee amputations for 41 patients were performed. The mean patient age was 68 and indications for surgery included infection (56%), arterial thrombosis (35%), and trauma (9%). Postoperative complications included superficial cellulitis (13%), soft tissue infection (4%), and flap ischemia (4%) necessitating one case of surgical debridement (4%) and four trans-femoral amputations (9%). 9 (22%) patients went on to ambulate. Postoperative ambulation was greatest in the traumatic cohort and for patients less than 50 years of age, P<0.05. Alternatively, diabetes mellitus and infection reduced the likelihood of postoperative ambulation, P<0.01. Conclusions Knee disarticulations are a safe and effective alternative to other lower extremity amputations when clinically feasible. For patient unlikely to ambulate, a through-knee amputation maximizes ease of transfers, promotes mobility by providing a counterbalance, and eliminates the potential for knee flexion contracture with subsequent skin breakdown. PMID:25276650

  6. Hybrid mesh generation using advancing reduction technique

    Technology Transfer Automated Retrieval System (TEKTRAN)

    This study presents an extension of the application of the advancing reduction technique to the hybrid mesh generation. The proposed algorithm is based on a pre-generated rectangle mesh (RM) with a certain orientation. The intersection points between the two sets of perpendicular mesh lines in RM an...

  7. Advanced techniques for future observations from space

    NASA Technical Reports Server (NTRS)

    Hinkley, E. D.

    1980-01-01

    Advanced remote sensing techniques for the study of global meteorology and the chemistry of the atmosphere are considered. Remote sensing from Spacelab/Shuttle and free-flying satellites will provide the platforms for instrumentation based on advanced technology. Several laser systems are being developed for the measurement of tropospheric winds and pressure, and trace species in the troposphere and stratosphere. In addition, a high-resolution passive infrared sensor shows promise for measuring temperature from sea level up through the stratosphere. Advanced optical and microwave instruments are being developed for wind measurements in the stratosphere and mesosphere. Microwave techniques are also useful for the study of meteorological parameters at the air-sea interface.

  8. Advanced endoscopic ultrasound management techniques for preneoplastic pancreatic cystic lesions

    PubMed Central

    Arshad, Hafiz Muhammad Sharjeel; Bharmal, Sheila; Duman, Deniz Guney; Liangpunsakul, Suthat; Turner, Brian G

    2017-01-01

    Pancreatic cystic lesions can be benign, premalignant or malignant. The recent increase in detection and tremendous clinical variability of pancreatic cysts has presented a significant therapeutic challenge to physicians. Mucinous cystic neoplasms are of particular interest given their known malignant potential. This review article provides a brief but comprehensive review of premalignant pancreatic cystic lesions with advanced endoscopic ultrasound (EUS) management approaches. A comprehensive literature search was performed using PubMed, Cochrane, OVID and EMBASE databases. Preneoplastic pancreatic cystic lesions include mucinous cystadenoma and intraductal papillary mucinous neoplasm. The 2012 International Sendai Guidelines guide physicians in their management of pancreatic cystic lesions. Some of the advanced EUS management techniques include ethanol ablation, chemotherapeutic (paclitaxel) ablation, radiofrequency ablation and cryotherapy. In future, EUS-guided injections of drug-eluting beads and neodymium:yttrium aluminum agent laser ablation is predicted to be an integral part of EUS-guided management techniques. In summary, International Sendai Consensus Guidelines should be used to make a decision regarding management of pancreatic cystic lesions. Advanced EUS techniques are proving extremely beneficial in management, especially in those patients who are at high surgical risk. PMID:27574295

  9. Surgical technique of orthotopic liver transplantation in rats: the Kamada technique and a new splint technique for hepatic artery reconstruction.

    PubMed

    Ishii, Eiichi; Shimizu, Akira; Takahashi, Mikiko; Terasaki, Mika; Kunugi, Shinobu; Nagasaka, Shinya; Terasaki, Yasuhiro; Ohashi, Ryuji; Masuda, Yukinari; Fukuda, Yuh

    2013-01-01

    Orthotopic liver transplantation (OLT) in rats is technically feasible and useful for the assessment of clinical liver transplantation and analysis of inflammatory liver diseases. OLT in rats was pioneered by Lee et al. in 1973 using hand-suture techniques of all vessels. This model has not been widely used due to the long operative time and technical demand. The cuff method was introduced by Kamada in 1979, and today, the Kamada technique is the one most commonly used worldwide. However, this technique does not include hepatic artery reconstruction, although this procedure is routinely performed in clinical transplantation. Nevertheless, several techniques for hepatic artery reconstruction in rat OLT have been reported recently, and our group also developed a simple splint technique from recipient right renal artery to donor celiac axis bearing the hepatic artery. In the present article, we describe the Kamada technique, as a standard surgical method for rat OLT. In addition, we also describe our splint technique for hepatic artery reconstruction. Then, we compare the features of Kamada technique and our splint technique for hepatic artery reconstruction and all other surgical techniques currently in use for rat OLT. The widespread use of the rat OLT model should help to provide full assessment of transplant immunology and the mechanism and treatment of inflammatory liver diseases.

  10. LESS living donor nephrectomy: Surgical technique and results

    PubMed Central

    Alessimi, Abdullah; Adam, Emilie; Haber, Georges-Pascal; Badet, Lionel; Codas, Ricardo; Fehri, Hakim Fassi; Martin, Xavier; Crouzet, Sébastien

    2015-01-01

    Purpose: We present the findings of 50 patients undergoing pure trans-umbilical laparo-endoscopic single-site surgery (LESS) living donor nephrectomy (LDN), between February 2010 and May 2014. Materials and Methods: Laparo-endoscopic single-site surgery LDN was performed through an umbilical incision. Different trocars were used, namely Gelpoint (Applied Mιdical, Rancho Santa Margarita, CA) SILS port (Covidien, Hamilton, Bermuda), R-port (Olympus Surgical, Orangeburg, NY) and standard trocars, inserted through the same skin incision but using separate fascial punctures. The standard laparoscopic technique was employed. The kidney was pre-entrapped in a retrieval bag and extracted trans-umbilically. Data were collected prospectively including questionnaires containing patient reported oral pain medication duration and time to recovery. Results: LESS LDN was successful in all patients. Mean warm ischemia time was 6.2 min (3–15), mean procedure time was 233.2 min (172–300), and hospitalization stay was 3.94 days (3–7) with a visual analogue pain score at discharge of 1.32 (0–3). No intraoperative complications occurred. The mean time of oral pain medication was 8.72 days (1–20) and final scar length was 4.06 cm (3–5). Each allograft was functional. Conclusion: Although challenging, trans-umbilical LESS LDN seems to be feasible and safe. Hence, LESS has the potential to improve cosmetic results and decrease morbidity. PMID:26229326

  11. Robotic-assisted mitral valve repair: surgical technique.

    PubMed

    Algarni, Khaled D; Suri, Rakesh M; Daly, Richard C

    2014-01-01

    Robotic-assisted mitral valve repair represents the least invasive surgical approach currently available for anatomical mitral valve repair in patients with myxomatous mitral valve disease. Standard mitral valve repair techniques utilized during conventional sternotomy/right thoracotomy are exactly replicated with the robotic instrumentation through 1-2 cm port-like incisions with superior 3D visualization. This is performed on cardiopulmonary bypass by peripheral cannulation of the femoral vessels/right internal jugular vein. The ascending aorta is occluded with a transthoracic aortic cross-clamp. Antegrade cardioplegia is delivered centrally into the aortic root through a cardioplegia vent catheter. By replicating conventional mitral valve repair done via an open sternotomy approach, the quality of mitral valve repair is ensured while providing the patients with advantages of less invasive surgery including shorter hospital stay, rapid recovery and return to normal activities, less blood transfusion, superior cosmesis and complete elimination of sternotomy-related morbidities such as deep sternal wound infection and sternal dehiscence. We reviewed the first consecutive 200 patients undergoing robotic mitral valve repair at Mayo Clinic Rochester between 24 January 2008 and 28 January 2011. Successful mitral valve repair was completed in all patients. There were no early (30-day) deaths. One patient suffered a stroke (0.5%). One patient required reoperation for bleeding (0.5%). Two patients (1%) required reoperation for recurrent mitral regurgitation. Twelve patients (6%) required transfusion of allogeneic blood products. We have noted a significant reduction in operative times and resource utilization over time.

  12. Bernese periacetabular osteotomy for hip dysplasia: Surgical technique and indications.

    PubMed

    Kamath, Atul F

    2016-05-18

    For young, active patients with healthy hip cartilage, pelvic osteotomy is a surgical option in to address hip pain and to improve mechanical loading conditions related to dysplasia. Hip dysplasia may lead to arthrosis at an early age due to poor coverage of the femoral head and abnormal loading of the joint articulation. In patients with symptomatic dysplasia and closed triradiate cartilage (generally over age 10), including adolescents and young adults (generally up to around age 40), the Bernese periacetabular osteotomy (PAO) is a durable technique for addressing underlying structural deformity. The PAO involves a modified Smith-Petersen approach. Advantages of the Bernese osteotomy include preservation of the weight-bearing posterior column of the hemi-pelvis, preservation of the acetabular blood supply, maintenance of the hip abductor musculature, and the ability to effect powerful deformity correction about an ideal center of rotation. There is an increasing body of evidence that preservation of the native hip can be improved through pelvic osteotomy. In contrast to hip osteotomy and joint preservation, the role of total hip arthroplasty in young, active patients with correctable hip deformity remains controversial. Moreover, the durability of hip replacement in young patients is inherently limited. Pelvic osteotomy should be considered the preferred method to address correctable structural deformity of the hip in the young, active patient with developmental dysplasia. The Bernese PAO is technically demanding, yet offers reproducible results with good long-term survivorship in carefully selected patients with preserved cartilage and the ability to meet the demands of rehabilitation.

  13. Ureteroscopy for management of stone disease: an up to date on surgical technique and disposable devices.

    PubMed

    Torricelli, Fabio C; Marchini, Giovanni S; Pedro, Renato N; Monga, Manoj

    2016-12-01

    The surgical management of urinary stone disease developed substantially over the past decades and advanced minimally invasive techniques have been successfully introduced into clinical practice. Retrograde ureteroscopy and ureterorrenoscopy have become the first-line option for treatment of ureteral and renal stones worldwide with high success rates allied with a low morbidity profile. In this review, we will discuss some key points in ureteroscopy for stone disease, such as the access to upper urinary tract, including balloon and catheter dilation; how to choose and use some disposable devices (hydrophilic versus PTFE guide wires, ureteral catheters, and laser fiber setting); and lastly present and compare different techniques for kidney or ureteral stone treatment (dusting versus basketing).

  14. Advanced Computational Techniques in Regional Wave Studies

    DTIC Science & Technology

    1990-01-03

    the new GERESS data. The dissertation work emphasized the development and use of advanced computa- tional techniques for studying regional seismic...hand, the possibility of new data sources at regional distances permits using previously ignored signals. Unfortunately, these regional signals will...the Green’s function around this new reference point is containing the propagation effects, and V is the source Gnk(x,t;r,t) - (2) volume where fJk

  15. Bernese periacetabular osteotomy for hip dysplasia: Surgical technique and indications

    PubMed Central

    Kamath, Atul F

    2016-01-01

    For young, active patients with healthy hip cartilage, pelvic osteotomy is a surgical option in to address hip pain and to improve mechanical loading conditions related to dysplasia. Hip dysplasia may lead to arthrosis at an early age due to poor coverage of the femoral head and abnormal loading of the joint articulation. In patients with symptomatic dysplasia and closed triradiate cartilage (generally over age 10), including adolescents and young adults (generally up to around age 40), the Bernese periacetabular osteotomy (PAO) is a durable technique for addressing underlying structural deformity. The PAO involves a modified Smith-Petersen approach. Advantages of the Bernese osteotomy include preservation of the weight-bearing posterior column of the hemi-pelvis, preservation of the acetabular blood supply, maintenance of the hip abductor musculature, and the ability to effect powerful deformity correction about an ideal center of rotation. There is an increasing body of evidence that preservation of the native hip can be improved through pelvic osteotomy. In contrast to hip osteotomy and joint preservation, the role of total hip arthroplasty in young, active patients with correctable hip deformity remains controversial. Moreover, the durability of hip replacement in young patients is inherently limited. Pelvic osteotomy should be considered the preferred method to address correctable structural deformity of the hip in the young, active patient with developmental dysplasia. The Bernese PAO is technically demanding, yet offers reproducible results with good long-term survivorship in carefully selected patients with preserved cartilage and the ability to meet the demands of rehabilitation. PMID:27190755

  16. Non-surgical treatment of early breast cancer: techniques on the way.

    PubMed

    Hamza, Alaa; Elrefaey, Shymaa

    2014-08-01

    Trials are still on the way to evaluate different non-surgical techniques to treat early breast cancer with achieving maximum oncological control and aesthetic outcome. Also these techniques can help old patients to bypass surgical and radiation complications and facilitate the treatment of early breast cancer with minimum side effects.

  17. Advanced Tools and Techniques for Formal Techniques in Aerospace Systems

    NASA Technical Reports Server (NTRS)

    Knight, John C.

    2005-01-01

    This is the final technical report for grant number NAG-1-02101. The title of this grant was "Advanced Tools and Techniques for Formal Techniques In Aerospace Systems". The principal investigator on this grant was Dr. John C. Knight of the Computer Science Department, University of Virginia, Charlottesville, Virginia 22904-4740. This report summarizes activities under the grant during the period 7/01/2002 to 9/30/2004. This report is organized as follows. In section 2, the technical background of the grant is summarized. Section 3 lists accomplishments and section 4 lists students funded under the grant. In section 5, we present a list of presentations given at various academic and research institutions about the research conducted. Finally, a list of publications generated under this grant is included in section 6.

  18. Advanced techniques in echocardiography in small animals.

    PubMed

    Chetboul, Valérie

    2010-07-01

    Transthoracic echocardiography has become a major imaging tool for the diagnosis and management of canine and feline cardiovascular diseases. During the last decade, more recent advances in ultrasound technology with the introduction of newer imaging modalities, such as tissue Doppler imaging, strain and strain rate imaging, and 2-dimensional speckle tracking echocardiography, have provided new parameters to assess myocardial performance, including regional myocardial velocities and deformation, ventricular twist, and mechanical synchrony. An outline of these 4 recent ultrasound techniques, their impact on the understanding of right and left ventricular function in small animals, and their application in research and clinical settings are given in this article.

  19. A survey to determine current practice patterns in the surgical treatment of advanced thumb carpometacarpal osteoarthrosis

    PubMed Central

    Brunton, Lance M.

    2010-01-01

    Background The purpose of this study was to determine current practice patterns and examine the influence of recent evidence in the surgical treatment of advanced thumb carpometacarpal (CMC) osteoarthrosis. Methods A survey was sent to 2,536 American Society for Surgery of the Hand members. Information regarding specialty training, years of experience, annual cases performed, treatment of choice, technique, and postoperative immobilization was collected. Respondents were asked whether their current treatment of choice differs from what they performed 5 years ago and about the importance of ligament reconstruction and “interposition” to thumb CMC arthroplasty success. Results One thousand twenty-four respondents completed the survey (40% response rate). Treatment of choice was trapeziectomy with ligament reconstruction and tendon interposition (68%), regardless of specialty training, years of experience, and annual cases performed. Over 70% favored treatment that was not different from what they performed 5 years ago. Less than 3% of respondents perform a trapeziectomy alone; only 14 surgeons have changed to this procedure in the last 5 years. Only 35% of the 822 respondents who perform a ligament reconstruction and 14% of the 764 respondents who perform an interposition believe those techniques are “extremely important” to thumb CMC arthroplasty success. Conclusions Despite recent evidence that suggests neither ligament reconstruction nor tendon interposition confers any additional benefit over trapeziectomy alone, few respondents have converted to the simpler procedure. Either the current evidence is not convincing enough to drastically change practice patterns, or other factors apart from this evidence have a greater influence on surgical decision-making for advanced thumb CMC osteoarthrosis. Electronic supplementary material The online version of this article (doi:10.1007/s11552-010-9275-7) contains supplementary material, which is available to

  20. Basic concepts of advanced MRI techniques.

    PubMed

    Pagani, Elisabetta; Bizzi, Alberto; Di Salle, Francesco; De Stefano, Nicola; Filippi, Massimo

    2008-10-01

    An overview is given of magnetic resonance (MR) techniques sensitized to diffusion, flow, magnetization transfer effect, and local field inhomogeneities induced by physiological changes, that can be viewed, in the clinical practice, as advanced because of their challenging implementation and interpretation. These techniques are known as diffusion-weighted, perfusion, magnetization transfer, functional MRI and MR spectroscopy. An important issue is that they can provide quantitative estimates of structural and functional characteristics that are below the voxel resolution. This review does not deal with the basic concepts of the MR physics and the description of the available acquisition and postprocessing methods, but hopefully provides an adequate background to readers and hence facilitate the understanding of the following clinical contributions.

  1. A New Surgical Technique for Closure of Pilonidal Sinus Defects: Triangular Closure Technique

    PubMed Central

    Mutaf, Mehmet; Temel, Metin; Koç, Mustafa Nihat

    2017-01-01

    Background We present a clinical experience with a new local flap procedure, namely the triangular closure technique, for reconstruction of sacrococcygeal skin defects resulting from excision of the pilonidal sinus. Material/Methods In this technique, the defect is surgically converted to a triangle in shape. Then, the triangular defect is closed by transposition of 2 skin flaps designed in an unequal z-plasty manner. Over 6 years, this technique has been used for closure of defects of chronic pilonidal sinus disease in 27 patients (6 females, 21 males). The size of the defect ranged between 3.5 cm and 12 cm in dimension. Results A tension-free defect closure was obtained in all patients. All flaps except one healed with no complications. A mean follow-up of 3.62±1.77 months revealed aesthetically and functionally acceptable results with the obliteration of the natal cleft in all patients. No recurrence was observed in the follow-up period. Conclusions The triangular closure technique was found to be a useful technique for the treatment of pilonidal sinus with favorable results regarding the time before return to work. PMID:28238003

  2. Advanced flow MRI: emerging techniques and applications.

    PubMed

    Markl, M; Schnell, S; Wu, C; Bollache, E; Jarvis, K; Barker, A J; Robinson, J D; Rigsby, C K

    2016-08-01

    Magnetic resonance imaging (MRI) techniques provide non-invasive and non-ionising methods for the highly accurate anatomical depiction of the heart and vessels throughout the cardiac cycle. In addition, the intrinsic sensitivity of MRI to motion offers the unique ability to acquire spatially registered blood flow simultaneously with the morphological data, within a single measurement. In clinical routine, flow MRI is typically accomplished using methods that resolve two spatial dimensions in individual planes and encode the time-resolved velocity in one principal direction, typically oriented perpendicular to the two-dimensional (2D) section. This review describes recently developed advanced MRI flow techniques, which allow for more comprehensive evaluation of blood flow characteristics, such as real-time flow imaging, 2D multiple-venc phase contrast MRI, four-dimensional (4D) flow MRI, quantification of complex haemodynamic properties, and highly accelerated flow imaging. Emerging techniques and novel applications are explored. In addition, applications of these new techniques for the improved evaluation of cardiovascular (aorta, pulmonary arteries, congenital heart disease, atrial fibrillation, coronary arteries) as well as cerebrovascular disease (intra-cranial arteries and veins) are presented.

  3. Comparison of surgical techniques in the treatment of laryngeal polypoid degeneration.

    PubMed

    Lumpkin, S M; Bishop, S G; Bennett, S

    1987-01-01

    Surgical excision has been the accepted treatment of laryngeal polypoid degeneration, or chronic polypoid corditis. We report on 29 women with polypoid degeneration who received one of three surgical treatments: vocal fold stripping, carbon dioxide laser obliteration, or the Hirano technique. The duration of postoperative dysphonia was longest with the laser removal and shortest with the Hirano technique. A combination of vocal hygiene management and the Hirano technique of removal provided the most efficacious treatment.

  4. Advances in Vitiligo: An Update on Medical and Surgical Treatments.

    PubMed

    Dillon, Alexander B; Sideris, Andrew; Hadi, Ali; Elbuluk, Nada

    2017-01-01

    Vitiligo is one of the most common cutaneous disorders of depigmentation. Although its underlying causes are still being studied and no definitive cure currently exists, recent research has provided insight into pathogenic mechanisms and new treatment options. Objective: The aim of this paper is to provide a comprehensive overview of the medical and surgical therapies for vitiligo with emphasis on the most recent treatment modalities. Design: This review was conducted through a literature search using PubMed and the National institutes of Health's clinicalTrials.gov databases from January 2010 to July 2015. This yielded 86 studies, 12 of which were excluded, and 74 of which were reviewed. Results: Recent studies and ongoing clinical trials indicate that there are many promising new medical and surgical treatment modalities for this chronic condition. Conclusion: A combination of traditional and newer treatments may work synergistically to provide additional improvement in patients' disease state and quality of life.

  5. Advances in Vitiligo: An Update on Medical and Surgical Treatments

    PubMed Central

    Dillon, Alexander B.; Sideris, Andrew; Hadi, Ali

    2017-01-01

    Vitiligo is one of the most common cutaneous disorders of depigmentation. Although its underlying causes are still being studied and no definitive cure currently exists, recent research has provided insight into pathogenic mechanisms and new treatment options. Objective: The aim of this paper is to provide a comprehensive overview of the medical and surgical therapies for vitiligo with emphasis on the most recent treatment modalities. Design: This review was conducted through a literature search using PubMed and the National institutes of Health’s clinicalTrials.gov databases from January 2010 to July 2015. This yielded 86 studies, 12 of which were excluded, and 74 of which were reviewed. Results: Recent studies and ongoing clinical trials indicate that there are many promising new medical and surgical treatment modalities for this chronic condition. Conclusion: A combination of traditional and newer treatments may work synergistically to provide additional improvement in patients’ disease state and quality of life. PMID:28210378

  6. Duodenal adenocarcinoma: Advances in diagnosis and surgical management

    PubMed Central

    Cloyd, Jordan M; George, Elizabeth; Visser, Brendan C

    2016-01-01

    Duodenal adenocarcinoma is a rare but aggressive malignancy. Given its rarity, previous studies have traditionally combined duodenal adenocarcinoma (DA) with either other periampullary cancers or small bowel adenocarcinomas, limiting the available data to guide treatment decisions. Nevertheless, management primarily involves complete surgical resection when technically feasible. Surgery may require pancreaticoduodenectomy or segmental duodenal resection; either are acceptable options as long as negative margins are achievable and an adequate lymphadenectomy can be performed. Adjuvant chemotherapy and radiation are important components of multi-modality treatment for patients at high risk of recurrence. Further research would benefit from multi-institutional trials that do not combine DA with other periampullary or small bowel malignancies. The purpose of this article is to perform a comprehensive review of DA with special focus on the surgical management and principles. PMID:27022448

  7. ESOPHAGEAL MUCOSAL RESECTION VERSUS ESOPHAGECTOMY: A COMPARATIVE STUDY OF SURGICAL RESULTS IN PATIENTS WITH ADVANCED MEGAESOPHAGUS

    PubMed Central

    de OLIVEIRA, Gustavo Carvalho; da ROCHA, Rodrigo Lima Bastos; COELHO-NETO, João de Souza; TERCIOTTI-JUNIOR, Valdir; LOPES, Luiz Roberto; ANDREOLLO, Nelson Adami

    2015-01-01

    Background The surgical treatment of advanced megaesophagus has no consensus, being esophagectomy the more commonly used method. Since it has high morbimortality - inconvenient for benign disease -, in recent years an alternative has been introduced: the esophageal mucosal resection. Aim To compare early and late results of the two techniques evaluating the operative time, length of ICU stay; postoperative hospitalization; total hospitalization; intra- and postoperative complication rates; mortality; and long-term results. Methods Were evaluated retrospectively 40 charts, 23 esophagectomies and 17 mucosectomies. In assessing postoperative results, interviews were conducted by using a specific questionnaire. Results Comparing the means of esophagectomy and mucosal resection, respectively, the data were: 1) surgical time - 310.2 min and 279.7 min (p> 0.05); 2) length of stay in ICU - 5 days and 2.53 days (p <0.05); 3) total time of hospitalization - 24.25 days and 20.76 days (p> 0.05); 4) length of hospital stay after surgery - 19.05 days and 14.94 days (p> 0.05); 5) presence of intraoperative complications - 65% and 18% (p <0.05); 6) the presence of postoperative complications - 65% and 35% (p> 0.05). In the assessment of late postoperative score (range 0-10) esophagectomy (n = 5) obtained 8.8 points and 8.8 points also got mucosal resection (n = 5). Conclusions Esophageal mucosal resection proved to be good alternative for surgical treatment of megaesophagus. It was advantageous in the immediate postoperative period by presenting a lower average time in operation, the total hospitalization, ICU staying and complications rate. In the late postoperative period, the result was excellent and good in both operations. PMID:25861065

  8. Surgical Treatment of Corneal Ectasia with Motowa's Trephine and Selective Suturing Technique

    PubMed Central

    Al-Motowa, Saeed; Al-Harby, Mosa

    2016-01-01

    A 40-year-old male presented with bilateral ectasia, contact lens intolerance, and astigmatism >10 D in both eyes. The patient had end-stage pellucid marginal degeneration that warranted surgical treatment. We present a unique surgical technique to stabilize the cornea, minimize astigmatism, improve vision and corneal status, and avoid penetrating keratoplasty. PMID:27994396

  9. Advances in the surgical treatment of morbid obesity.

    PubMed

    Stefater, Margaret A; Kohli, Rohit; Inge, Thomas H

    2013-02-01

    Due to the rapidly expanding prevalence of obesity, bariatric surgery is becoming an increasingly popular treatment option. Bariatric surgeries including Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) produce long-term weight loss and metabolic improvement, reducing mortality. This review discusses the important benefits and risks of RYGB and VSG, highlighting hypothesized mechanisms for these effects. We present data suggesting that VSG, albeit a newer procedure, may be as effective as RYGB with fewer adverse effects including less surgical risk, reduced nutritional deficiency, and less incidence of dumping syndrome. This may position VSG as an increasingly important procedure, particularly for the treatment of pediatric obesity.

  10. Surgical adjuvant treatment of locally advanced breast cancer.

    PubMed Central

    Townsend, C M; Abston, S; Fish, J C

    1985-01-01

    The reported incidence of local recurrence after mastectomy for locally advanced breast cancer (TNM Stage III and IV) is between 30% and 50%. The purpose of this study was to evaluate the effect of radiation therapy (XRT) followed by total mastectomy on the incidence of local recurrence in patients with locally advanced breast cancer. Fifty-three patients who presented with locally advanced breast cancer, without distant metastases, were treated with XRT (4500-5000 R) to the breast, chest wall, and regional lymph nodes. Five weeks after completion of XRT, total mastectomy was performed. There were no operative deaths. The complications that occurred in 22 patients after surgery were flap necrosis, wound infection, and seroma. Patients have been followed from 3 to 134 months. Twenty-five patients are alive (3-134 months), 12 free of disease; 28 patients have died with distant metastases (6-67 months). Isolated local recurrence occurred in only two patients. Four patients had local and distant recurrence (total local recurrence is 6/53). The remaining patients all developed distant metastases. We have devised a treatment strategy which significantly decreases the incidence of local recurrence in patients with locally advanced breast cancer. However, the rapid appearance of distant metastases emphasizes the need for systemically active therapy in patients with locally advanced breast cancer. PMID:3994434

  11. Advanced diagnostic imaging and surgical treatment of an odontogenic retromasseteric abscess in a guinea pig.

    PubMed

    Capello, V; Lennox, A

    2015-02-01

    A two-year-old guinea pig presented for difficulty chewing. Examination and diagnostic imaging, including computed tomography and magnetic resonance, revealed an odontogenic retromasseteric abscess associated with a mandibular cheek tooth. Treatment included removal of the abscess and marsupialisation of the surgical site for repeated debridement and healing by second intention. Unique features of this case included the use of advanced diagnostic imaging and utilisation of marsupialisation for surgical correction.

  12. Advanced techniques in current signature analysis

    NASA Astrophysics Data System (ADS)

    Smith, S. F.; Castleberry, K. N.

    1992-02-01

    In general, both ac and dc motors can be characterized as weakly nonlinear systems, in which both linear and nonlinear effects occur simultaneously. Fortunately, the nonlinearities are generally well behaved and understood and can be handled via several standard mathematical techniques already well developed in the systems modeling area; examples are piecewise linear approximations and Volterra series representations. Field measurements of numerous motors and motor-driven systems confirm the rather complex nature of motor current spectra and illustrate both linear and nonlinear effects (including line harmonics and modulation components). Although previous current signature analysis (CSA) work at Oak Ridge and other sites has principally focused on the modulation mechanisms and detection methods (AM, PM, and FM), more recent studies have been conducted on linear spectral components (those appearing in the electric current at their actual frequencies and not as modulation sidebands). For example, large axial-flow compressors (approximately 3300 hp) in the US gaseous diffusion uranium enrichment plants exhibit running-speed (approximately 20 Hz) and high-frequency vibrational information (greater than 1 kHz) in their motor current spectra. Several signal-processing techniques developed to facilitate analysis of these components, including specialized filtering schemes, are presented. Finally, concepts for the designs of advanced digitally based CSA units are offered, which should serve to foster the development of much more computationally capable 'smart' CSA instrumentation in the next several years.

  13. Multi-organ resection for locally advanced adrenocortical cancer: surgical strategy and literature review

    PubMed Central

    GUIDA, F.; CLEMENTE, M.; VALVANO, L.; NAPOLITANO, C.

    2015-01-01

    Adrenocortical carcinoma (ACC) is a rare and aggressive endocrine malignancy with an estimated worldwide incidence of 0.5–2 per million/year. Complete surgical removal of ACC represents the current treatment of choice for this tumor. A disease-free resection margin (R0) is an important predictor of long-term survival: surgery is demanding and must be performed by a highly experienced surgical team. We report the surgical strategy adopted in a patient with locally advanced ACC and virilization to obtain a R0 resection. PMID:26712261

  14. INFLUENCE OF SURGICAL TECHNIQUE IN THE PERITONEAL CARCINOMATOSIS SURGICAL WOUND IMPLANT: EXPERIMENTAL MODEL IN MICE

    PubMed Central

    ROSA, Roberto Maranhão; CAIADO, Rafael Coelho; REIS, Paulo Roberto de Melo; LACERDA, Elisângela de Paula Silveira; SUGITA, Denis Masashi; MRUÉ, Fátima

    2015-01-01

    Background The number of malignancies increased alarmingly. Surgery constitutes one of the most efficient therapeutic modalities for the treatment of solid tumors. The neoplastic implant in surgical wound is a complication whose percentage of occurrence reported in the literature is variable, but sets with high morbidity and therapeutic difficulties. Protecting the wound is one of the recommended principles of oncologic surgery. Aim To evaluate the influence of wound protection in the development of tumor implantation. Methods Sarcoma 180 tumor cells were used, with intraperitoneal inoculation in Swiss mice. After the establishment of neoplastic ascites, animals were randomized into two groups of 10, each group consisting of five males and five females. In both groups, laparotomy and manipulation of intra-abdominal organs was performed. In a group laparotomy was performed using the protection of the abdominal wound and the other group without it. On the 9th postoperative day macroscopic evaluation of the operative scar was performed, which was later removed for microscopic evaluation. Results There was microscopic infiltration of tumor cells in the wound of all animals. However, the group that held the protection, infiltration was less intense when compared to the group without it. The infiltration was also more severe in females than in males of the same group. Conclusion Tumor infiltration into the wound was more intense in the group in which the protection of the surgical site was not performed, and in females when compared to males of the same group. PMID:25861061

  15. [Merle D'Aubigne's oblique proximal femoral osteotomy. Surgical technique].

    PubMed

    López Sosa, Francisco H; Valentín-Guerrero, Santiago; Miranda-López, Eduardo

    2008-01-01

    Proximal femoral osteotomy with the technique described by Merle D'AubignC and Valliant was used in the treatment of adult patients with osteoarthritis or idiopathic avascular necrosis. Dr. Antonio Flores applied this technique to children with subluxation and acetabular dysplasia, identified with exaggerated anteversion and valgus of the proximal femur. He reported correction of the deformity in 75% of patients. The purpose of this paper is to describe the technique, its indications and complications.

  16. Combined operative technique with anterior surgical approach and video-assisted thoracoscopic surgical lobectomy for anterior superior sulcus tumours.

    PubMed

    Yokoyama, Yuhei; Chen, Fengshi; Aoyama, Akihiro; Sato, Toshihiko; Date, Hiroshi

    2014-11-01

    Video-assisted thoracoscopic surgery (VATS) has been widely used, but surgical resections of superior sulcus tumours remain challenging because of their anatomical location. For such cases, less-invasive procedures, such as the anterior transcervical-thoracic and transmanubrial approaches, have been widely performed because of their excellent visualization of the subclavian vessels. Recently, a combined operative technique with an anterior surgical approach and VATS for anterior superior sulcus tumours has been introduced. Herein, we report three cases of anterior superior sulcus tumours successfully resected by surgical approaches combined with a VATS-based lobectomy. In all cases, operability was confirmed by VATS, and upper lobectomies with hilar and mediastinal lymph node dissections were performed. Subsequently, dissections of the anterior inlet of the tumours were performed using the transmanubrial approach in two patients and the anterior trans-cervical-thoracic approach in one patient. Both approaches provided excellent access to the anterior inlet of the tumour and exposure of the subclavian vessels, resulting in radical resection of the tumour with concomitant resection of the surrounding anatomical structures, including the chest wall and vessels. In conclusion, VATS lobectomy combined with the anterior surgical approach might be an excellent procedure for the resection of anterior superior sulcus tumours.

  17. Surgical treatment of localized gingival recessions using coronally advanced flaps with or without subepithelial connective tissue graft

    PubMed Central

    Bellver-Fernández, Ricardo; Martínez-Rodriguez, Ana-María; Gioia-Palavecino, Claudio; Caffesse, Raul-Guillermo

    2016-01-01

    Background A coronally advanced flap with subepithelial connective tissue graft is the gold standard surgical treatment of gingival recessions, since it offers a higher probability of achieving complete root coverage compared with other techniques. However, optimum short- and middle-term clinical results have also been obtained with coronally advanced flaps alone. The aim of the present study was to evaluate the results obtained by the surgical treatment of localized gingival recessions using coronally advanced flaps with or without subepithelial connective tissue graft. Material and Methods The reduction of recession height was assessed, together with the gain in gingival attachment apical to the recession, and total reduction of recession, in a comparative study of two techniques. Twenty-two gingival recessions were operated upon: 13 in the control group (coronally advanced flap) and 9 in the test group (coronally advanced flap associated to subepithelial connective tissue graft). Results After 18 months, the mean reduction of recession height was 2.2 ± 0.8 mm in the control group and 2.3 ± 0.7 mm in the test group, with a mean gain in gingival attachment of 1.3 ± 0.9 mm and 2.3 ± 1.3 mm, respectively. In percentage terms, the mean reduction of recession height was 84.6 ± 19.6% in the control group and 81.7 ± 17.8% in the test group, with a mean gain in gingival attachment of 20.5 ± 37.4% and 184.4 ± 135.5%, respectively. Conclusions Significant reduction of gingival recession was achieved with both techniques, though the mean gain in gingival attachment (in mm and as a %) was greater in test group. Key words:Gingival recession, coronally advanced flap, subepthelial connective tissue graft. PMID:26595836

  18. Postoperative diet advancement: surgical dogma vs evidence-based medicine.

    PubMed

    Warren, Jeremy; Bhalla, Varun; Cresci, Gail

    2011-04-01

    Postoperative ileus is a natural part of recovery following abdominal and intestinal surgery. Research in the laboratory and clinical arenas has challenged the long-held belief that enteral nutrition (EN) should not be administered until bowel function has resumed, which is typically judged by a subjective bowel function assessment. Traditional postoperative management begins with clinical monitoring of return of bowel function, followed by a clear liquid diet that is advanced to regular solid food as tolerated. Studies have consistently demonstrated that early EN is safe and well tolerated, showing a reduction in wound morbidity and healing, fewer septic complications, diminished weight loss, and improved protein kinetics in patients administered early EN. Barriers to early enteral feeding include fear of GI morbidity, anastomotic disruption or leak but have not been proven valid in clinical or experimental trials. A clear liquid diet is the most frequently ordered first postoperative meal regardless of early or delayed administration. Although generally well tolerated, this diet fails to provide adequate nutrients to the postsurgical patient. In contrast, advancement to a regular diet as the initial meal has been shown to be well tolerated and provides significantly more nutrients than a clear liquid diet. This article reviews basic GI physiology, including motility, nutrient absorption, and the changes that occur in regulation and function of the GI tract following surgery, as well as clinical data regarding postoperative GI function and diet advancement. This will be applied to the clinical practices of postoperative dietary advancement to discuss the timing and choice of initial feeding in the postoperative patient.

  19. Key discoveries in the evolution of surgical techniques.

    PubMed

    The BJN reported on a paper given by the superintendent of the General Hospital, Kingston, Ontario. It seems that there were three key discoveries in the history of surgery, which of course are still relevant today. The first was Ambrose Pare, who was responsible for introducing the ligature and replacing the 'red hot knife and cautery'. Ligature is the term given to the length of thread or other material, which was used in the surgical process of tying off a duct or a blood vessel to stop bleeding. Cautery or cauterization was the application of a heated instrument, such as a knife, in those days to destroy tissues to stop bleeding and promote healing. Cauterization has been largely replaced by electrocoagulation, which is the use of a high-frequency electric current to seal blood vessels by heat and thus stop bleeding.

  20. Surgical management of metastatic long bone fractures: principles and techniques.

    PubMed

    Scolaro, John Alan; Lackman, Richard D

    2014-02-01

    Management of metastatic long bone fractures requires identification of the lesion and the use of sound fracture fixation principles to relieve pain and restore function. The treating surgeon must understand the principles of pathologic fracture fixation before initiating treatment. Because these fractures occur in the context of a progressive systemic disease, management typically involves a multidisciplinary approach. When considering surgical stabilization of these fractures, the abnormal (or absent) healing environment associated with diseased bone and the overall condition of the patient must be taken into account. The goal of surgery is to obtain a rigid mechanical construct, which allows for early mobility and weight bearing. This can be achieved using internal fixation with polymethyl methacrylate cement or segmental resection and joint reconstruction. Prosthetic joint arthroplasty is a more reliable means of fracture management when insufficient bone is present for fixation. Prophylactic stabilization of impending pathologic fractures can reduce the morbidity associated with metastatic lesions.

  1. Advancing Age and 30-Day Adverse Outcomes Following Non-Emergent General Surgical Operations

    PubMed Central

    Gajdos, Csaba; Kile, Deidre; Hawn, Mary T.; Finlayson, Emily; Henderson, William G.; Robinson, Thomas N.

    2014-01-01

    Background While some single center studies have demonstrated that major surgical operations are safe to perform in older adults, most multicenter database studies find advancing age to independently predict adverse postoperative outcomes. We hypothesized that thirty-day postoperative mortality, complications, failure to rescue rates and postoperative length of stay will increase with advancing age. Design Retrospective cohort study. Setting Hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Participants Patients undergoing non-emergent major general surgical operations between 2005 and 2008 were studied. Measures Postoperative outcomes of interest were complications occurring within 30 days of the index operation, return to OR within 30 days, failure to rescue after a postoperative complication, post-surgical length of stay and 30 day mortality. Results A total of 165,600 patients were studied. The rates of postoperative mortality, overall morbidity, and each type of postoperative complication increased as age increased. The rates of failure to rescue after each type of postoperative complication also increased with age. Mortality rates in patients ≥80 following renal insufficiency (43.3%), stroke (36.5%), myocardial infarction (35.6%), and pulmonary complications (25-39%) were particularly high. Median postoperative length of stay increased with age following surgical site infection, UTI, pneumonia, return to OR, and overall morbidity, but not after venous thromboembolism, stroke, myocardial infarction, renal insufficiency, failure to wean from the ventilator or reintubations. Conclusion Thirty-day mortality, complications and failure to rescue rates increase with advancing age following non-emergent general surgical operations. Patients over 80 years of age have especially high mortality following renal, cardiovascular, and pulmonary complications. As patient age advances, surgeons need to be

  2. Surgical time for graft preparation using different suture techniques

    PubMed Central

    Camarda, Lawrence; Giambartino, Sebastian; Lauria, Michele; Saporito, Michele; Triolo, Vito; D’Arienzo, Michele

    2016-01-01

    Summary Background The purpose of the present study was to compare the operative time for graft preparation using different techniques for graft suturing. Material and methods Flexor profundus tendons were harvested from fresh pig hind-leg trotters. Three different suture techniques were investigated: the Krackow stitch (K), the Whipstitch (W), and the Modified Finger-Trap suture (MFT). Tendons were sutured starting at 10 mm from the distal free end of the tendon. The suture configurations of the Krackow stitch and Whipstitch were completed with five suture throws. According to the MFT technique, the suture was wrapped five times around the tendon over a distance of 30 mm. The time required to perform a complete suture on each tendon was measured. Five independent examiners of different levels of training measured the time required for graft preparation during 3 separate occasions to determine intraobserver repeatability and interobserver reproducibility. Results The mean time required for graft preparation following the Krackow technique was 69.1 seconds ± 18.3 SD (range 31.8–120). The Whipstitch technique took an average of 59.9 seconds ± 21.2 SD (range 27–93). The MFT suture required a mean of 29.3 seconds ± 11.4 SD for completing the suture (range 21.6–33). In all examiners the time required to complete the MFT suture was significantly less than the other suture techniques (p < 0.05). Intraobserver intraclass correlation coefficients for each examiner ranged from 0.72 to 0.83. Conclusion Low graft preparation time is required to complete a MFT suture in a porcine tendon model. Further, time required for graft preparation using the MFT was shorter than other suturing techniques such as the Krackow and Whipstitch techniques. Clinical relevance The MFT suture could be used for graft set-up with the main advantage of reducing the time required in comparison with other suture techniques. PMID:27900298

  3. PREFERED SURGICAL TECHNIQUE USED BY ORTHOPEDISTS IN ACUTE ACROMIOCLAVICULAR DISLOCATION

    PubMed Central

    NISHIMI, ALEXANDRE YUKIO; ARBEX, DEMETRIO SIMÃO; MARTINS, DIOGO LUCAS CAMPOS; GUSMÃO, CARLOS VINICIUS BUARQUE DE; BONGIOVANNI, ROBERTO RANGEL; PASCARELLI, LUCIANO

    2016-01-01

    ABSTRACT Objective: To determine whether training on shoulder and elbow surgery influences the orthopedist surgeons' preferred technique to address acute acromioclavicular joint dislocation (ACD). Methods: A survey was conducted with shoulder and elbow specialists and general orthopedists on their preferred technique to address acute ACD. Results: Thirty specialists and forty-five general orthopedists joined the study. Most specialists preferred the endobutton technique, while most general orthopedists preferred the modified Phemister procedure for coracoclavicular ligament repair using anchors. We found no difference between specialists and general orthopedists in the number of tunnels used to repair the coracoclavicular ligament; preferred method for wire insertion through the clavicular tunnels; buried versus unburied Kirschner wire insertion for acromioclavicular temporary fixation; and time for its removal; and regarding the suture thread used for deltotrapezoidal fascia closure. Conclusion: Training on shoulder and elbow surgery influences the surgeons' preferred technique to address acute ACD. Level of Evidence V, Expert Opinion. PMID:28149190

  4. Assessing suturing techniques using a virtual reality surgical simulator.

    PubMed

    Kazemi, Hamed; Rappel, James K; Poston, Timothy; Hai Lim, Beng; Burdet, Etienne; Leong Teo, Chee

    2010-09-01

    Advantages of virtual-reality simulators surgical skill assessment and training include more training time, no risk to patient, repeatable difficulty level, reliable feedback, without the resource demands, and ethical issues of animal-based training. We tested this for a key subtask and showed a strong link between skill in the simulator and in reality. Suturing performance was assessed for four groups of participants, including experienced surgeons and naive subjects, on a custom-made virtual-reality simulator. Each subject tried the experiment 30 times using five different types of needles to perform a standardized suture placement task. Traditional metrics of performance as well as new metrics enabled by our system were proposed, and the data indicate difference between trained and untrained performance. In all traditional parameters such as time, number of attempts, and motion quantity, the medical surgeons outperformed the other three groups, though differences were not significant. However, motion smoothness, penetration and exit angles, tear size areas, and orientation change were statistically significant in the trained group when compared with untrained group. This suggests that these parameters can be used in virtual microsurgery training.

  5. Frenectomy: a review with the reports of surgical techniques.

    PubMed

    Devishree; Gujjari, Sheela Kumar; Shubhashini, P V

    2012-11-01

    The frenum is a mucous membrane fold that attaches the lip and the cheek to the alveolar mucosa, the gingiva, and the underlying periosteum. The frena may jeopardize the gingival health when they are attached too closely to the gingival margin, either due to an interference in the plaque control or due to a muscle pull. In addition to this, the maxillary frenum may present aesthetic problems or compromise the orthodontic result in the midline diastema cases, thus causing a recurrence after the treatment. The management of such an aberrant frenum is accomplished by performing a frenectomy.The present article is a compilation of a brief overview about the frenum, with a focus on the indications, contraindications, advantages and the disadvantages of various frenectomy techniques, like Miller's technique, V-Y plasty, Z-plasty and frenectomy by using electrocautery. A series of clinical cases of frenectomy which were approached by various techniques have also been reported.

  6. Frenectomy: A Review with the Reports of Surgical Techniques

    PubMed Central

    Devishree; Gujjari, Sheela Kumar; Shubhashini, P.V.

    2012-01-01

    The frenum is a mucous membrane fold that attaches the lip and the cheek to the alveolar mucosa, the gingiva, and the underlying periosteum. The frena may jeopardize the gingival health when they are attached too closely to the gingival margin, either due to an interference in the plaque control or due to a muscle pull. In addition to this, the maxillary frenum may present aesthetic problems or compromise the orthodontic result in the midline diastema cases, thus causing a recurrence after the treatment. The management of such an aberrant frenum is accomplished by performing a frenectomy. The present article is a compilation of a brief overview about the frenum, with a focus on the indications, contraindications, advantages and the disadvantages of various frenectomy techniques, like Miller's technique, V-Y plasty, Z-plasty and frenectomy by using electrocautery. A series of clinical cases of frenectomy which were approached by various techniques have also been reported. PMID:23285469

  7. Surgical management of maxillomandibular advancement in sleep apnea patients: specific technical considerations.

    PubMed

    Gilon, Y; Raskin, S; Heymans, O; Poirrier, R

    2001-01-01

    Maxillomandibular advancement is an integral part of the surgical treatment of patients suffering from obstructive sleep apnea. A number of publications report its efficacy and have attempted to define predictive success criteria. However, few authors have shown an interest in the surgical specificity of this intervention and in the difficulties that can be encountered, which differ from those seen in conventional orthognathic surgery. In this article, a series of patients treated with maxillomandibular osteotomy to correct obstructive sleep apnea syndrome (n = 17) are compared with patients who underwent surgery for the correction of dentofacial disharmonies (n = 33). Observations emphasized the importance of respecting a strict surgical and postsurgical protocol to avoid any technical traps linked to maxillomandibular advancement, both in preoperative simulations and during and after surgery. Results concerning sleep parameters will be the subject of a future publication.

  8. Robot assisted radical prostatectomy: how I do it. Part II: Surgical technique.

    PubMed

    Valdivieso, Roger F; Hueber, Pierre-Alain; Zorn, Kevin C

    2013-12-01

    The introduction of the "da Vinci Robotic Surgical System" (Intuitive Surgical, Sunnyvale, CA, USA) has been an important step towards a minimally invasive approach to radical prostatectomy. Technologic peculiarities, such as three-dimensional vision, wristed instrumentation with seven degrees of freedom of motion, lack of tremor, a 10x-magnification and a comfortable seated position for the surgeon has added value to the procedure for the surgeon and the patient. In this article, we describe the 9 step surgical technique for robot assisted radical prostatectomy (RARP) that is currently used in our institution (University of Montreal Hospital Center (CHUM) - Hopital St-Luc). We use the four-arm da Vinci Surgical System. Our experience with RARP is now over 250 cases with the senior surgeon having performed over 1200 RARPs and we have continually refined our technique to improve patient outcomes.

  9. Novel surgical techniques, regenerative medicine, tissue engineering and innovative immunosuppression in kidney transplantation

    PubMed Central

    Nowacki, Maciej; Nazarewski, Łukasz; Tyloch, Dominik; Pokrywczyńska, Marta; Pietkun, Katarzyna; Jundziłł, Arkadiusz; Tyloch, Janusz; Habib, Samy L.; Drewa, Tomasz

    2016-01-01

    On the 60th anniversary of the first successfully performed renal transplantation, we summarize the historical, current and potential future status of kidney transplantation. We discuss three different aspects with a potential significant influence on kidney transplantation progress: the development of surgical techniques, the influence of regenerative medicine and tissue engineering, and changes in immunosuppression. We evaluate the standard open surgical procedures with modern techniques and compare them to less invasive videoscopic as well as robotic techniques. The role of tissue engineering and regenerative medicine as a potential method for future kidney regeneration or replacement and the interesting search for novel solutions in the field of immunosuppression will be discussed. After 60 years since the first successfully performed kidney transplantation, we can conclude that the greatest achievements are associated with the development of surgical techniques and with planned systemic immunosuppression. PMID:27695507

  10. Liver transplantation surgical techniques for extensive retroperitoneal tumor with major blood vessel involvement: a case report.

    PubMed

    Miura, K; Sato, Y; Kokai, H; Hara, Y; Kobayashi, T; Oya, H; Yamamoto, S; Hatakeyama, K

    2012-03-01

    A case of a 71-year-old man with a huge retroperitoneal tumor situated behind the liver, which strongly compressed the liver inferior vena cava (IVC), and gastrointestinal tract is described. With the techniques of whole liver extraction and autologous orthotopic liver transplantation, we successfully removed the tumor. We have the surgical techniques, essential elements, and indications for this procedure.

  11. Surgical management of Gorlin syndrome: a 4-decade experience using local excision technique.

    PubMed

    Griner, Devan; Sutphin, Daniel; Sargent, Larry A

    2015-04-01

    Basal cell nevus syndrome (aka Gorlin syndrome, Gorlin-Goltz syndrome, nevoid basal cell carcinoma syndrome, and fifth phacomatosis) is a rare but well-described autosomal dominant condition with variable penetrance. We present a female patient who has been successfully treated using local surgical excision and diligent skin surveillance for more than 4 decades, demonstrating that simple local incision is an efficacious and reasonable surgical alternative that may circumvent the specialization and expense of Mohs technique.

  12. Minimally Invasive Surgical Approach to Distal Fibula Fractures: A Technique Tip

    PubMed Central

    Gonzalez, Tyler; Chien, Bonnie; Ghorbanhoseini, Mohammad; Kwon, John Y.

    2017-01-01

    Wound complications following ankle fracture surgery are a major concern. Through the use of minimally invasive surgical techniques some of these complications can be mitigated. Recent investigations have reported on percutaneous fixation of distal fibula fractures demonstrating similar radiographic and functional outcomes to traditional open approaches. The purpose of this manuscript is to describe in detail the minimally invasive surgical approach for distal fibula fractures. PMID:28271086

  13. Surgical treatment of advanced colorectal cancer in the elderly.

    PubMed

    Chiappa, Antonio; Zbar, Andrew P; Bertani, Emilio; Biffi, Roberto; Luca, Fabrizio; Pace, Ugo; Viale, Giuseppe; Pruneri, Giancarlo; Orecchia, Roberto; Lazzari, Roberta; Biella, Francesca; Grassi, Carmine; Zampino, Giulia; Fazio, Nicola; Della Vigna, Paolo; Andreoni, Luca; Andreoni, Bruno

    2005-01-01

    The aim of the study was to compare the short and long-term outcomes of older and younger colorectal cancer patients with advanced disease resected with a curative intent. Six hundred and ninety-two patients were analysed. Four hundred and seventy-nine patients were younger than 70 years (Group 1), and 213 were 70 years of age or above (Group 2). The overall perioperative mortality rate in the younger group was 0.8% (n = 7), as against 1.4% (n = 3) in the elderly group (p = NS). The morbidity rates were 35% and 42%, respectively (p = NS). At univariate analysis, the elderly patients had a worse overall survival compared to the younger group, when only patients undergoing postoperative chemo-radiotherapy were considered (54% vs 67% overall survival at 5 years; p = 0.03). Using logistic regression analysis, tumour stage (p < 0.0001) and radicality of surgery (p < 0.0001) correlated significantly with overall survival rates in the elderly. Colorectal surgery for malignancy can be performed safely in the elderly with acceptable morbidity and mortality rates and long-term survival.

  14. [Orthotopic liver transplant in rats. Surgical technique, complications and treatment].

    PubMed

    Lausada, Natalia R; Gondolesi, G E; Ortiz, E; Dreizzen, E; Raimondi, J C

    2002-01-01

    The orthotopic rat liver transplant model is a widely used technique in transplantation research. It has many advantages over other animal transplant models because of its availability and low cost. However, it must be emphasized that success with the rat model requires thorough training. The aim of this paper is to describe the microsurgical technique involved in 60 rat liver transplants and to discuss the complications and their treatments. Forty-nine liver transplants were performed at the Experimental Laboratory of the University Hospital, Ontario, Canada (ELUH) and 11 were performed at the Laboratorio de Trasplante de Organos de la Facultad de Ciencias Médicas de La Plata, Buenos Aires. Argentina (LTO). Among the transplants performed at the ELUH, the observed complications were haemorrhage (n = 4), pneumothorax (n = 1), anastomotic failure (n = 15), bile leak (n = 3), and bile duct necrosis (n = 9). The remaining 17 rats at the ELUH were healthy at day 7 after surgery. Animal survival immediately postop, at 24 hours postop and at 7 days postop was achieved with the 9th, 20th and 21st transplants respectively. At the LTO, 3 rats died as a result of anaesthetic complications. Seven-day animal survival was achieved with the 11th transplant. We beleive that the description of the orthotopic rat liver transplantation technique, as well as the discussion regarding complications and their management, can be useful for researchers interested in performing liver transplantation in rats.

  15. Surgical techniques for cochlear implantation in the very young child.

    PubMed

    Parisier, S C; Chute, P M; Popp, A L; Hanson, M B

    1997-09-01

    Early cochlear implantation to treat prelingually deafened children has been shown to improve speech perception and overall performance. The current age limit for implantation is 24 months in accordance with US Food and Drug Administration guidelines, but it is believed that earlier implantation is possible and may result in better performance. Implantation in children younger than 36 months, however, is complicated by the altered anatomy of the temporal bone in this young age group. We have developed specific modifications in the cochlear implantation technique for this young age group. This technique was used in implantation for 17 children younger than 36 months. The ages ranged from 16 to 36 months and averaged 30 months. All patients except one had complete electrode insertion without complication. The technique of cochlear implantation must be modified not only for differences in anatomy in these young children but also for the expected continued growth of the temporal bone and related structures. Cochlear implantation can be safely performed on children as young as 16 months.

  16. Influence of surgical technique, implant shape and diameter on the primary stability in cancellous bone.

    PubMed

    Bilhan, H; Geckili, O; Mumcu, E; Bozdag, E; Sünbüloğlu, E; Kutay, O

    2010-12-01

    Achievement of primary stability during surgical placement of dental implants is one of the most important factors for successful osseointegration depending on various anatomical, surgical and implant-related factors. Resonance frequency analysis (RFA) has been shown as a non-invasive and objective technique for measuring the stability of implants. The aim of this study was to evaluate the effect of some surgical and implant-related factors in enhancing primary stability and to estimate a correlation between RFA and insertion torque (IT) in proximal regions of cow ribs representing cancellous bone. Fifteen implant beds were prepared in the most proximal region of six fresh cow ribs. Ninety implants with three different shapes and two different diameters were placed with two different surgical techniques, and the primary stability was compared using RFA and IT. Significantly higher RFA and IT values were achieved when under-dimensioned drilling was used as the surgical method (P<0·01); significantly higher IT values were obtained with the use of wider implants (P<0·01) and partially conical Astra Tech implants showed the highest IT values (P<0·01). When all the implants were considered, significant correlations between the IT and RFA values were noted (%40·6, P<0·05). Partially conical implants with a wide diameter to be placed with the modified surgical technique proposed appear to be useful in enhancing the primary stability in cancellous bone.

  17. Surgical technique for lung retransplantation in the mouse

    PubMed Central

    Li, Wenjun; Goldstein, Daniel R.; Bribriesco, Alejandro C.; Nava, Ruben G.; Spahn, Jessica H.; Wang, Xingan; Gelman, Andrew E.; Krupnick, Alexander S.

    2013-01-01

    Microsurgical cuff techniques for orthotopic vascularized murine lung transplantation have allowed for the design of studies that examine mechanisms contributing to the high failure rate of pulmonary grafts. Here, we provide a detailed technical description of orthotopic lung retransplantation in mice, which we have thus far performed in 144 animals. The total time of the retransplantation procedure is approximately 55 minutes, 20 minutes for donor harvest and 35 minutes for the implantation, with a success rate exceeding 95%. The mouse lung retransplantation model represents a novel and powerful tool to examine how cells that reside in or infiltrate pulmonary grafts shape immune responses. PMID:23825768

  18. Innovation in surgical technology and techniques: Challenges and ethical issues.

    PubMed

    Geiger, James D; Hirschl, Ronald B

    2015-06-01

    The pace of medical innovation continues to increase. The deployment of new technologies in surgery creates many ethical challenges including how to determine safety of the technology, what is the timing and process for deployment of a new technology, how are patients informed before undergoing a new technology or technique, how are the outcomes of a new technology evaluated and how are the responsibilities of individual patients and society at large balanced. Ethical considerations relevant to the implementation of ECMO and robotic surgery are explored to further discussion of how we can optimize the delicate balance between innovation and regulation.

  19. Sentinel lymph node biopsy for conjunctival malignant melanoma: surgical techniques

    PubMed Central

    Wainstein, Alberto JA; Drummond-Lage, Ana P; Kansaon, Milhem JM; Bretas, Gustavo O; Almeida, Rodrigo F; Gloria, Ana LF; Figueiredo, Ana RP

    2015-01-01

    Background The purpose of this report is to examine the viability and safety of preoperative lymphoscintigraphy and radio guided sentinel lymph node (SLN) biopsy for conjunctival melanoma, and to identify the best technique to perform this procedure. Methods Three patients diagnosed with malignant melanoma of the conjunctiva underwent lymphoscintigraphy and SLN biopsy using a dual technique comprising isosulfan blue dye and technetium Tc 99m sulfur colloid. Each patient was anesthetized and the conjunctival melanoma was excised. SLNs were localized by a gamma probe, identified according to radioactivity and sentinel blue printing, and dissected, along with drainage of the associated lymphatic basins. The SLNs were evaluated by a pathologist using hematoxylin-eosin staining following serial sectioning and immunohistochemistry using a triple melanoma cocktail (S-100, Melan-A, and HMB-45 antigens). Results Two SLNs were stained in the jugular chain during preoperative lymphoscintigraphy in the first patient, two SLNs were identified in the preauricular and submandibular areas in the second patient, and two SLNs were identified in the submandibular and parotid areas in the third patient. All lymph nodes identified by lymphoscintigraphy were dissected and identified at surgery with 100% accuracy in all three patients. All SLNs were histologically and immunohistochemically negative. Patients had good cosmetic and functional results, and maintained their visual acuity and ocular motility. Conclusion Patients with conjunctival melanoma can undergo preoperative lymphoscintigraphy and SLN biopsy safely using radioactive technetium and isosulfan blue dye. PMID:25565762

  20. Evaluation of the effect of pulmonary hydatid cyst location on the surgical technique approaches

    PubMed Central

    Sadrizadeh, Ali; Haghi, Seyed Ziaollah; Masuom, Seyed Hossein Fattahi; Bagheri, Reza; Dalouee, Marziyeh Nouri

    2014-01-01

    Purpose: A hydatid cyst is the most common lung parasitic disease and is endemic in Iran. A hydatid cyst is more common in the right lung and lower lobes. Objective: The aim of this study was to assess surgical treatment of pulmonary hydatid cysts and whether the location of cyst affects surgical technique approaches. Materials and Methods: This study was performed on 87 patients with a pulmonary hydatid cyst who were referred to Qaem Hospital from 2010 to 2012. Selection of surgical technique was according to size, location, and the number of cysts. Patients were divided into two groups: (1) surgery with preserving lung parenchyma and (2) lobectomy. Afterward, the relationship between the location of cyst and surgical technique approaches was evaluated. Data was analyzed by Chi-square and Fisher exact tests. Results: In this study, no significant relation was found between the size (P = 0.682) and number (P = 0.344) of cysts and lobectomy necessity. But, there was a significant relation between the occurrence of cyst in middle lobe and lobectomy necessity (P = 0.016). Conclusions: According to the results, type of surgical technique does not depend on the size and number of cysts, but it may be related to the location of the cyst and the ratio of lung destruction. PMID:25378844

  1. Bringing Advanced Computational Techniques to Energy Research

    SciTech Connect

    Mitchell, Julie C

    2012-11-17

    Please find attached our final technical report for the BACTER Institute award. BACTER was created as a graduate and postdoctoral training program for the advancement of computational biology applied to questions of relevance to bioenergy research.

  2. Robotic assisted adrenalectomy: Surgical techniques, feasibility, indications, oncological outcome and safety.

    PubMed

    Yiannakopoulou, Eugenia

    2016-04-01

    Nowadays robotic assisted adrenalectomy has become an alternative to conventional laparoscopic adrenalectomy. However, evidence on the possible advantages and drawbacks of robotic assisted adrenalectomy remains still limited. This manuscript aimed to review evidence on robotic assisted adrenalectomy in terms of surgical technique, feasibility, indications, oncological outcome and safety. Existing evidence, although limited, suggests that robotic assisted adrenalectomy is feasible and safe. However, the number of patients submitted to robotic assisted adrenalectomy is limited with the majority of them being operated for benign disease. There are only a few case reports of robotic assisted adrenalectomy performed for adrenocortical carcinoma, oncocytoma or metastasis. Partial adrenalectomy seems to be a promising application of robotic assisted adrenalectomy especially for the treatment of hereditary pheocromocytomas. Robotic assisted adrenalectomy overcoming the technical limitations of laparoscopic surgery could possibly elicit a mild surgical response instead of the well described surgical response. Surgical response affects surgical morbidity and mortality as well as oncological outcome of malignant disease. If this hypothesis is proved correct, robotic assisted adrenalectomy could be possibly indicated in the treatment of disease. In conclusion, robotic assisted adrenalectomy is feasible and safe. Further research is needed on the oncological outcome of this minimally invasive technique as well as on its effect on surgical stress response.

  3. Minimally invasive corticotomy in orthodontics: a new technique using a CAD/CAM surgical template.

    PubMed

    Cassetta, M; Pandolfi, S; Giansanti, M

    2015-07-01

    Accelerating orthodontic tooth movement is a topical issue. Despite the different techniques described in the literature, the corticotomy is the only effective and safe means of accelerating orthodontic tooth movement. Although effective, the corticotomy presents significant postoperative discomfort. The aggressive nature of these particular methods, related to the elevation of mucoperiosteal flaps and to the length of the surgery, has resulted in reluctance to proceed with this technique among both patients and the dental community. To overcome the disadvantages of the corticotomy, this technical note describes an innovative, minimally invasive, flapless procedure combining piezoelectric surgical cortical micro-incisions with the use of a 3D Printed CAD/CAM surgical guide.

  4. A Practical Surgical Technique to Expose the Mental Nerve in Narrowing Genioplasty

    PubMed Central

    Wang, Chenglong; Gui, Lai

    2015-01-01

    Summary: In this article, the authors present a practical surgical technique using the anatomical character of the inferior alveolar nerve to fully expose the mental nerve (MN) in narrowing genioplasty. During the procedure, a rectangular mandibular outer cortex adjacent to the mental foramen is removed before the osteotomy. The objective is to avoid the injury of the MN from the reciprocating saw or bur and offer abundant space for the surgical operation. The technique has a minimal learning curve and will be useful to plastic surgeons to minimize unintentional cutting or pulling injury to the MN in narrowing genioplasty. PMID:26893979

  5. A surgical technique to protect the macular hole in indocyanine green-assisted vitrectomy.

    PubMed

    Saito, Masaaki; Iida, Tomohiro

    2006-01-01

    To prevent indocyanine green (ICG) toxicity during macular hole repair, a surgical technique was designed in which the hole is protected by a viscoelastic material before injecting ICG to stain the internal limiting membrane. The area covered by the viscoelastic material was not stained by ICG. The internal limiting membrane was peeled without difficulty by taking advantage of the ICG stain outlining it. After surgery, all holes closed and the postoperative outcomes were favorable. Only a small amount of residual ICG remained in the macular area. This surgical technique does not interfere with internal limiting membrane peeling and reduces the residual ICG postoperatively.

  6. Nasal packing and transseptal suturing techniques: surgical and anaesthetic perspectives.

    PubMed

    Günaydın, Rıza Önder; Aygenc, Erdinc; Karakullukcu, Selma; Fidan, Fatih; Celikkanat, Serdar

    2011-08-01

    The objective of this study is to compare the nasal packing and the transseptal suturing techniques regarding the extubation difficulty evaluation scores, follow-up times in post-anaesthesia care unit (PACU), pain scores, and postoperative complications. Two hundred patients who underwent septoplasty from January 2009 to October 2009 were randomly assigned either to have nasal packs (n: 100) or transeptal sutures (n: 100). In the transseptal suture group, extubation was easier and PACU follow-up times were shorter, when compared to the nasal packing group (p < 0.001). Patients with nasal packing had significantly higher pain scores (p < 0.001). Minor bleeding was significantly higher in the transseptal group with seven cases, compared to the nasal packing group without any bleeding cases (p = 0.014). There were two patients who had postoperative major bleeding, and two patients who had septal hematoma in the transseptal suture group. One patient with nasal packing had postoperative infection. Septal perforation was not seen in any of the cases. While patients in both groups experienced postoperative crusting, patients in the transseptal suture group also complained about foreign body sensation. Extubation was more comfortable; post-anaesthesia monitorization duration was shorter, and postoperative pain was less, but minor bleeding was seen more with transseptal sutures. There was no significant difference in terms of major bleeding, hematoma, infection or perforation. Foreign body sensation was the main cause of postoperative discomfort in the transseptal suture group. Transseptal suturing might be a significantly comfortable, cost-effective and reliable alternative to nasal packing.

  7. Parma tracheostomy technique: a hybrid approach to tracheostomy between classical surgical and percutaneous tracheostomies

    PubMed Central

    Benassi, Filippo; Manca, Tullio; Ramelli, Andrea; Vezzani, Antonella; Nicolini, Francesco; Romano, Giorgio; Ricci, Matteo; Carino, Davide; Di Chicco, Maria Vincenza; Gherli, Tiziano

    2016-01-01

    Background The aim of our study is to compare the classical surgical tracheostomy (TT) technique with a modified surgical technique designed and created by the cardiothoracic surgery staff of our department to reduce surgical trauma and postoperative complications. This modified technique combines features of percutaneous TT and surgical TT avoiding the use of specialized tools, which are required in percutaneous TT. Methods From October 2008 to March 2014 we performed 67 tracheostomies using this New Modified Surgical Technique (NMST) and 56 TT with the Classical Surgical Technique (CST). We collected data about the early clinical complications, deaths TT-related, deaths due to other complications and the presence of late TT’s complications were performed by a telephone follow-up. SPSS software (IMB version 21) was used for the statistical analysis. Categorical data were treated with chi-square test and continuous data were treated with t-test for independent samples. Results NMST group had a significant lower number of early complications (P=0.005) compared to CST group (5 vs. 15). In-hospital mortality was significantly higher in CST group (18 deaths vs. 4 in NMST group, P=0.001) but we registered only one case of TT-related mortality in CST group (P=0.280). We did not note other differences between the two groups regarding short or mid-long term complications. Conclusions In our experience the NMST demonstrated to be easily safe and reproducible with an amount of early, mid- and long-term complications similar to the CST; furthermore the aesthetic results of the procedure appear similar to those of percutaneous TT. PMID:28149558

  8. Distraction osteogenesis: a new surgical technique for use with the multiplanar mandibular distractor.

    PubMed

    Gateño, J; Teichgraeber, J F; Aguilar, E

    2000-03-01

    If distraction osteogenesis is to reach its full potential and achieve the level of accuracy that is possible with orthognathic surgery, its outcomes need to be as predictable. To this end, the authors developed a planning process for distraction osteogenesis similar to that used in orthognathic surgery. However, the success of the planning process depends on the authors' ability to execute the plan at the time of surgery. As a result, the authors needed to develop a surgical technique that would enable them to precisely install the distractor as indicated in the presurgical plan. The surgical technique presented in this article was developed for this purpose. The authors used this technique in seven patients (four boys and three girls; age range, 4 to 10 years). Four patients presented with unilateral deformities, and three patients presented with bilateral deformities. The follow-up period in this group of patients ranged from 12 to 33 months. The purpose of the technique is to replicate the position of the distractor on the mandible as determined by the presurgical plan. To this purpose, a custom drill guide and a surgical template have been developed. Both of these are used following the principles of triangulation to establish the pin position and orientation of the distractor. In the authors' hands, the use of this surgical technique has resulted in outcomes close to those predicted by the planning process.

  9. An Inexpensive Modified Primary Closure Technique for Class IV (Dirty) Wounds Significantly Decreases Superficial and Deep Surgical Site Infection.

    PubMed

    Kim, Bradford J; Aloia, Thomas A

    2016-11-01

    Despite the creation of several programs to decrease the incidence of surgical site infection, it remains a common complication that has a significant impact on patient recovery and medical costs. The following is a description and brief outcome report of a modified primary closure technique used for dirty (Class IV) wounds. There were 14 consecutive patients who had a laparotomy with Class IV wounds treated by a single surgeon (TAA) from 2011 to 2015. All patients had a history of cancer and either showed signs suggestive for an acute abdomen and required an emergent exploratory laparotomy or were found to have purulent intraabdominal infection at the time of elective surgery. The operation and "modified primary closure" technique (subcutaneous wound wicks with stapled skin closure) were performed in every case. The modified primary closure technique was utilized in 14 patients with a Class IV wound. There were no 30-day mortalities or readmissions. Wound wicks were slowly advanced out over a 7-day period, and only one patient required subsequent wound packing of a single-wicked area. There were no superficial or deep surgical site infections, or wound dehiscence during the hospital course, or 30-day postoperative period. The modified primary closure technique is efficient and inexpensive and was effective in a series of 14 patients with wounds classified as dirty.

  10. Endoscopic Debridement for Treatment of Chronic Plantar Fasciitis: An Innovative Surgical Technique.

    PubMed

    Cottom, James M; Maker, Jared M

    2016-01-01

    Plantar fasciitis is one the most common pathologies seen by foot and ankle surgeons. When nonoperative therapy fails, surgical intervention is warranted. Various surgical procedures are available for the treatment of recalcitrant plantar fasciitis. The most common surgical management typically consists of open versus endoscopic plantar fascia release. The documented comorbidities associated with the release of the plantar fascia include lateral column overload and metatarsalgia. We present a new technique for this painful condition that is minimally invasive, allows visualization of the plantar fascia, and maintains the integrity of this fascia. Our hypothesis was that the use of endoscopic debridement of the plantar fascia would provide a minimally invasive technique with acceptable patient outcomes.

  11. The core of a competent surgeon: a working knowledge of surgical anatomy and safe dissection techniques.

    PubMed

    Rogers, Robert M; Taylor, Richard H

    2011-12-01

    The competent gynecologic surgeon has a sure, working knowledge of the anatomy in the field of pelvic dissection and is expert in the techniques and in the millimeter by millimeter progression of surgical dissections. When operating in the pelvis, the surgeon always asks several questions. The first is, “In what anatomic area am I dissecting?” This question defines the anatomy to be dissected out. The second is,“What dissection techniques will I use here?” The measured steps of surgical dissection give the surgeon the confidence to proceed with the operation, while safeguarding the integrity of the surrounding anatomic structures. With less blood loss and less trauma to the tissues and anatomic structures, the surgeon may expect a better surgical outcome for the patient.

  12. Pedunculopontine Nucleus Region Deep Brain Stimulation in Parkinson Disease: Surgical Techniques, Side Effects, and Postoperative Imaging

    PubMed Central

    Hamani, Clement; Lozano, Andres M.; Mazzone, Paolo A.M.; Moro, Elena; Hutchison, William; Silburn, Peter A.; Zrinzo, Ludvic; Alam, Mesbah; Goetz, Laurent; Pereira, Erlick; Rughani, Anand; Thevathasan, Wesley; Aziz, Tipu; Bloem, Bastiaan R.; Brown, Peter; Chabardes, Stephan; Coyne, Terry; Foote, Kelly; Garcia-Rill, Edgar; Hirsch, Etienne C.; Okun, Michael S.; Krauss, Joachim K.

    2017-01-01

    The pedunculopontine nucleus (PPN) region has received considerable attention in clinical studies as a target for deep brain stimulation (DBS) in Parkinson disease. These studies have yielded variable results with an overall impression of improvement in falls and freezing in many but not all patients treated. We evaluated the available data on the surgical anatomy and terminology of the PPN region in a companion paper. Here we focus on issues concerning surgical technique, imaging, and early side effects of surgery. The aim of this paper was to gain more insight into the reasoning for choosing specific techniques and to discuss short-comings of available studies. Our data demonstrate the wide range in almost all fields which were investigated. There are a number of important challenges to be resolved, such as identification of the optimal target, the choice of the surgical approach to optimize electrode placement, the impact on the outcome of specific surgical techniques, the reliability of intraoperative confirmation of the target, and methodological differences in postoperative validation of the electrode position. There is considerable variability both within and across groups, the overall experience with PPN DBS is still limited, and there is a lack of controlled trials. Despite these challenges, the procedure seems to provide benefit to selected patients and appears to be relatively safe. One important limitation in comparing studies from different centers and analyzing outcomes is the great variability in targeting and surgical techniques, as shown in our paper. The challenges we identified will be of relevance when designing future studies to better address several controversial issues. We hope that the data we accumulated may facilitate the development of surgical protocols for PPN DBS. PMID:27728909

  13. [Forum on tissue expansion. Expansion of the scalp. Surgical techniques and clinical applications].

    PubMed

    Foyatier, J L; Delay, E; Comparin, J P; Latarjet, J; Masson, C L

    1993-02-01

    Repair of all forms of alopecia is one of the principal applications of scalp expansion. The authors have inserted 400 expansion prostheses, including 20 in the scalp. The surgical technique, choice of material and various types of flaps are described and illustrated by clinical cases of extensive alopecia.

  14. Comparative study of 2 surgical techniques for castration of guinea pigs (Cavia porcellus)

    PubMed Central

    Guilmette, Josée; Langlois, Isabelle; Hélie, Pierre; de Oliveira El Warrak, Alexander

    2015-01-01

    The objective of this study was to compare 2 surgical approaches (scrotal or abdominal) for castration of guinea pigs and to investigate post-operative infection rates with either technique. Forty-eight guinea pigs were castrated by scrotal or abdominal technique after being randomly assigned to 1 of 2 groups (n = 24). Individuals were either castrated by an experienced exotic animal surgeon (n = 12) or by an experienced small animal surgeon (n = 12). Surgical wounds were evaluated daily before euthanasia for histological evaluation 2 wks after surgery. Post-operative infection rate was significantly higher in the scrotal group than in the abdominal group, with a higher rate for the experienced small animal surgeon. Castration of guinea pigs with the abdominal technique is significantly faster and has a significantly lower post-operative infection rate than the scrotal technique. PMID:26424914

  15. Posterior Segment Intraocular Foreign Body: Extraction Surgical Techniques, Timing, and Indications for Vitrectomy

    PubMed Central

    Guevara-Villarreal, Dante A.

    2016-01-01

    Ocular penetrating injury with Intraocular Foreign Body (IOFB) is a common form of ocular injury. Several techniques to remove IOFB have been reported by different authors. The aim of this publication is to review different timing and surgical techniques related to the extraction of IOFB. Material and Methods. A PubMed search on “Extraction of Intraocular Foreign Body,” “Timing for Surgery Intraocular Foreign Body,” and “Surgical Technique Intraocular Foreign Body” was made. Results. Potential advantages of immediate and delayed IOFB removal have been reported with different results. Several techniques to remove IOFB have been reported by different authors with good results. Conclusion. The most important factor at the time to perform IOFB extraction is the experience of the surgeon. PMID:28025619

  16. Subcutaneous pedicled V-Y advancement flap for surgical reconstruction of the auricle of the ear.

    PubMed

    González-Sixto, B; Pérez-Bustillo, A; Otero-Rivas, M M; Rodríguez-Prieto, M Á

    2014-05-01

    The subcutaneous pedicled V-Y advancement flap is useful for the repair of small and medium-sized defects in areas where it is easy to obtain a good subcutaneous pedicle (upper lip, cheek, eyebrow, and nasal tip and ala). The almost complete absence of subcutaneous tissue on the anterior aspect of the auricle of the ear can limit the use of this approach in this region. We present 4 patients in whom subcutaneous pedicled V-Y advancement flaps were used to repair surgical defects of the helix, scaphoid fossa, and antitragus, achieving a good functional and aesthetic result in all cases.

  17. Advanced rehabilitation techniques for the multi-limb amputee.

    PubMed

    Harvey, Zach T; Loomis, Gregory A; Mitsch, Sarah; Murphy, Ian C; Griffin, Sarah C; Potter, Benjamin K; Pasquina, Paul

    2012-01-01

    Advances in combat casualty care have contributed to unprecedented survival rates of battlefield injuries, challenging the field of rehabilitation to help injured service members achieve maximal functional recovery and independence. Nowhere is this better illustrated than in the care of the multiple-limb amputee. Specialized medical, surgical, and rehabilitative interventions are needed to optimize the care of this unique patient population. This article describes lessons learned at Walter Reed National Military Medical Center Bethesda in providing advanced therapy and prosthetics for combat casualties, but provides guidelines for all providers involved in the care of individuals with amputation.

  18. Combined preputial advancement and phallopexy as a revision technique for treating paraphimosis in a dog.

    PubMed

    Wasik, S M; Wallace, A M

    2014-11-01

    A 7-year-old neutered male Jack Russell terrier-cross was presented for signs of recurrent paraphimosis, despite previous surgical enlargement of the preputial ostium. Revision surgery was performed using a combination of preputial advancement and phallopexy, which resulted in complete and permanent coverage of the glans penis by the prepuce, and at 1 year postoperatively, no recurrence of paraphimosis had been observed. The combined techniques allow preservation of the normal penile anatomy, are relatively simple to perform and provide a cosmetic result. We recommend this combination for the treatment of paraphimosis in the dog, particularly when other techniques have failed.

  19. Advanced crystallization techniques of 'solar grade' silicon

    NASA Astrophysics Data System (ADS)

    Gasparini, M.; Calligarich, C.; Rava, P.; Sardi, L.; Alessandri, M.; Redaelli, F.; Pizzini, S.

    Microstructural, electrical and photo-voltaic characteristics of polycrystal line silicon solar cells fabricated with silicon ingots containing 5, 100 and 500 ppmw iron are reported and discussed. All silicon ingots were grown by the directional solidification technique in graphite or special quartz molds and doped intentionally with iron, in order to evaluate the potentiality of the D.S. technique when employed with solar silicon feedstocks. Results indicate that structural breakdown limits the amount of the ingot which is usable for solar cells fabrication, but also that efficiencies in excess of 10 percent are obtained using the 'good' region of the ingot.

  20. Surgical innovation as sui generis surgical research.

    PubMed

    Lotz, Mianna

    2013-12-01

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

  1. Advances in laparoscopic urologic surgery techniques

    PubMed Central

    Abdul-Muhsin, Haidar M.; Humphreys, Mitchell R.

    2016-01-01

    The last two decades witnessed the inception and exponential implementation of key technological advancements in laparoscopic urology. While some of these technologies thrived and became part of daily practice, others are still hindered by major challenges. This review was conducted through a comprehensive literature search in order to highlight some of the most promising technologies in laparoscopic visualization, augmented reality, and insufflation. Additionally, this review will provide an update regarding the current status of single-site and natural orifice surgery in urology. PMID:27134743

  2. Pigment dispersion syndrome associated with intraocular lens implantation: a new surgical technique

    PubMed Central

    Jordana, M Isabel Canut; Formigó, Daniel Pérez; González, Rodrigo Abreu; Reus, Jeroni Nadal

    2010-01-01

    Aims We report the case of a myopic patient who, after intraocular lens transplant in the posterior chamber, suffered elevated intraocular pressure due to pigment dispersion, with recurrent episodes of blurred vision. The patient was treated with a new surgical technique that can avoid potential iridolenticular contact. Methods Complete ophthalmologic examination and optical coherence tomography (OCT) of the anterior segment were performed. Results Contact between the pigmentary epithelium and the iris with an intraocular lens was revealed by utrasound biomicroscopy and OCT. In this case, Nd:YAG laser iridotomy and laser iridoplasty were not effective for iridolenticular separation and control of the pigment dispersion. We propose a new technique: stitches on the surface of the iris to obtain good iridolenticular separation and good intraocular pressure control. Conclusion Stitches on the iris surface should be considered as optional therapy in pigmentary glaucoma secondary to intraocular lens implantation. This surgical technique can avoid potential iridolenticular contacts more definitively. PMID:21151331

  3. Complications, Not Minimally Invasive Surgical Technique, Are Associated with Increased Cost after Esophagectomy

    PubMed Central

    Fu, Sue J.; Ho, Vanessa P.; Ginsberg, Jennifer; Perry, Yaron; Delaney, Conor P.; Linden, Philip A.

    2016-01-01

    Background. Minimally invasive esophagectomy (MIE) techniques offer similar oncological and surgical outcomes to open methods. The effects of MIE on hospital costs are not well documented. Methods. We reviewed the electronic records of patients who underwent esophagectomy at a single academic institution between January 2012 and December 2014. Esophagectomy techniques were grouped into open, hybrid, MIE, and transhiatal (THE) esophagectomy. Univariate and multivariate analyses were performed to assess the impact of surgery on total hospital cost after esophagectomy. Results. 80 patients were identified: 11 THE, 11 open, 41 hybrid, and 17 MIE. Median total cost of the hospitalization was $31,375 and was similar between surgical technique groups. MIE was associated with higher intraoperative costs, but not total hospital cost. Multivariable analysis revealed that the presence of a complication, increased age, American Society of Anesthesiologists class IV (ASA4), and preoperative coronary artery disease (CAD) were associated with significantly increased cost. Conclusions. Despite the association of MIE with higher operation costs, the total hospital cost was not different between surgical technique groups. Postoperative complications and severe preoperative comorbidities are significant drivers of hospital cost associated with esophagectomy. Surgeons should choose technique based on clinical factors, rather than cost implications. PMID:28053785

  4. Outcomes of Ahmed glaucoma valve implantation in advanced primary congenital glaucoma with previous surgical failure

    PubMed Central

    Huang, Jingjing; Lin, Jialiu; Wu, Ziqiang; Xu, Hongzhi; Zuo, Chengguo; Ge, Jian

    2015-01-01

    Purpose The purpose of this study was to evaluate the intermediate surgical results of Ahmed glaucoma valve (AGV) implantation in patients less than 7 years of age, with advanced primary congenital glaucoma who have failed previous surgeries. Patients and methods Consecutive patients with advanced primary congenital glaucoma that failed previous operations and had undergone subsequent AGV implantation were evaluated retrospectively. Surgical success was defined as 1) intraocular pressure (IOP) ≥6 and ≤21 mmHg; 2) IOP reduction of at least 30% relative to preoperative values; and 3) without the need for additional surgical intervention for IOP control, loss of light perception, or serious complications. Results Fourteen eyes of eleven patients were studied. Preoperatively, the average axial length was 27.71±1.52 (25.56–30.80) mm, corneal diameter was 14.71±1.07 (13.0–16.0) mm, cup-to-disc ratio was 0.95±0.04 (0.9–1.0), and IOP was 39.5±5.7 (30–55) mmHg. The mean follow-up time was 18.29±10.96 (5–44, median 18) months. There were significant reductions in IOPs and the number of glaucoma medications (P<0.001) postoperatively. The IOPs after operation were 11.3±3.4, 13.6±5.1, 16.3±2.7, and 16.1±2.6 mmHg at 1 month, 6 months, 12 months, and 18 months, respectively. Kaplan–Meier estimates of the cumulative probability of valve success were 85.7%, 71.4%, and 71.4% at 6, 12, and 18 months, respectively. Severe surgical complications, including erosion of tube, endophthalmitis, retinal detachment, choroidal detachment, and delayed suprachoroidal hemorrhage, occurred in 28.6% cases. Conclusion AGV implantation remains a viable option for patients with advanced primary congenital glaucoma unresponsive to previous surgical intervention, despite a relatively high incidence of severe surgical complications. PMID:26082610

  5. [Advanced online search techniques and dedicated search engines for physicians].

    PubMed

    Nahum, Yoav

    2008-02-01

    In recent years search engines have become an essential tool in the work of physicians. This article will review advanced search techniques from the world of information specialists, as well as some advanced search engine operators that may help physicians improve their online search capabilities, and maximize the yield of their searches. This article also reviews popular dedicated scientific and biomedical literature search engines.

  6. Sutureless surgical techniques for arch aneurysm repair in a patient with Behçet's disease.

    PubMed

    Uchida, Naomichi; Takasaki, Taiichi; Takahashi, Shinya; Sueda, Taijiro

    2014-01-01

    In patients with vasculo-Behçet's disease, endovascular stent graft is a reasonable treatment from the viewpoint of prevention of an anastomotic pseudo-aneurysm. We report a case of total arch replacement combined with open stent grafting technique to the downstream aorta and graft inclusion into sino-tubular junction as sutureless surgical techniques for an arch aneurysm in a 42-year-old woman with Behçet's disease. Postoperative computed tomography (CT) showed that the aortic aneurysm had completely disappeared in 11 months after the operation. Open stent grafting technique was effective to prevent anastomotic pseudo-aneurysm formation.

  7. Preservation of the Pulmonary Valve During Early Repair of Tetralogy of Fallot: Surgical Techniques.

    PubMed

    Vida, Vladimiro L; Guariento, Alvise; Zucchetta, Fabio; Padalino, Massimo; Castaldi, Biagio; Milanesi, Ornella; Stellin, Giovanni

    2016-01-01

    During the last decade interest in preserving pulmonary valve (PV) function has stimulated a few surgeons to apply valve-sparing techniques in repairing tetralogy of Fallot (TOF), with the aim of preserving long-term right ventricular function. Since June 2007, we embarked upon a program for preserving PV function in selected patients during TOF repair. More recently, the introduction of more complex PV plasty techniques allowed us to further extend the applicability of PV preservation techniques. We believe that preservation of PV function during early repair of TOF, by combining different intraoperative surgical maneuvers, can be extended to almost all patients with classic TOF.

  8. Advanced analysis techniques for uranium assay

    SciTech Connect

    Geist, W. H.; Ensslin, Norbert; Carrillo, L. A.; Beard, C. A.

    2001-01-01

    Uranium has a negligible passive neutron emission rate making its assay practicable only with an active interrogation method. The active interrogation uses external neutron sources to induce fission events in the uranium in order to determine the mass. This technique requires careful calibration with standards that are representative of the items to be assayed. The samples to be measured are not always well represented by the available standards which often leads to large biases. A technique of active multiplicity counting is being developed to reduce some of these assay difficulties. Active multiplicity counting uses the measured doubles and triples count rates to determine the neutron multiplication (f4) and the product of the source-sample coupling ( C ) and the 235U mass (m). Since the 35U mass always appears in the multiplicity equations as the product of Cm, the coupling needs to be determined before the mass can be known. A relationship has been developed that relates the coupling to the neutron multiplication. The relationship is based on both an analytical derivation and also on empirical observations. To determine a scaling constant present in this relationship, known standards must be used. Evaluation of experimental data revealed an improvement over the traditional calibration curve analysis method of fitting the doubles count rate to the 235Um ass. Active multiplicity assay appears to relax the requirement that the calibration standards and unknown items have the same chemical form and geometry.

  9. [Surgical techniques in mitral valve diseases. Reconstruction and/or replacement].

    PubMed

    Noack, T; Mohr, F-W

    2016-02-01

    Mitral valve (MV) disease is one of the most common heart valve diseases. The surgical and interventional treatment for MV disease requires a multidisciplinary approach. For primary mitral valve regurgitation (MVR) surgical MV repair is the treatment of choice, which can be performed with an excellent outcome and long-term survival in reference centers. The surgical technique used for MV repair depends on the pathological mechanism, the morphological dimensions of the MV, the operative risk and the expertise of the cardiac surgeon. The surgical and interventional treatment of secondary MVVR is the subject of on-going discussions. In patients with moderate secondary MVR undergoing coronary artery bypass grafting, concomitant MV repair should be performed. In the presence of severe secondary MR with risk factors for failure of MV repair, patients should consider having MV replacement. In the rare cases of patients presenting with mitral valve stenosis (MVS) MV repair can be considered in young patients and who are most often treated with MV replacement. The choice between biological or mechanical MV replacement depends on the pathophysiology, the comorbidities, the amount of anticoagulation necessary and the age of the patient. New percutaneous techniques for MV replacement offer new treatment options for reoperation in high-risk patients.

  10. Recent advances in DNA sequencing techniques

    NASA Astrophysics Data System (ADS)

    Singh, Rama Shankar

    2013-06-01

    Successful mapping of the draft human genome in 2001 and more recent mapping of the human microbiome genome in 2012 have relied heavily on the parallel processing of the second generation/Next Generation Sequencing (NGS) DNA machines at a cost of several millions dollars and long computer processing times. These have been mainly biochemical approaches. Here a system analysis approach is used to review these techniques by identifying the requirements, specifications, test methods, error estimates, repeatability, reliability and trends in the cost reduction. The first generation, NGS and the Third Generation Single Molecule Real Time (SMART) detection sequencing methods are reviewed. Based on the National Human Genome Research Institute (NHGRI) data, the achieved cost reduction of 1.5 times per yr. from Sep. 2001 to July 2007; 7 times per yr., from Oct. 2007 to Apr. 2010; and 2.5 times per yr. from July 2010 to Jan 2012 are discussed.

  11. The Influence of Frontal Lobe Tumors and Surgical Treatment on Advanced Cognitive Functions.

    PubMed

    Fang, Shengyu; Wang, Yinyan; Jiang, Tao

    2016-07-01

    Brain cognitive functions affect patient quality of life. The frontal lobe plays a crucial role in advanced cognitive functions, including executive function, meta-cognition, decision-making, memory, emotion, and language. Therefore, frontal tumors can lead to serious cognitive impairments. Currently, neurosurgical treatment is the primary method to treat brain tumors; however, the effects of the surgical treatments are difficult to predict or control. The treatment may both resolve the effects of the tumor to improve cognitive function or cause permanent disabilities resulting from damage to healthy functional brain tissue. Previous studies have focused on the influence of frontal lesions and surgical treatments on patient cognitive function. Here, we review cognitive impairment caused by frontal lobe brain tumors.

  12. Diagnostics of nonlocal plasmas: advanced techniques

    NASA Astrophysics Data System (ADS)

    Mustafaev, Alexander; Grabovskiy, Artiom; Strakhova, Anastasiya; Soukhomlinov, Vladimir

    2014-10-01

    This talk generalizes our recent results, obtained in different directions of plasma diagnostics. First-method of flat single-sided probe, based on expansion of the electron velocity distribution function (EVDF) in series of Legendre polynomials. It will be demonstrated, that flat probe, oriented under different angles with respect to the discharge axis, allow to determine full EVDF in nonlocal plasmas. It is also shown, that cylindrical probe is unable to determine full EVDF. We propose the solution of this problem by combined using the kinetic Boltzmann equation and experimental probe data. Second-magnetic diagnostics. This method is implemented in knudsen diode with surface ionization of atoms (KDSI) and based on measurements of the magnetic characteristics of the KDSI in presence of transverse magnetic field. Using magnetic diagnostics we can investigate the wide range of plasma processes: from scattering cross-sections of electrons to plasma-surface interactions. Third-noncontact diagnostics method for direct measurements of EVDF in remote plasma objects by combination of the flat single-sided probe technique and magnetic polarization Hanley method.

  13. A new surgical technique for extensive exposure of the proximal humerus and shoulder.

    PubMed

    Puthezhath, Kishore; Puthur, Dominic K

    2013-11-01

    Different techniques have been described for surgical exposure of the shoulder and proximal humerus. However, the neurovascular and muscular anatomy in the proximity of the humerus precludes the use of a "safe" extensive approach. We here present a new technique for extensive exposure of the proximal humerus and shoulder for wide resection of tumors. By reflecting the deltoid with its origin as an osteomyocutaneous flap downwards and backwards, the entire shoulder, including the rotator cuff and proximal humerus, are exposed with minimal damage to the blood supply and function of the deltoid muscle. This approach, which is a logical combination of anterior, transacromial and deltoid splitting approaches, was used in 17 patients, 11 achieving satisfactory functional results. Our new surgical approach reduces intraoperative damage to the blood supply of the deltoid and results in better function of the shoulder postoperatively because both the powerful intermediate muscle fibers of the deltoid and its acromial origin remain intact.

  14. [Surgical technique of aortic valve replacement for small aortic annulus in elderly patients].

    PubMed

    Hata, T; Fujiwara, K; Furukawa, H; Tsushima, Y; Yoshitaka, H; Kuinose, M; Minami, H; Ishida, A; Tamura, K; Totsugawa, T; Kanemitsu, H; Ozawa, M

    2006-04-01

    Recent reports have shown that aortic valve replacement in elderly patients over 65 years with atherosclerotic aortic stenosis and a small aortic annulus is possible by using a small sized bioprosthesis (Carpentier-Edwards pericardial valve). Here we present out surgical technique. Firstly, the native calcified aortic valve was removed completely to gain total exposure of the surrounding aortic root and sinus of Valsalva like Bentall procedure. Secondly, a small sized bioprosthesis was implanted with intermittent noneverting mattress 2-0 sutures with spaghetti and small polytetrafluoroethylene (PTFE) felt. Aortic annulus is the dilated by inserting Hegar dilator sizing from 25 to 27 mm. Therefore, aortic valve replacement for small aortic annulus in intra- or supra-annular position should be easily accomplished. Good surgical results and hemodynamic state were achieved in 25 consecutive cases using this technique.

  15. Surgical outcome after docetaxel-based neoadjuvant chemotherapy in locally-advanced gastric cancer

    PubMed Central

    Biffi, Roberto; Fazio, Nicola; Luca, Fabrizio; Chiappa, Antonio; Andreoni, Bruno; Zampino, Maria Giulia; Roth, Arnaud; Schuller, Jan Christian; Fiori, Giancarla; Orsi, Franco; Bonomo, Guido; Crosta, Cristiano; Huber, Olivier

    2010-01-01

    AIM: To investigate feasibility, morbidity and surgical mortality of a docetaxel-based chemotherapy regimen randomly administered before or after gastrectomy in patients suffering from locally-advanced resectable gastric cancer. METHODS: Patients suffering from locally-advanced (T3-4 any N M0 or any T N1-3 M0) gastric carcinoma, staged with endoscopic ultrasound, bone scan, computed tomography, and laparoscopy, were assigned to receive four 21 d/cycles of TCF (docetaxel 75 mg/m2 day 1, cisplatin 75 mg/m2 day 1, and fluorouracil 300 mg/m2 per day for days 1-14), either before (Arm A) or after (Arm B) gastrectomy. Operative morbidity, overall mortality, and severe adverse events were compared by intention-to-treat analysis. RESULTS: From November 1999 to November 2005, 70 patients were treated. After preoperative TCF (Arm A), thirty-two (94%) resections were performed, 85% of which were R0. Pathological response was complete in 4 patients (11.7%), and partial in 18 (55%). No surgical mortality and 28.5% morbidity rate were observed, similar to those of immediate surgery arm (P = 0.86). Serious chemotherapy adverse events tended to be more frequent in arm B (23% vs 11%, P = 0.07), with a single death per arm. CONCLUSION: Surgery following docetaxel-based chemotherapy was safe and with similar morbidity to immediate surgery in patients with locally-advanced resectable gastric carcinoma. PMID:20143466

  16. Surgical repair of isolated triceps tendon rupture using a suture anchor technique: a case report

    PubMed Central

    MANCINI, FEDERICO; BERNARDI, GABRIELE; DE LUNA, VINCENZO; TUDISCO, COSIMO

    2016-01-01

    Rupture or avulsion of the distal triceps tendon is one of the least common tendon injuries. The most common clinical presentation of the injury is avulsion from the olecranon. The diagnosis of acute triceps tendon rupture may be missed and this can result in prolonged disability. We report the case of a 42-year-old man with isolated triceps rupture treated by an open surgical repair technique involving the use of bone suture anchors. PMID:28217662

  17. A Minimally Disruptive Surgical Technique for the Treatment of Osteitis Pubis in Athletes

    PubMed Central

    Hechtman, Keith S.; Zvijac, John E.; Popkin, Charles A.; Zych, Gregory A.; Botto-van Bemden, Angie

    2010-01-01

    Background: Multiple surgical procedures exist for the treatment of osteitis pubis: curettage of the symphysis joint, wedge resection, complete resection of the joint, placement of extraperitoneal retropubic synthetic mesh, and arthrodesis of the joint. However, a paucity of literature has reported long-term successful outcomes with the aforementioned approaches. Patients treated operatively have reported recalcitrant pain resulting from iatrogenic instability. The article presents the results of a conservative operative technique that avoids disruption of adjacent ligaments. Hypothesis: Preserving the adjacent ligamentous structures will allow competitive athletes to return to competition and activities of daily living free of iatrogenic pelvic instability and pain. Study Design: Case series. Methods: Four competitive athletes (2 professional and 2 collegiate football players) diagnosed with osteitis pubis were treated conservatively for a minimum of 6 months. Patients underwent surgical intervention upon failure to respond to nonoperative management. The degenerative tissue was resected, allowing only bleeding cancellous bone to remain while preserving the adjacent ligaments. An arthroscope was used to assist in curettage, allowing the debridement to be performed through a small incision in the anterior capsule. Results: The symptoms of all 4 patients resolved, and they returned to competitive athletics. This ligament-sparing technique provided a solid, stable repair and pain relief. Conclusion: This surgical technique preserves the adjacent ligamentous structures and allows competitive athletes to return to competition and activities of daily living free of pain and void of pelvic instability. Clinical Relevance: This technique is a surgical treatment option for athletes with osteitis pubis who fail conservative treatment. PMID:23015940

  18. Innovative Tools Advance Revolutionary Weld Technique

    NASA Technical Reports Server (NTRS)

    2009-01-01

    The iconic, orange external tank of the space shuttle launch system not only contains the fuel used by the shuttle s main engines during liftoff but also comprises the shuttle s backbone, supporting the space shuttle orbiter and solid rocket boosters. Given the tank s structural importance and the extreme forces (7.8 million pounds of thrust load) and temperatures it encounters during launch, the welds used to construct the tank must be highly reliable. Variable polarity plasma arc welding, developed for manufacturing the external tank and later employed for building the International Space Station, was until 1994 the best process for joining the aluminum alloys used during construction. That year, Marshall Space Flight Center engineers began experimenting with a relatively new welding technique called friction stir welding (FSW), developed in 1991 by The Welding Institute, of Cambridge, England. FSW differs from traditional fusion welding in that it is a solid-state welding technique, using frictional heat and motion to join structural components without actually melting any of the material. The weld is created by a shouldered pin tool that is plunged into the seam of the materials to be joined. The tool traverses the line while rotating at high speeds, generating friction that heats and softens but does not melt the metal. (The heat produced approaches about 80 percent of the metal s melting temperature.) The pin tool s rotation crushes and stirs the plasticized metal, extruding it along the seam as the tool moves forward. The material cools and consolidates, resulting in a weld with superior mechanical properties as compared to those weld properties of fusion welds. The innovative FSW technology promises a number of attractive benefits. Because the welded materials are not melted, many of the undesirables associated with fusion welding porosity, cracking, shrinkage, and distortion of the weld are minimized or avoided. The process is more energy efficient, safe

  19. Oncoplastic breast conserving surgery: a renaissance of anatomically-based surgical technique.

    PubMed

    Chen, C Y; Calhoun, K E; Masetti, R; Anderson, B O

    2006-10-01

    Using oncoplastic surgical techniques for breast preservation, breast surgeons can achieve widened surgical margins at the same time that the shape and appearance of the breast is preserved and sometimes rejuvenated. Oncoplastic surgical resection is designed to follow the cancer's contour, which generally follows the segmental anatomy of the breast, which has been well understood since the mid 19th century because of pioneering anatomic studies performed by Sir Astley Paston Cooper. The quadrantectomy, developed by Veronesi and colleagues in the 1970's, follows these same anatomic principles of wide segmental resection. The more surgically narrow lumpectomy as popularized in the U.S. uses a smaller, scoop-like non-anatomic resection of cancer. With negative surgical margins, the lumpectomy is equivalent to the quadrantectomy in achieving the goals of breast conservation as measured by local recurrence and survival. However, the lumpectomy is less versatile for resection of larger cancers, and can be more prone to creating suboptimal cosmetic defects. Cancers with large in situ components can be particularly problematic for resection with the standard lumpectomy, when they extend both centrally toward the nipple and peripherally to distal terminal ductulo-lobular units, which typically occur in a pie-shaped segmental distribution. Ductal segments, each of which ultimately drains to a single major lactiferous sinus at the nipple, vary in size and depth in the breast. Breast surgeons should carefully evaluate the cancer distribution and extent in the breast before operation. A combination of imaging methods (mammography with magnification views, ultrasonography, magnetic resonance imaging [MRI], or all) may yield the best estimates of overall tumor extent. Multiple bracketing wires afford the greater help to complete surgical excision. Those tumors with segmental spreading are best excised by oncoplastic resections according to their distribution.

  20. A surgical glove port technique for laparoscopic-assisted ovariohysterectomy for pyometra in the bitch.

    PubMed

    Becher-Deichsel, Anja; Aurich, Jörg E; Schrammel, Nadine; Dupré, Gilles

    2016-07-15

    The objective of the study was to describe the feasibility of a glove port technique for laparoscopic-assisted surgical treatment of canine pyometra. In this retrospective case series, a total of 10 female dogs (median age 7 years, range 5.5-10.5 years; median weight 37.0 kg, range 12.9-64.0 kg) with pyometra were included. A multiaccess port was created from a surgical glove attached to an Alexis wound retractor and placed in the ventral midline between the middle and caudal third of the distance between umbilicus and pubic rim. A vessel sealing device was used for transection of the ovarian pedicle. The port size was selected on the basis of maximum uterine diameter determined by ultrasound. Median incision length was 5.0 cm (range 3.1-7.7 cm) for a maximum uterine diameter of 4.0 cm (range 2.0-7.0 cm). Median surgical time was 57 minutes (range 48-65 minutes). No case had to be converted to open celiotomy. Complications included one case of minor, self-limiting splenic trauma by the endoscope. In eight dogs, the distended uterine horns endangered safe access to the ovarian pedicle, and the vessel sealing device was inserted through a second cannula placed periumbilically. Extension of the original incision was necessary to exteriorize organs in two dogs. All dogs recovered quickly and were discharged either on the day of surgery or 1 day thereafter. In conclusion, a surgical glove port technique in combination with an Alexis wound retractor is feasible for surgical laparoscopic treatment of canine pyometra up to a diameter of 7 cm.

  1. SEVERE VALGUS DEFORMITY OF THE KNEE: DESCRIPTION OF NEW SURGICAL TECHNIQUE FOR ITS CORRECTION

    PubMed Central

    da Silva, Robson Rocha; Matos, Marcos Almeida; Pimentel, Maurício; Martins, Bruno Jacomeli; Oliveira, Rafael Valadares

    2015-01-01

    Varus supracondylar osteotomy of the femur is the established procedure for treating painful knees that present lateral arthrosis and valgus deformity. In descriptions of the conventional surgical techniques, there are divergences regarding the location, access route, correction level, fixation type and area for synthesis insertion. This is most evident in cases of severe valgus with angles greater than 30° and distal femoral deformation, in association with hypoplasia of the lateral condyle. The authors describe a new surgical technique for distal femoral osteotomy, based on anatomical and geometrical criteria, which was developed in their clinic for treating severe valgus cases, and they present one of the cases treated. In the new technique, the wedge to be surgically resected has an oblique direction and the format of an isosceles triangle. This new proposal thus seeks to resolve problems that have been presented in such cases, through enabling valgus correction without causing any new deformity of the distal femur. Good cortical bone contact is promoted, and application of a stable synthesis system is made easier. However, the age limits for such patients and the degree of knee arthrosis that might contraindicate this procedure remain unknown. Hence, a larger sample and longer follow-up for operated cases are required. PMID:27042630

  2. Primary cerebral echinoccocosis in a child: Case report – Surgical technique, technical pitfalls, and video atlas

    PubMed Central

    Altibi, Ahmed M. A.; Qarajeh, Raed A. H.; Belsuzarri, Telmo A. B.; Maani, Walid; Kanaan, Tareq M. A.

    2016-01-01

    Background: Hydatid disease is a life-threatening parasitic infestation caused by Echinococcus granulosus. Infection with E. granulosus typically results in the formation of hydatid cysts in the liver, lungs, kidney, and spleen. Primary intracranial hydatid cyst disease is extremely rare. Here, we are reporting an unusual case of Echinococcus, where the only identifiable lesion was a hydatid cyst in the brain without liver or lung involvement. We are also providing a description for the surgical technique used to remove the cyst, highlighting the possible surgical pitfalls. Case Description: The patient is a 13-year-old male with a history of progressive headache for 1 month. Intracranial hydatid cyst was suspected based on computed tomography and magnetic resonance imaging findings. The cyst was delivered without rupture using hydrostatic dissection (Dowling's technique), and pathological analysis confirmed the diagnosis. Postoperatively, the patient showed marked neurological improvement and all signs and symptoms resolved. Conclusion: Intracranial hydatid cyst is very rare. Nevertheless, it should always be considered as a differential diagnosis in cerebral cystic lesions, especially in children. The surgical technique used to remove the cyst appears to be safe. However, several precautions must be applied intraoperatively to avoid the catastrophe of cyst rupture. PMID:27999716

  3. "The Superficial Quad Technique" for Medial Patellofemoral Ligament Reconstruction: The Surgical Video Technique.

    PubMed

    Goyal, Deepak

    2015-10-01

    With the introduction of the superficial quad technique, there has been a recent revival of interest in the quadriceps tendon as a graft choice for medial patellofemoral ligament (MPFL) reconstruction. The superficial quad technique has many anatomic advantages because the length, breadth, and thickness of the graft are similar to those of the native MPFL; moreover, the graft provides a continuous patellar attachment at the superior half of the medial border of the patella. The technique requires neither a patellar bony procedure nor patellar hardware. Biomechanically, the mean strength and stiffness of the graft are very similar to those of the native MPFL. The anatomic and biomechanical advantages depend on correct identification of the anatomic superficial lamina of the quadriceps tendon; hence the correct harvesting technique for the superficial lamina is crucial. Various sub-techniques for harvesting the quadriceps graft have emerged recently, such as superficial strip, pedicled, or partial graft harvesting; these can create confusion for surgeons. Additional confusion related to the preparation and fixation of the graft should also be addressed to avoid any potential complications. A step-by-step video of the superficial quad technique is presented, covering the exact dissection of the graft material and its preparation, delivery, and fixation.

  4. "TuNa-saving" endoscopic medial maxillectomy: a surgical technique for maxillary inverted papilloma.

    PubMed

    Pagella, Fabio; Pusateri, Alessandro; Matti, Elina; Avato, Irene; Zaccari, Dario; Emanuelli, Enzo; Volo, Tiziana; Cazzador, Diego; Citraro, Leonardo; Ricci, Giampiero; Tomacelli, Giovanni Leo

    2017-04-03

    The maxillary sinus is the most common site of sinonasal inverted papilloma. Endoscopic sinus surgery, in particular endoscopic medial maxillectomy, is currently the gold standard for treatment of maxillary sinus papilloma. Although a common technique, complications such as stenosis of the lacrimal pathway and consequent development of epiphora are still possible. To avoid these problems, we propose a modification of this surgical technique that preserves the head of the inferior turbinate and the nasolacrimal duct. A retrospective analysis was performed on patients treated for maxillary inverted papilloma in three tertiary medical centres between 2006 and 2014. Pedicle-oriented endoscopic surgery principles were applied and, in select cases where the tumour pedicle was located on the anterior wall, a modified endoscopic medial maxillectomy was carried out as described in this paper. From 2006 to 2014 a total of 84 patients were treated. A standard endoscopic medial maxillectomy was performed in 55 patients (65.4%), while the remaining 29 (34.6%) had a modified technique performed. Three recurrences (3/84; 3.6%) were observed after a minimum follow-up of 24 months. A new surgical approach for select cases of maxillary sinus inverted papilloma is proposed in this paper. In this technique, the endoscopic medial maxillectomy was performed while preserving the head of the inferior turbinate and the nasolacrimal duct ("TuNa-saving"). This technique allowed for good visualization of the maxillary sinus, good oncological control and a reduction in the rate of complications.

  5. Advances in gamma titanium aluminides and their manufacturing techniques

    NASA Astrophysics Data System (ADS)

    Kothari, Kunal; Radhakrishnan, Ramachandran; Wereley, Norman M.

    2012-11-01

    Gamma titanium aluminides display attractive properties for high temperature applications. For over a decade in the 1990s, the attractive properties of titanium aluminides were outweighed by difficulties encountered in processing and machining at room temperature. But advances in manufacturing technologies, deeper understanding of titanium aluminides microstructure, deformation mechanisms, and advances in micro-alloying, has led to the production of gamma titanium aluminide sheets. An in-depth review of key advances in gamma titanium aluminides is presented, including microstructure, deformation mechanisms, and alloy development. Traditional manufacturing techniques such as ingot metallurgy and investment casting are reviewed and advances via powder metallurgy based manufacturing techniques are discussed. Finally, manufacturing challenges facing gamma titanium aluminides, as well as avenues to overcome them, are discussed.

  6. 75 FR 44015 - Certain Semiconductor Products Made by Advanced Lithography Techniques and Products Containing...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-27

    ... COMMISSION Certain Semiconductor Products Made by Advanced Lithography Techniques and Products Containing... importation of certain semiconductor products made by advanced lithography techniques and products containing... certain semiconductor products made by advanced lithography techniques or products containing same...

  7. Surgical techniques for the treatment of ankyloglossia in children: a case series.

    PubMed

    Junqueira, Marina Azevedo; Cunha, Nayara Nery Oliveira; Costa e Silva, Lidiane Lucas; Araújo, Leandro Borges; Moretti, Ana Beatriz Silveira; Couto Filho, Carlos Eduardo Gomes; Sakai, Vivien Thiemy

    2014-06-01

    This paper reports a series of clinical cases of ankyloglossia in children, which were approached by different techniques: frenotomy and frenectomy with the use of one hemostat, two hemostats, a groove director or laser. Information on the indications, contraindications, advantages and disadvantages of the techniques was also presented. Children diagnosed with ankyloglossia were subjected to different surgical procedures. The choice of the techniques was based on the age of the patient, length of the frenulum and availability of the instruments and equipment. All the techniques presented are successful for the treatment of ankyloglossia and require a skilled professional. Laser may be considered a simple and safe alternative for children while reducing the amount of local anesthetics needed, the bleeding and the chances of infection, swelling and discomfort.

  8. Surgical techniques for the treatment of ankyloglossia in children: a case series

    PubMed Central

    JUNQUEIRA, Marina Azevedo; CUNHA, Nayara Nery Oliveira; SILVA, Lidiane Lucas Costa e; ARAÚJO, Leandro Borges; MORETTI, Ana Beatriz Silveira; COUTO FILHO, Carlos Eduardo Gomes; SAKAI, Vivien Thiemy

    2014-01-01

    This paper reports a series of clinical cases of ankyloglossia in children, which were approached by different techniques: frenotomy and frenectomy with the use of one hemostat, two hemostats, a groove director or laser. Information on the indications, contraindications, advantages and disadvantages of the techniques was also presented. Children diagnosed with ankyloglossia were subjected to different surgical procedures. The choice of the techniques was based on the age of the patient, length of the frenulum and availability of the instruments and equipment. All the techniques presented are successful for the treatment of ankyloglossia and require a skilled professional. Laser may be considered a simple and safe alternative for children while reducing the amount of local anesthetics needed, the bleeding and the chances of infection, swelling and discomfort. PMID:25025566

  9. Advanced liner-cooling techniques for gas turbine combustors

    NASA Technical Reports Server (NTRS)

    Norgren, C. T.; Riddlebaugh, S. M.

    1985-01-01

    Component research for advanced small gas turbine engines is currently underway at the NASA Lewis Research Center. As part of this program, a basic reverse-flow combustor geometry was being maintained while different advanced liner wall cooling techniques were investigated. Performance and liner cooling effectiveness of the experimental combustor configuration featuring counter-flow film-cooled panels is presented and compared with two previously reported combustors featuring: splash film-cooled liner walls; and transpiration cooled liner walls (Lamilloy).

  10. The many faces of ALPPS: surgical indications and techniques among surgeons collaborating in the international registry

    PubMed Central

    Buac, Suzana; Schadde, Erik; Schnitzbauer, Andreas A.; Vogt, Kelly; Hernandez-Alejandro, Roberto

    2016-01-01

    Background ALPPS was developed to induce accelerated future liver remnant (FLR) hypertrophy in order to increase hepatic tumour resectability and reduce the risk of post-operative liver failure. While early studies demonstrated concerning complication rates, others reported favourable results. This inconsistency may be due to variability in surgical indications and technique. Methods A web-based survey was sent to surgeons participating in the International ALPPS Registry in September of 2014. Questions addressed surgeon demographics and training, surgical indications and technique, and clinical management approaches. Results Fifty six out of 85 surgeons from 78 centers responded (66%) and half (n = 30) had training in liver transplantation. Forty seven (84%) did not reserve ALPPS solely for colorectal liver metastases (CRLM) and 30 (54%) would perform ALPPS for an FLR over 30%. Neoadjuvant chemotherapy for CRLM was recommended by 37 (66%) respondents. Surgical approaches varied considerably, with 30% not preserving outflow to the middle hepatic vein and 39% believing it necessary to skeletonize the hepatoduodenal ligament. Twenty five (45%) surgeons have observed segment 4 necrosis. Conclusion There is considerable variability in how ALPPS is performed internationally. This heterogeneity in practice patterns may explain the current incongruity in published outcomes, and highlights the need for standardization. PMID:27154808

  11. A new technique for feeding dogs with a congenital cleft palate for surgical research.

    PubMed

    Martínez-Sanz, Elena; Casado-Gómez, Inmaculada; Martín, Concepción; López-Gordillo, Yamila; González, Pablo; Rodríguez-Bobada, Cruz; Paradas, Irene; González-Meli, Beatriz; Maldonado, Estela; Maestro, Carmen; Prados, Juan Carlos; Martínez-Álvarez, Concepción

    2011-04-01

    In humans, cleft palate (CP) is one of the most common malformations. Although surgeons use palatoplasty to close CP defects in children, its consequences for subsequent facial growth have prompted investigations into other novel surgical alternatives. The animal models of CP used to evaluate new surgical treatments are frequently obtained by creating surgically induced clefts in adult dogs. This procedure has been ethically criticized due to its severity and questionable value as an animal model for human CP. Dogs born with a congenital CP would be much better for this purpose, provided they developed CP at a sufficient rate and could be fed. Up until now, feeding these pups carried the risk of aspiration pneumonia, while impeding normal suckling and chewing, and thus compromising orofacial growth. We developed a technique for feeding dog pups with CP from birth to the time of surgery using two old Spanish pointer dog pups bearing a complete CP. This dog strain develops CP in 15-20% of the offspring spontaneously. Custom-made feeding teats and palatal prostheses adapted to the pups' palates were made from thermoplastic plates. This feeding technique allowed lactation, eating and drinking in the pups with CP, with only sporadic rhinitis. To determine whether the use of this palatal prosthesis interferes with palatal growth, the palates of three littermate German shorthaired pointer pups without CP, either wearing or not wearing (controls) the prosthesis, were measured. The results showed that the permanent use of this prosthesis does not impede palatal growth in the pups.

  12. Robotic Surgery in Women With Ovarian Cancer: Surgical Technique and Evidence of Clinical Outcomes.

    PubMed

    Minig, Lucas; Padilla Iserte, Pablo; Zorrero, Cristina; Zanagnolo, Vanna

    2016-01-01

    Robotic surgery is a new technology that has been progressively implemented to treat endometrial and cervical cancer. However, the use of robotic surgery for ovarian cancer is limited to a few series of cases and comparative studies with laparoscopy or laparotomy. The technical issues concerning robotic surgery, as well as clinical evidence, are described in this review. Robotic surgery in early stage, advanced stage, and relapsed ovarian cancer is discussed separately. In conclusion, evidence regarding the use of robotic-assisted surgical treatment for women with ovarian cancer is still scarce, but its use is progressively growing. Robotic-assisted staging in selected patients with early stage disease has an important role in referral institutions when well-trained gynecologists perform surgeries. However, minimally invasive surgery in patients with advanced stage or relapsed ovarian cancer requires further investigation, even in selected cases.

  13. Management of surgical splenorenal shunt-related hepatic myelopathy with endovascular interventional techniques.

    PubMed

    Wang, Mao-Qiang; Liu, Feng-Yong; Duan, Feng

    2012-12-21

    We present a case with hepatic myelopathy (HM) due to a surgical splenorenal shunt that was successfully treated by endovascular interventional techniques. A 39-year-old man presented with progressive spastic paraparesis of his lower limbs 14 mo after a splenorenal shunt. A portal venogram identified a widened patent splenorenal shunt. We used an occlusion balloon catheter initially to occlude the shunt. Further monitoring of the patient revealed a decrease in his serum ammonia level and an improvement in leg strength. We then used an Amplatzer vascular plug (AVP) to enable closure of the shunt. During the follow up period of 7 mo, the patient experienced significant clinical improvement and normalization of blood ammonia, without any complications. Occlusion of a surgically created splenorenal shunt with AVP represents an alternative therapy to surgery or coil embolization that can help to relieve shunt-induced HM symptoms.

  14. Computer-assisted surgical techniques evaluated with wound-healing-impaired animal model

    NASA Astrophysics Data System (ADS)

    Reinisch, Lou; West, Courtney; Rivas, Mike; Patil, Yash; Ossoff, Robert H.

    1996-04-01

    As part of our computer assisted surgical techniques (CAST) program, we use computers to assist in the guidance of surgical lasers. The computer helps to create laser incisions with minimal widths, a reduction of collateral thermal damage, and regulates the rate of tissue ablation. Previous studies have compared laser incisions under manual control to incisions made with the CAST system. These studies were carried out with healthy animals. In this study, we compare the manual and CAST laser incisions on rats with induced diabetes. The diabetic rats have impaired wound healing and make a better model for our wound healing studies. Cutaneous incisions were made on the dorsal pelt using a carbon dioxide laser. The incisions were sutured and allowed to heal for 3, 7, 14, and 21 days. Wounds were analyzed histologically and with tensiometry. We have found definite advantages to the CAST program.

  15. Minimally invasive selective osteotomy of the knee: A new surgical technique.

    PubMed

    Leon, H O; Blanco, C E; Guthrie, T B

    2001-05-01

    We present a simple surgical technique created by the authors to address degenerative chondral lesions of the knee and its application in a limited prospective case series. The technique assumes the concept of beneficial epiphyseal changes caused by disruption of the subchondral bone in improving symptoms, as with drilling, microfracture, periarticular osteotomy, and other invasive procedures. Minimally invasive selective osteotomy (MISO) is an expansion of the arthroscopic treatment of the knee, specifically targeting symptomatic lesions with minimal additional trauma and cost, while avoiding disruption of the articular surface of the subchondral bone. The technique involves a mimimal access approach with selective saw cuts placed with a 1-cm oscillating blade parallel to the joint surface 1 to 1.5 cm deep to identified lesions. The technique does not address malalignment but can address lesions not addressed by classic osteotomies and, as such, may be combined with other corrective alignment procedures as necessary. We present the results of MISO of the knee in a case series of 62 outpatients carried out at the Orthopaedic Division of the Clinical and Surgical Hermanos Ameijeiras Hospital in Havana, Cuba. At 2-year follow-up, there was improvement of symptoms without significant complications.

  16. Surgical technique in cadaveric donors for partial hand allotransplant in patients with rheumatoid arthritis.

    PubMed

    Iglesias, M; Butrón, P; Santander-Flores, S; Ricaño-Enciso, D; Negrete-Najar, J P; Pérez-Monzó, M F; González-Chávez, A; González-Chávez, M; de Rienzo-Madero, B; Hamdan-Pérez, N

    2010-01-01

    For patients with severe hand deformities due to rheumatoid arthritis, we propose an allotransplantation of an osteomyotendinose structure (OMTS), preserving the recipient's skin and sensory nerves. Our objective was to develop the surgical technique in a 10 cadavers, five as donors and five as recipients. The donor's hand was 10% to 15% smaller than the recipient's. Dissections were performed by two surgical teams under magnification. In the donor, the OMTS was procured at the distal third of the forearm, maintaining the integrity of the arterial system, with its concomitant veins and motor branches of the median and ulnar nerves, leaving the skin envelope. In the recipient, the OMTS was removed, taking care to preserve the cutaneous cover with the digital arteries in continuity with the superficial palmar arch and radial and ulnar arteries. Also, the digital nerves were maintained in the skin flap, in continuity with the median and ulnar nerves. Their motor branches were divided after emergence from the main nerves. The superficial dorsal veins and radial nerve were kept adhered to the cutaneous cover. Then, the donor OMTS was placed within the recipient cutaneous flap; all the anatomic structures were repaired. The average surgical time was 780 minutes. Methylene blue was present in the digital arteries. There were no difficulties in the anatomic repair. The surgical technique is quite laborious, especially the dissection of the recipient interdigital spaces. Due to the requirement for arterial system integrity, the cutaneous flap must be viable. Also, the allotransplanted OMTS has all necessary conditions to obtain good tissue perfusion for subsequent function. Procurement without skin permits a greater opportunity to find donors, and greater social and personal acceptance by the recipient.

  17. [Surgical reconstruction of maxillary defects using a computer-assisted techniques].

    PubMed

    Zhang, W B; Yu, Y; Wang, Y; Liu, X J; Mao, C; Guo, C B; Yu, G Y; Peng, X

    2017-02-18

    The maxilla is the most important bony support of the mid-face skeleton and is critical for both esthetics and function. Maxillary defects, resulting from tumor resection, can cause severe functional and cosmetic deformities. Furthermore, maxillary reconstruction presents a great challenge for oral and maxillofacial surgeons. Nowadays, vascularized composite bone flap transfer has been widely used for functional maxillary reconstruction. In the last decade, we have performed a comprehensive research on functional maxillary reconstruction with free fibula flap and reported excellent functional and acceptable esthetic results. However, this experience based clinical procedure still remainssome problems in accuracy and efficiency. In recent years, computer assisted techniques are now widely used in oral and maxillofacial surgery. We have performed a series of study on maxillary reconstruction with computer assisted techniques. The computer assisted techniques used for maxillary reconstruction mainly include: (1) Three dimensional (3D) reconstruction and tumor mapping: providing a 3D view of maxillary tumor and adjacent structures and helping to make the diagnosis of maxillary tumor accurate and objective; (2) Virtual planning: simulating tumor resection and maxillectomy as well as fibula reconstruction on the computer, so that to make an ideal surgical plan; (3) 3D printing: producing a 3D stereo model for prebending individualized titanium mesh and also providing template or cutting guide for the surgery; (4) Surgical navigation: the bridge between virtual plan and real surgery, confirming the virtual plan during the surgery and guarantee the accuracy; (5) Computer assisted analyzing and evaluating: making a quantitative and objective of the final result and evaluating the outcome. We also performed a series of studies to evaluate the application of computer assisted techniques used for maxillary reconstruction, including: (1) 3D tumor mapping technique for accurate

  18. A Challenging Surgical Approach to Locally Advanced Primary Urethral Carcinoma: A Case Report and Literature Review.

    PubMed

    Lucarelli, Giuseppe; Spilotros, Marco; Vavallo, Antonio; Palazzo, Silvano; Miacola, Carlos; Forte, Saverio; Matera, Matteo; Campagna, Marcello; Colamonico, Ottavio; Schiralli, Francesco; Sebastiani, Francesco; Di Cosmo, Federica; Bettocchi, Carlo; Di Lorenzo, Giuseppe; Buonerba, Carlo; Vincenti, Leonardo; Ludovico, Giuseppe; Ditonno, Pasquale; Battaglia, Michele

    2016-05-01

    Primary urethral carcinoma (PUC) is a rare and aggressive cancer, often underdetected and consequently unsatisfactorily treated. We report a case of advanced PUC, surgically treated with combined approaches.A 47-year-old man underwent transurethral resection of a urethral lesion with histological evidence of a poorly differentiated squamous cancer of the bulbomembranous urethra. Computed tomography (CT) and bone scans excluded metastatic spread of the disease but showed involvement of both corpora cavernosa (cT3N0M0). A radical surgical approach was advised, but the patient refused this and opted for chemotherapy. After 17 months the patient was referred to our department due to the evidence of a fistula in the scrotal area. CT scan showed bilateral metastatic disease in the inguinal, external iliac, and obturator lymph nodes as well as the involvement of both corpora cavernosa. Additionally, a fistula originating from the right corpus cavernosum extended to the scrotal skin. At this stage, the patient accepted the surgical treatment, consisting of different phases. Phase I: Radical extraperitoneal cystoprostatectomy with iliac-obturator lymph nodes dissection. Phase II: Creation of a urinary diversion through a Bricker ileal conduit. Phase III: Repositioning of the patient in lithotomic position for an overturned Y skin incision, total penectomy, fistula excision, and "en bloc" removal of surgical specimens including the bladder, through the perineal breach. Phase IV: Right inguinal lymphadenectomy.The procedure lasted 9-and-a-half hours, was complication-free, and intraoperative blood loss was 600 mL. The patient was discharged 8 days after surgery. Pathological examination documented a T4N2M0 tumor. The clinical situation was stable during the first 3 months postoperatively but then metastatic spread occurred, not responsive to adjuvant chemotherapy, which led to the patient's death 6 months after surgery.Patients with advanced stage tumors of the

  19. A Novel Surgical Pre-suturing Technique for the Management of Ankyloglossia.

    PubMed

    Khairnar, Mayur; Pawar, Babita; Khairnar, Darshana

    2014-01-01

    Ankyloglossia or "tongue-tie" is a congenital anomaly caused by tight lingual frenulum that abnormally connects the tongue base to the floor of the mouth. Ankyloglossia can results in difficulty during speech and deglutition. This case series presents a novel surgical technique in the management of ankyloglossia in using presuturing technique in which different sets of sutures are given on lingual frenum before severing it. This results in reduced opening of the wound, minimal bleeding, pain and discomfort. Two male patients with severe ankyloglossia had been managed with this technique and after 2 years of follow-up of these cases showed satisfactory protrusive and lateral movement of the tongue with minimal scarring and discomfort.

  20. A Novel Surgical Pre-suturing Technique for the Management of Ankyloglossia

    PubMed Central

    Khairnar, Mayur; Pawar, Babita; Khairnar, Darshana

    2014-01-01

    Ankyloglossia or “tongue-tie” is a congenital anomaly caused by tight lingual frenulum that abnormally connects the tongue base to the floor of the mouth. Ankyloglossia can results in difficulty during speech and deglutition. This case series presents a novel surgical technique in the management of ankyloglossia in using presuturing technique in which different sets of sutures are given on lingual frenum before severing it. This results in reduced opening of the wound, minimal bleeding, pain and discomfort. Two male patients with severe ankyloglossia had been managed with this technique and after 2 years of follow-up of these cases showed satisfactory protrusive and lateral movement of the tongue with minimal scarring and discomfort. PMID:25598942

  1. Wafer hot spot identification through advanced photomask characterization techniques

    NASA Astrophysics Data System (ADS)

    Choi, Yohan; Green, Michael; McMurran, Jeff; Ham, Young; Lin, Howard; Lan, Andy; Yang, Richer; Lung, Mike

    2016-10-01

    As device manufacturers progress through advanced technology nodes, limitations in standard 1-dimensional (1D) mask Critical Dimension (CD) metrics are becoming apparent. Historically, 1D metrics such as Mean to Target (MTT) and CD Uniformity (CDU) have been adequate for end users to evaluate and predict the mask impact on the wafer process. However, the wafer lithographer's process margin is shrinking at advanced nodes to a point that the classical mask CD metrics are no longer adequate to gauge the mask contribution to wafer process error. For example, wafer CDU error at advanced nodes is impacted by mask factors such as 3-dimensional (3D) effects and mask pattern fidelity on subresolution assist features (SRAFs) used in Optical Proximity Correction (OPC) models of ever-increasing complexity. These items are not quantifiable with the 1D metrology techniques of today. Likewise, the mask maker needs advanced characterization methods in order to optimize the mask process to meet the wafer lithographer's needs. These advanced characterization metrics are what is needed to harmonize mask and wafer processes for enhanced wafer hot spot analysis. In this paper, we study advanced mask pattern characterization techniques and their correlation with modeled wafer performance.

  2. Surgical approach to right colon cancer: From open technique to robot. State of art.

    PubMed

    Fabozzi, Massimiliano; Cirillo, Pia; Corcione, Francesco

    2016-08-27

    This work is a topic highlight on the surgical treatment of the right colon pathologies, focusing on the literature state of art and comparing the open surgery to the different laparoscopic and robotic procedures. Different laparoscopic procedures have been described for the treatment of right colon tumors: Totally laparoscopic right colectomy, laparoscopic assisted right colectomy, laparoscopic facilitated right colectomy, hand-assisted right colectomy, single incision laparoscopic surgery colectomy, robotic right colectomy. Two main characteristics of these techniques are the different type of anastomosis: Intracorporeal (for totally laparoscopic right colectomy, single incision laparoscopic surgery colectomy, laparoscopic assisted right colectomy and robotic technique) or extracorporeal (for laparoscopic assisted right colectomy, laparoscopic facilitated right colectomy, hand-assisted right colectomy and open right colectomy) and the different incision (suprapubic, median or transverse on the right side of abdomen). The different laparoscopic techniques meet the same oncological criteria of radicalism as the open surgery for the right colon. The totally laparoscopic right colectomy with intracorporeal anastomosis and even more the single incision laparoscopic surgery colectomy, remain a technical challenge due to the complexity of procedures (especially for the single incision laparoscopic surgery colectomy) and the particular right colon vascular anatomy but they seem to have some theoretical advantages compared to the other laparoscopic and open procedures. Data reported in literature while confirming the advantages of laparoscopic approach, do not allow to solve controversies about which is the best laparoscopic technique (Intracorporeal vs Extracorporeal Anastomosis) to treat the right colon cancer. However, the laparoscopic techniques with intracorporeal anastomosis for the right colon seem to show some theoretical advantages (functional, technical

  3. The impact of surgical technique on neck dissection nodal yield: making a difference.

    PubMed

    Lörincz, Balazs B; Langwieder, Felix; Möckelmann, Nikolaus; Sehner, Susanne; Knecht, Rainald

    2016-05-01

    The nodal yield of neck dissections is an independent prognostic factor in several types of head and neck cancer. The authors aimed to determine whether the applied dissection technique has a significant impact on nodal yield. This is a single-institution, prospective study with internal control group (level of evidence: 2A). Data of 150 patients undergoing 223 neck dissections between February 2011 and March 2013 have been collected in a comprehensive cancer centre. Eighty-two patients underwent neck dissection with unwrapping the cervical fascia from lateral to medial, while 68 patients were operated without specifically unwrapping the fascia, in a caudal to cranial fashion. The standardised, horizontal neck dissection technique along the fascial planes resulted in a significantly higher nodal count in Levels I, II, III and IV, as well as in terms of overall nodal yield (mean: n = 22.53) than that of the vertical dissection applied in the control group (mean: n = 15.00). This is the first publication showing a direct correlation between neck dissection nodal yield and surgical technique. Therefore, it is paramount to optimise the applied surgical concept to maximise the oncological benefit.

  4. Testing of a new prototype surgical stapler that automates the rollover sleeve technique for venous anastomoses.

    PubMed

    Carroll, Patricia B; Defaria, Werviston; Gandia, Carlos; Berho, Mariana; Misiakos, Evangelos; Tzakis, Andreas G

    2006-01-01

    The creation of successful vascular anastomoses is of primary importance in many surgical fields. Numerous attempts to automate this process have been made. These techniques have slowly gained acceptance, but their use is still limited. This report details feasibility testing of a new prototype stapler that automates the rollover sleeve technique for venous vascular anastomoses. Male and female mongrel dogs (n=7) (25-32 kg) were used. A segment of the right (n=5) or left (n=2) iliac vein was harvested for interposition grafts after the contra lateral side was transected. In each dog, two end-to-end venous anastomoses at the interposition grafts were performed. The standard anastomosis employed continuous mattress sutures. The experimental anastomosis was performed with a new prototype surgical stapler. The stapled anastomosis was proximal and the sutured was distal. In all experiments, it was possible to perform the experimental anastomosis with the stapler. Complications included two small leaks, one due to misfiring of a single pin in one experimental site. These leaks required suture reinforcement. One dog died of hemorrhage due to a slipped suture at the vein harvest site. One vein had thrombus seen at the sutured site although no technical abnormalities at either of the anastomoses could be found. After two weeks, grafts were inspected grossly and histologically. Healing appeared normal. There was a trend for less inflammatory cells infiltrating stapled sites; however, this was not statistically significant. The experiments demonstrate that this device can automate the rollover sleeve technique for venous anastomoses.

  5. Bringing The Web Down to Size: Advanced Search Techniques.

    ERIC Educational Resources Information Center

    Huber, Joe; Miley, Donna

    1997-01-01

    Examines advanced Internet search techniques, focusing on six search engines. Includes a chart comparison of nine search features: "include two words,""exclude one of two words,""exclude mature audience content,""two adjacent words,""exact match,""contains first and neither of two following…

  6. Advanced Marketing Core Curriculum. Test Items and Assessment Techniques.

    ERIC Educational Resources Information Center

    Smith, Clifton L.; And Others

    This document contains duties and tasks, multiple-choice test items, and other assessment techniques for Missouri's advanced marketing core curriculum. The core curriculum begins with a list of 13 suggested textbook resources. Next, nine duties with their associated tasks are given. Under each task appears one or more citations to appropriate…

  7. Image guidance could aid performance of atraumatic cochlear implantation surgical techniques

    NASA Astrophysics Data System (ADS)

    Noble, Jack H.; Labadie, Robert F.; Wanna, George B.; Dawant, Benoit M.

    2013-03-01

    It is widely believed that major factors in achieving atraumatic insertion of the electrode array into the cochlea in cochlear implant (CI) surgery include amount of tissue resection, selection of the entry point, and angle of insertion. Our group is interested in developing an image guidance (IG) system for electrode insertion if IG can improve outcomes. Thus, in this work we conducted the first study evaluating whether IG could aid atraumatic electrode insertion. To do this, we measured the performance of experienced surgeons when tasked to perform cochleostomy resection and to select CI insertion trajectories in virtual 3D surgical field-of-view simulation software. This software, which simulates views through the surgical microscope, was designed to allow a user to manually perform cochleostomy resection and to select a preferred insertion trajectory in one of two modes: (a) where the traditional approach is simulated and sub-surface anatomy is not visible; and (b) where an IG approach is simulated and the surgical view is augmented with rendering of subsurface intra-cochlear structures. We used this software to compare two surgeons' performance in selecting insertion trajectories with and without IG. Our results show that when using virtual IG, both surgeons could choose insertion trajectories with less variability, select higher quality insertion trajectories, and create the cochleostomy with substantially less tissue resection. These results suggest that IG could indeed aid performance of atraumatic cochlear implantation techniques.

  8. Case Report: ALCAPA syndrome: successful repair with an anatomical and physiological alternative surgical technique

    PubMed Central

    Vilá Mollinedo, Luis Gustavo; Jaime Uribe, Andrés; Aceves Chimal, José Luis; Martínez-Rubio, Roberto Pablo; Hernández-Romero, Karen Patricia

    2016-01-01

    Anomalous left coronary artery from the pulmonary artery, or ALCAPA syndrome, is a rare congenital cardiac disease that can cause myocardial infarction, heart failure and even death in paediatric patients. Only few untreated patients survive until adult age. Here we present the case of a 33-year-old female patient with paroxysmal tachycardia, syncope and mild exertional dyspnoea. She was diagnosed with ALCAPA syndrome and underwent surgical correction with an alternative technique of left main coronary artery extension to the aorta. PMID:27547381

  9. [A new surgical method: lengthening of jaw bone by means of distraction technique].

    PubMed

    Nord, P G

    2001-05-30

    Callus distraction, or distraction osteogenesis as the method also is called, is a new surgical technique which makes it possible to create new bone by bone elongation. The method was originally used in orthopedic surgery to extend long bones but has subsequently proved useful for extending the mandible as well as other bones in the facial skeleton. By callus distraction, it is now possible to treat severe jaw anomalies and also to treat bone defects in the jaws without bone transplantation. This article describes the biological background to the method and the basic principles that must be observed for successful results. The treatment of four patients illustrates the method.

  10. Above-elbow (supracondylar) arm transplantation: clinical considerations and surgical technique.

    PubMed

    Shores, Jaimie T; Higgins, James P; Lee, W P Andrew

    2013-12-01

    Vascularized composite allotransplantation, also known as "Reconstructive Transplantation" is becoming more commonplace worldwide. Hand and upper extremity transplantation make up the majority of clinical vascularized composite allotransplantation cases performed so far. As success with reconstructive transplantation becomes more common, more challenging examples of limb loss are being addressed, including above-elbow, or "supracondylar" upper extremity transplants. Although very few of these cases have been performed worldwide, the authors' experience includes the only 2 cases performed in the United States at the time of this report. This article will discuss indications, challenges, surgical technique, expected outcomes, and alternative technologies for treatment of limb loss above the elbow.

  11. CORONIS - International study of caesarean section surgical techniques: the follow-up study

    PubMed Central

    2013-01-01

    Background The CORONIS Trial was a 2×2×2×2×2 non-regular, fractional, factorial trial of five pairs of alternative caesarean section surgical techniques on a range of short-term outcomes, the primary outcome being a composite of maternal death or infectious morbidity. The consequences of different surgical techniques on longer term outcomes have not been well assessed in previous studies. Such outcomes include those related to subsequent pregnancy: mode of delivery; abnormal placentation (e.g. accreta); postpartum hysterectomy, as well as longer term pelvic problems: pain, urinary problems, infertility. The Coronis Follow-up Study aims to measure and compare the incidence of these outcomes between the randomised groups at around three years after women participated in the CORONIS Trial. Methods/Design This study will assess the following null hypotheses: In women who underwent delivery by caesarean section, no differences will be detected with respect to a range of long-term outcomes when comparing the following five pairs of alternative surgical techniques evaluated in the CORONIS Trial: 1. Blunt versus sharp abdominal entry 2. Exteriorisation of the uterus for repair versus intra-abdominal repair 3. Single versus double layer closure of the uterus 4. Closure versus non-closure of the peritoneum (pelvic and parietal) 5. Chromic catgut versus Polyglactin-910 for uterine repair The outcomes will include (1) women’s health: pelvic pain; dysmenorrhoea; deep dyspareunia; urinary symptoms; laparoscopy; hysterectomy; tubal/ovarian surgery; abdominal hernias; bowel obstruction; infertility; death. (2) Outcomes of subsequent pregnancies: inter-pregnancy interval; pregnancy outcome; gestation at delivery; mode of delivery; pregnancy complications; surgery during or following delivery. Discussion The results of this follow-up study will have importance for all pregnant women and for health professionals who provide care for pregnant women. Although the results will

  12. Surgical treatment of Madelung disease by the Sauvé-Kapandji technique.

    PubMed

    Angelini, L C; Leite, V M; Faloppa, F

    1996-01-01

    The Madelung deformity, a congenital alteration of growth in the distal radial epiphysis, becomes evident during adolescence, producing serious esthetic and functional disturbances. From 1982 to 1991, 15 patients ranging from 16 to 23 years old, suffering from Madelung deformity were operated by the Sauvé-Kapandji surgical technique (a pseudarthrosis is created on the ulna and an arthrodesis on the distal radio ulnar joint). The esthetic appearance and grip strength were improved. Pain was eliminated and the incidence of complications was very low.

  13. Total ankle replacement using HINTEGRA, an unconstrained, three-component system: surgical technique and pitfalls.

    PubMed

    Barg, Alexej; Knupp, Markus; Henninger, Heath B; Zwicky, Lukas; Hintermann, Beat

    2012-12-01

    Total ankle replacement (TAR) has become a valuable treatment option in patients with end-stage ankle osteoarthritis. One popular 3-component system, the HINTEGRA TAR, is an unconstrained system that provides inversion-eversion stability. More natural biomechanics of the replaced ankle may be expected when anatomic considerations drive prosthesis design. The HINTEGRA prosthesis includes 2 anatomically contoured metal components and a polyethylene insert, providing axial rotation and physiologic flexion-extension mobility. This article describes the HINTEGRA TAR design and surgical technique. Use of the prosthesis for complex hindfoot reconstruction in patients with an osteoarthritic, varus, or valgus ankle deformity is described.

  14. Lateralization of the inferior alveolar nerve with simultaneous implant placement: surgical techniques.

    PubMed

    Garg, A K; Morales, M J

    1998-01-01

    In the event of moderate to severe mandibular bone resorption posterior to the mental foramen, repositioning of the inferior alveolar nerve provides a greater amount of available bone for implant placement and reduces the risk of nerve injury. While neural paresthesia may initially occur, this altered sensation generally resolves spontaneously. Alveolar nerve repositioning may be possible in cases in which other procedures cannot be performed due to the extent of atrophy of the posterior mandibular alveolar crest. This article presents the surgical technique to achieve this objective.

  15. “Central” Quadriceps Tendon Harvest With Patellar Bone Plug: Surgical Technique Revisited

    PubMed Central

    Scully, William F.; Wilson, David J.; Arrington, Edward D.

    2013-01-01

    The objective of this article is to review the surgical technique for quadriceps tendon graft harvest while highlighting an additional technical note that has not been previously emphasized. The quadriceps tendon typically inserts eccentrically on the superior pole of the patella. By shifting the soft-tissue harvest to a location just off the medial edge of the tendon, the adjoining patellar bone plug will be centered on the superior pole of the patella, reducing the risk of an iatrogenic patellar fracture. PMID:24400194

  16. Microsurgical subinguinal varicocelectomy in children, adolescents, and adults: surgical anatomy and anatomically justified technique.

    PubMed

    Mirilas, Petros; Mentessidou, Anastasia

    2012-01-01

    Microsurgical varicocelectomy has become the gold standard in adults because of low recurrence and postoperative hydrocele rates; it is increasingly applied in children and adolescents. This review aims to provide the surgeon with the necessary surgical anatomy of the spermatic cord and with a step-by-step, anatomically justified description of technique, toward clearer comprehension and improved application. The anatomic compartments of the spermatic cord are delineated by the external and internal spermatic fasciae. Venous drainage of testis-epididymis is accomplished by the internal spermatic, deferential, and external spermatic (cremasteric) veins. All 3 anastomose at the caudal pole of testis, and then via gubernacular veins with the posterior scrotal veins. Another anastomosis exists between a cremasteric branch and anterior scrotal veins, which gives the external pudendal vein. Subinguinal approach offers access to varicose spermatic veins and collaterals. Use of surgical microscope offers identification of small veins, preservation of arteries, lymphatics, and nerves, and appreciation of spermatic cord fasciae, which permits the development of two surgical planes. In the surgical plane of internal spermatic vessels, internal spermatic veins are ligated, whereas the testicular artery and innervation, as well as lymphatics, are preserved. In the plane of cremasteric vessels and vas, cremasteric veins are ligated, whereas the cremasteric artery, vas deferens and its vasculature, lymphatics, and the genital branch of genitofemoral nerve are preserved. Delivery of the testis to ligate gubernacular veins is at the discretion of the surgeon. Finally, venous return is effected by deferential and scrotal veins, or, when gubernacular veins are ligated, by deferential veins only.

  17. Surgical technique for single-port laparoscopy in huge ovarian tumors: SW Kim's technique and comparison to laparotomy

    PubMed Central

    Kim, Jeong Sook; Lee, In Ok; Eoh, Kyung Jin; Chung, Young Shin; Lee, Inha; Lee, Jung-Yun; Nam, Eun Ji; Kim, Sunghoon; Kim, Young Tae

    2017-01-01

    Objective This study aimed to introduce a method to remove huge ovarian tumors (≥15 cm) intact with single-port laparoscopic surgery (SPLS) using SW Kim's technique and to compare the surgical outcomes with those of laparotomy. Methods Medical records were retrospectively reviewed for patients who underwent either SPLS (n=21) with SW Kim's technique using a specially designed 30×30-cm2-sized 3XL LapBag or laparotomy (n=22) for a huge ovarian tumor from December 2008 to May 2016. Perioperative surgical outcomes were compared. Results In 19/21 (90.5%) patients, SPLS was successfully performed without any tumor spillage or conversion to multi-port laparoscopy or laparotomy. There was no significant difference in patient characteristics, including tumor diameter and total operation time, between both groups. The postoperative hospital stay was significantly shorter for the SPLS group than for the laparotomy group (median, 2 [1 to 5] vs. 4 [3 to 17] days; P<0.001). The number of postoperative general diet build-up days was also significantly shorter for the SPLS group (median, 1 [1 to 4] vs. 3 [2 to 16] days; P<0.001). Immediate post-operative pain score was lower in the SPLS group (median, 2.0 [0 to 8] vs. 4.0 [0 to 8]; P=0.045). Patient-controlled anesthesia was used less in the SPLS group (61.9% vs. 100%). Conclusion SPLS was successful in removing most large ovarian tumors without rupture and showed quicker recovery and less immediate post-operative pain in comparison to laparotomy. SPLS using SW Kim's technique could be a feasible solution to removing huge ovarian tumors. PMID:28344959

  18. Advanced techniques in safeguarding a conditioning facility for spent fuel

    SciTech Connect

    Rudolf, K.; Weh, R. )

    1992-01-01

    Although reprocessing continues to be the main factor in the waste management of nuclear reactors, the alternative of direct final disposal is currently being developed to the level of industrial applications, based on an agreement between the heads of the federal government and the federal states of Germany. Thus, the Konrad and Gorleben sites are being studied as potential final repositories as is the pilot conditioning facility (PKA) under construction. Discussions on the application of safeguards measures have led to the drafting of an approach that will cover the entire back end of the fuel cycle. The conditioning of fuel prior to direct final disposal represents one element in the overall approach. A modern facility equipped with advanced technology, PKA is a pilot plant with regard to conditioning techniques as well as to safeguards. Therefore, the PKA safeguards approach is expected to facilitate future industrial applications of the conditioning procedure. This cannot be satisfactorily implemented without advanced safeguards techniques. The level of development of the safeguards techniques varies. While advanced camera and seal systems are basically available, the other techniques and methods still require research and development. Feasibility studies and equipment development are geared to providing applicable safeguards techniques in time for commissioning of the PKA.

  19. The “excluding” suture technique for surgical closure of ventricular septal defects: A retrospective study comparing the standard technique

    PubMed Central

    Varghese, Roy; Saheed, Sanni; Ravi, Amrutha K; Sherrif, Ejaz Ahmed; Agarwal, Ravi; Kothandam, Sivakumar

    2016-01-01

    Background: Conventional methods of closure of ventricular septal defects involve placement of sutures 4-5 mm from the posterior inferior margin. This study compares the conventional method with an alternative technique wherein sutures are placed along the edge of the defect thereby “excluding” the conduction system and the tensor apparatus of the tricuspid valve from the suture line. Materials and Methods: Between January 2013 and January 2016, 409 consecutive patients were retrospectively reviewed and divided into two matched groups. Group A (n = 174) underwent closure using the alternative technique and Group B (n = 235) with the conventional technique. Patients with isolated ventricular septal defects (VSDs) (n = 136) were separately analyzed as were infants within this subset. Results: Immediate postoperative results were similar with no statistically significant differences in either group in terms of incidence of residual defects or postoperative tricuspid regurgitation. There was however a significantly increased incidence of post operative complete heart block (CHB) among patients in the conventional group (P = 0.02). Incidence of temporary heart block that reverted to sinus rhythm was also more in the conventional method group (Group B) (P = 0.03) as was right bundle branch block (P ≤ 0.05) in all the subsets of patients analyzed. Conclusion: Surgical closure of VSDs can be accomplished by placing sutures along the margins or away with comparable results. The incidence of CHB, however, seems to be less when the “excluding” technique is employed. PMID:27625520

  20. Role of the advanced practice physiotherapist in decreasing surgical wait times.

    PubMed

    Aiken, Alice B; Harrison, Mark M; Hope, John

    2009-01-01

    The role of the advanced practice physiotherapist (APP) in outpatient orthopedic clinics has been present in Ontario for over five years. These professionals have additional duties beyond those of a regular physiotherapist in order to screen patients pre- and post-operatively, triage patients for surgery, prescribe conservative management and monitor patients on an ongoing basis. The purpose of this role is to improve patient access to timely surgical care by reducing wait times for hip and knee replacement surgeries. Several positive outcomes have been reported in the literature. It has been established that an APP can effectively manage over 30% of the patients referred to a surgeon for hip or knee replacement surgery because these patients do not require surgery; rather, they require conservative management.

  1. Activity analysis: measurement of the effectiveness of surgical training and operative technique.

    PubMed

    Shepherd, J P; Brickley, M

    1992-11-01

    All surgical procedures are characterised by a sequence of steps and instrument changes. Although surgical efficiency and training in operative technique closely relate to this process, few studies have attempted to analyse it quantitatively. Because efficiency is particularly important in day surgery and lower third molar removal is a high-volume procedure, the need for which is responsible for particularly long waiting-lists in almost all UK health regions, this operation was selected for evaluation. A series of 80 consecutive procedures, carried out for 43 day-stay patients under general anaesthesia by seven junior staff (senior house officers and registrars: 39 procedures) and four senior staff (senior registrars and consultants: 41 procedures) were analysed. Median operating time for procedures which required retraction of periosteum was 9.5 min (range 2.7-23.3 min). Where these steps were necessary, median time for incision was 25 s (range 10-90 s); for retraction of periosteum, 79 s (range 5-340 s); for bone removal, 118 s (range 10-380 s); for tooth excision, 131 s (range 10-900 s); for debridement, 74 s (range 5-270 s); and for suture, 144 s (range 25-320 s). Junior surgeons could be differentiated from senior surgeons on the basis of omission, repetition and duration of these steps. Juniors omitted retraction of periosteum in 10% of procedures (seniors 23%) and suture in 13% (seniors 32%). Juniors repeated steps in 47% of operations; seniors, 14%. Junior surgeons took significantly more time than senior surgeons for incision, bone removal and tooth excision. No significant differences between junior and senior surgeons were found in relation to the incidence of altered lingual and labial sensation at 7 days. It was concluded that activity analysis may be a useful measure of the effectiveness of surgical training and the efficiency of operative technique.

  2. A variant technique for the surgical treatment of left ventricular aneurysms

    PubMed Central

    Evora, Paulo Roberto Barbosa; Tubino, Paulo Victor Alves; Gali, Luis Gustavo; Alves Junior, Lafaiete; Ferreira, Cesar Augusto; Bassetto, Solange; Menardi, Antônio Carlos; Rodrigues, Alfredo José; Vicente, Walter Vilella de Andrade

    2014-01-01

    Objective To present a surgical variant technique to repair left ventricular aneurysms. Methods After anesthesia, cardiopulmonary bypass, and myocardial protection with hyperkalemic tepic blood cardioplegia: 1) The left ventricle is opened through the infarct and an endocardial encircling suture is placed at the transitional zone between the scarred and normal tissue; 2) Next, the scar tissue is circumferentially plicated with deep stitches using the same suture thread, taking care to eliminate the entire septal scar; 3) Then, a second encircling suture is placed, completing the occlusion of the aneurysm, and; 4) Finally, the remaining scar tissue is oversewn with an invaginating suture, to ensure hemostasis. Myocardium revascularization is performed after correction of the left ventricle aneurysm. The same surgeon performed all the operations. Results Regarding the post-surgical outcome 4 patients (40%) had surgery 8 eight years ago, 2 patients (20%) were operated on over 6 years ago, and 1 patient (10%) was operated on more than 5 years ago. Three patients (30%) were in functional class I, class II in 2 patients (20%) and 2 patients (20%) with severe comorbidities remains in class III of the NYHA. There were three deaths (at four days, 15 days and eight months) in septuagenarians with acute myocardial infarction, diabetes and pulmonary emphysema. Conclusion The technique is easy to perform, safe and it can be an option for the correction of left ventricle aneurysms. PMID:25714220

  3. Laparoscopic vasectomy in African savannah elephant (Loxodonta africana); surgical technique and results.

    PubMed

    Marais, Hendrik J; Hendrickson, Dean A; Stetter, Mark; Zuba, Jeffery R; Penning, Mark; Siegal-Willott, Jess; Hardy, Christine

    2013-12-01

    Several small, enclosed reserves in southern Africa are experiencing significant elephant population growth, which has resulted in associated environmental damage and changes in biodiversity. Although several techniques exist to control elephant populations, e.g., culling, relocation, and immunocontraception, the technique of laparoscopic vasectomy of free-ranging bull elephants was investigated. Bilateral vasectomies were performed in 45 elephants. Of these elephants, one died within 24 hr of recovery and two had complications during surgery but recovered uneventfully. Histologic examination confirmed the resected tissue as ductus deferens in all the bulls. Most animals recovered uneventfully and showed no abnormal behavior after surgery. Complications recorded included incisional dehiscence, 1 full-thickness and 2 partial-thickness lacerations of the large intestine, and initial sling-associated complications, for example, deep radial nerve paresis. One bull was found dead 6 weeks after surgery without showing any prior abnormal signs. Vasectomy in free-ranging African bull elephants may be effectively performed in their normal environment. The surgical procedure can be used as a realistic population management tool in free-ranging elephants without major anesthetic, surgical, or postoperative complications.

  4. Three-dimensional evaluation of surgical techniques in neonates with orofacial cleft

    PubMed Central

    Carrara, Cleide Felício Carvalho; Ambrosio, Eloá Cristina Passucci; Mello, Bianca Zeponi Fernandes; Jorge, Paula Karine; Soares, Simone; Machado, Maria Aparecida Andrade Moreira; Oliveira, Thais Marchini

    2016-01-01

    Background: Individuals with cleft lip and palate have many anatomic and functional alterations compromising esthetics, hearing, speech, occlusion, and development/craniofacial growth. The rehabilitative treatment of these patients is very challenging and starts at birth aiming at the best treatment for all functional demands. This study aimed to evaluate the dimensional alterations of the dental arches of neonates with cleft lip and palate after two different primary surgical techniques. Materials and Methods: The sample comprised 114 digital models of children aged from 3 to 36 months, with unilateral complete cleft lip and palate divided into two groups. Two different phases were evaluated: precheiloplasty and 1 year after palatoplasty. The evaluation was performed through the digital models of each child obtained by scanning digitalization (3D Scanner). Dental arches measurements were accomplished through Appliance Designer software. The following measurements were assessed: dental arch area, anterior amplitude of the cleft, total length of dental arch, intercanine distance, and intertuberosity distance. t-test was applied to compare differences between groups. Results: No statistically significant differences were observed between groups at precheiloplasty phase. At 1 year after palatoplasty, the groups differed in the total length of dental arch (P = 0.002), with greater values for Group I. Conclusion: This study suggests that the results of the different surgical techniques may alter the growth and development of the dental arches of neonates with cleft lip and palate. PMID:28299266

  5. Surgical Treatment of Iatrogenic Ventral Glottic Stenosis Using a Mucosal Flap Technique

    PubMed Central

    Barnett, Timothy P.; O'Leary, John Mark; Dixon, Padraic M.

    2016-01-01

    Objective To describe a novel surgical technique for correcting postoperative ventral glottic stenosis (cicatrix or web formation) and the outcome in 2 Thoroughbred racehorses. Study Design Retrospective case report. Animals Thoroughbreds diagnosed with ventral glottic stenosis (n=2). Methods Horses presenting with iatrogenic ventral glottic stenosis and resultant exercise intolerance and abnormal exercise‐related noise were anesthetized and a midline sagittal skin incision was made over the ventral larynx and between the sternohyoideus muscles overlying the cricothyroid notch. The cricothyroid ligament, attached laryngeal cicatrix, and overlying mucosa were sagittally sectioned at the dorsal aspect of the cicatrix on the left side. The laryngeal mucosa, cicatrix, and underlying cricothyroid ligament immediately rostral and caudal to the cicatrix were sectioned in a medial (axial) direction as far as the right side of the cricothyroid notch. After resection of the majority of the attached cicatrix tissue, the residual mucosal flap (attached to the right side of the larynx) was reflected ventrally and sutured to the attachment of the cricothyroid ligament on the right side of the cricothyroid notch, creating an intact mucosal layer on the right side of the ventral larynx. Results Both horses had good intralaryngeal wound healing with minimal redevelopment of ventral glottic stenosis at 5 and 9 months postoperatively and were successfully returned to racing with complete absence of abnormal respiratory noise. Conclusion The unique laryngeal anatomy of horses, with a cartilage‐free ventral laryngeal area (cricothyroid notch), allowed the use of this novel surgical technique to successfully treat ventral glottic stenosis. PMID:27013024

  6. A novel technique for three-dimensional reconstruction for surgical simulation around the craniocervical junction region.

    PubMed

    Liu, Guang-Jiu; Zhang, Shao-Xiang; Qiu, Ming-Guo; Tan, Li-Wen; Li, Qi-Yu; Li, Kai

    2011-01-01

    Performing surgeries on the craniocervical junction presents a technical challenge for operating surgeons. Three-dimensional (3D) reconstruction and surgical simulation have improved the efficacy and success rate of surgeries. The aim of this study was to create a 3D, digitized visible model of the craniocervical junction region to help realize accurate simulation of craniocervical surgery on a graphic workstation. Transverse sectional anatomy data for the study were chosen from the first Chinese visible human. Manual axial segmentation of the skull base, cervical spine, cerebellum, vertebral artery, internal carotid artery, sigmoid sinus, internal jugular vein, brain stem, and spinal cord were carried out by using Photoshop software. The segmented structures were reconstructed in 3 dimensions with surface and volume rendering to accurately display 3D models spatially. In contrast to conventional 3D reconstruction techniques that are based on computed tomography and magnetic resonance imaging Digital Imaging and Communications in Medicine (DICOM) inputs and provide mostly osseous details, this technique can help to illustrate the surrounding soft tissue structure and provide a realistic surgical simulation. The reconstructed 3D model was successfully used in simulating complex procedures in the virtual environment, including the transoral approach, bone drillings, and clivus resection.

  7. Posterior compartment defect repair in vaginal surgery: update on surgical techniques.

    PubMed

    Ginger, Van Anh T; Kobashi, Kathleen C

    2007-09-01

    Posterior colporrhaphy has been the most common surgical technique for the repair of posterior compartment defects. Traditional posterior colporrhaphy involves plication of the levator ani, which may result in dyspareunia related to narrowing of the introitus. Current posterior compartment repairs either plicate the midline fascia or repair the specific site of fascial weakness. Despite insubstantial data, the use of grafts to reinforce posterior repairs has gained popularity. Grafts such as allografts, xenografts, and synthetic meshes have been used to reinforce the posterior wall. Complications include infection and erosion, as well as recurrence of prolapse. Minimally invasive techniques have been developed to recreate the apical support of the vaginal vault and repair the posterior prolapse. Properly conducted randomized prospective trials are needed to adequately assess these new approaches.

  8. Laparoscopic Free Omental Flap for Craniofacial Reconstruction: A Video Article Demonstrating Operative Technique and Surgical Applications.

    PubMed

    McIntyre, Benjamin C; Lobb, David; Navarro, Fernando; Nottingham, James

    2017-03-01

    The omental flap is a well described pedicled flap for surgical reconstruction of multiple body locations. As a laparoscopically harvested free flap, the omentum offers a minimally invasive solution to many reconstructive problems including extremity and head and neck wounds. This video article highlights the operative technique involved in flap harvest and inset for a cranial defect. An illustrative case involving a 23-year-old female's traumatic scalp degloving injury that was resurfaced by free omental flap and split-thickness skin graft is presented. This patient had stable long-term wound coverage for a very severe injury. Through video media we demonstrate that the laparoscopically harvested free omental flap is a minimally invasive, 2-team operation that provides soft tissue coverage of severe, remote wounds. This video demonstrates a safe operative technique and nuances specific to laparoscopic harvest of this flap.

  9. Planned posterior assisted levitation in severe subluxated cataract: surgical technique and clinical results.

    PubMed

    Lifshitz, Tova; Levy, Jaime; Kratz, Assaf; Belfair, Nadav; Tsumi, Erez

    2012-01-01

    We report the surgical technique and outcome of planned posterior assisted levitation (P-PAL) in four cases of subluxated cataract. P-PAL was planned as the preferred approach in all cases. A spatula was inserted via the pars plana, the whole lens was lifted to the anterior chamber and then removed through a scleral tunnel incision. Anterior chamber intraocular lenses were implanted in all cases. All four eyes had severe subluxation of the crystalline lenses with marked phacodonesis. Two eyes had history of blunt trauma, and the other two eyes had severe pseudoexfoliation with spontaneous lens subluxation. Follow-up ranged from 1 to 2 years in three cases. The postoperative visual acuity was 20/80 or better. No intraoperative complications were observed. In conclusion, the P-PAL technique was successfully performed during cataract surgery in four eyes with severe subluxated cataracts. There were no complications over the long-term follow-up.

  10. A comparison of two anesthesia methods for the surgical removal of maxillary third molars: PSA nerve block technique vs. local infiltration technique

    PubMed Central

    2014-01-01

    Objectives: The purpose of this study was to compare the effect of PSA block injection with infiltration technique regarding local anesthesia for surgical extraction of upper third molar. Material and Methods: A prospective, intra individual, single-blind randomized controlled trial was designed to study the severity of pain during injection and after surgical extraction of the bilaterally and symmetrically similar upper third molar in a total of 53 patients, in addition to evaluating the need to repeat the injection and requirement of post operative anti-inflammatory tablets. Result: Although the average pain score for all studied times in PSA side was lower than the average pain score in infiltration technique, repeated statistical measures demonstrated that no significant pain reduction occurred in the two techniques. Conclusion: The both tested methods have the same statistic equivalence for the surgical extraction of maxillary third molars. Key words:Surgical extraction, maxillary third molars, PSA block, infiltration. PMID:24596629

  11. Arthroscopic contact Nd:YAG laser meniscectomy: surgical technique and clinical follow-up

    NASA Astrophysics Data System (ADS)

    O'Brien, Stephen J.; Miller, Drew V.; Fealy, Stephen V.; Gibney, Mary A.; Kelly, Anne M.

    1991-05-01

    Fifteen patients were studied prospectively as a pilot study to evaluate the safety and efficacy of the contact Neodynium: Yttrium Aluminum Garnet (Nd:YAG) laser in performing arthroscopic meniscal resection in a saline medium, (Surgical Laser Technologies; Malverne, PA). All fifteen patients were rated as having clinically excellent results based on pain relief, wound healing, and post-operative swelling. Although there was increased time involved with setting up and calibrating the laser, there was not an increase in time for meniscal resection. In addition, the decreased need for secondary trimming and increased accessibility to the posterior horns of the menisci represent advantages over conventional instruments. Based on the findings, arthroscopic contact Nd:YAG laser surgery is a safe and effective clinical tool for meniscal resection which may, with increased technological advancements and cost reduction, replace standard instrumentation.

  12. The consequences of using advanced physical assessment skills in medical and surgical nursing: A hermeneutic pragmatic study

    PubMed Central

    Zambas, Shelaine I.; Smythe, Elizabeth A.; Koziol-Mclain, Jane

    2016-01-01

    Aims and objectives The aim of this study was to explore the consequences of the nurse's use of advanced assessment skills on medical and surgical wards. Background Appropriate, accurate, and timely assessment by nurses is the cornerstone of maintaining patient safety in hospitals. The inclusion of “advanced” physical assessment skills such as auscultation, palpation, and percussion is thought to better prepare nurses for complex patient presentations within a wide range of clinical situations. Design This qualitative study used a hermeneutic pragmatic approach. Method Unstructured interviews were conducted with five experienced medical and surgical nurses to obtain 13 detailed narratives of assessment practice. Narratives were analyzed using Van Manen's six-step approach to identify the consequences of the nurse's use of advanced assessment skills. Results The consequences of using advanced assessment skills include looking for more, challenging interpretations, and perseverance. The use of advanced assessment skills directs what the nurse looks for, what she sees, interpretation of the findings, and her response. It is the interpretation of what is seen, heard, or felt within the full context of the patient situation, which is the advanced skill. Conclusion Advanced assessment skill is the means to an accurate interpretation of the clinical situation and contributes to appropriate diagnosis and medical management in complex patient situations. Relevance to clinical practice The nurse's use of advanced assessment skills enables her to contribute to diagnostic reasoning within the acute medical and surgical setting. PMID:27607193

  13. ARTHROSCOPIC RELEASE OF THE SUPRASCAPULAR NERVE: SURGICAL TECHNIQUE AND EVALUATION OF CLINICAL CASES

    PubMed Central

    Garcia Júnior, José Carlos; Paccola, Ana Maria Ferreira; Tonoli, Cristiane; Zabeu, José Luis Amin; Garcia, Jesely Pereira Myrrha

    2015-01-01

    To describe a specific surgical technique for arthroscopic decompression of the suprascapular nerve (SSN) and evaluate its preliminary results. Methods: Ten shoulders of nine patients were operated using a technique with portals differing from the already-known techniques, which did not use traction and made use of materials available within the public healthcare system. Results: Among the ten shoulders of nine patients, eight were right shoulders and two were left shoulders. The mean age was 69.5 years. The UCLA score increased from 11.7 to 26.1 points over the postoperative follow-up of 16.6 months. The SF-36 questionnaire score was 122.9 and the raw pain scale value was 88%. Conclusion: Arthroscopic decompression of the SSN in accordance with the described technique is reproducible and less traumatic than the open techniques. The patients achieved improvements in many of the parameters evaluated, particularly with regard to pain. Arthroscopic decompression of the SSN may be a therapeutic option for pathological compression of the SSN. PMID:27027028

  14. Advanced Packaging Materials and Techniques for High Power TR Module: Standard Flight vs. Advanced Packaging

    NASA Technical Reports Server (NTRS)

    Hoffman, James Patrick; Del Castillo, Linda; Miller, Jennifer; Jenabi, Masud; Hunter, Donald; Birur, Gajanana

    2011-01-01

    The higher output power densities required of modern radar architectures, such as the proposed DESDynI [Deformation, Ecosystem Structure, and Dynamics of Ice] SAR [Synthetic Aperture Radar] Instrument (or DSI) require increasingly dense high power electronics. To enable these higher power densities, while maintaining or even improving hardware reliability, requires advances in integrating advanced thermal packaging technologies into radar transmit/receive (TR) modules. New materials and techniques have been studied and compared to standard technologies.

  15. Technology development of fabrication techniques for advanced solar dynamic concentrators

    NASA Technical Reports Server (NTRS)

    Richter, Scott W.

    1991-01-01

    The objective of the advanced concentrator program is to develop the technology that will lead to lightweight, highly reflective, accurate, scaleable, and long lived space solar dynamic concentrators. The advanced concentrator program encompasses new and innovative concepts, fabrication techniques, materials selection, and simulated space environmental testing. Fabrication techniques include methods of fabricating the substrates and coating substrate surfaces to produce high quality optical surfaces, acceptable for further coating with vapor deposited optical films. The selected materials to obtain a high quality optical surface include microsheet glass and Eccocoat EP-3 epoxy, with DC-93-500 selected as a candidate silicone adhesive and levelizing layer. The following procedures are defined: cutting, cleaning, forming, and bonding microsheet glass. Procedures are also defined for surface cleaning, and EP-3 epoxy application. The results and analyses from atomic oxygen and thermal cycling tests are used to determine the effects of orbital conditions in a space environment.

  16. Advanced thermal management techniques for space power electronics

    NASA Astrophysics Data System (ADS)

    Reyes, Angel Samuel

    1992-01-01

    Modern electronic systems used in space must be reliable and efficient with thermal management unaffected by outer space constraints. Current thermal management techniques are not sufficient for the increasing waste heat dissipation of novel electronic technologies. Many advanced thermal management techniques have been developed in recent years that have application in high power electronic systems. The benefits and limitations of emerging cooling technologies are discussed. These technologies include: liquid pumped devices, mechanically pumped two-phase cooling, capillary pumped evaporative cooling, and thermoelectric devices. Currently, liquid pumped devices offer the most promising alternative for electronics thermal control.

  17. Data Compression Techniques for Advanced Space Transportation Systems

    NASA Technical Reports Server (NTRS)

    Bradley, William G.

    1998-01-01

    Advanced space transportation systems, including vehicle state of health systems, will produce large amounts of data which must be stored on board the vehicle and or transmitted to the ground and stored. The cost of storage or transmission of the data could be reduced if the number of bits required to represent the data is reduced by the use of data compression techniques. Most of the work done in this study was rather generic and could apply to many data compression systems, but the first application area to be considered was launch vehicle state of health telemetry systems. Both lossless and lossy compression techniques were considered in this study.

  18. Advance techniques for monitoring human tolerance to positive Gz accelerations

    NASA Technical Reports Server (NTRS)

    Pelligra, R.; Sandler, H.; Rositano, S.; Skrettingland, K.; Mancini, R.

    1973-01-01

    Tolerance to positive g accelerations was measured in ten normal male subjects using both standard and advanced techniques. In addition to routine electrocardiogram, heart rate, respiratory rate, and infrared television, monitoring techniques during acceleration exposure included measurement of peripheral vision loss, noninvasive temporal, brachial, and/or radial arterial blood flow, and automatic measurement of indirect systolic and diastolic blood pressure at 60-sec intervals. Although brachial and radial arterial flow measurements reflected significant cardiovascular changes during and after acceleration, they were inconsistent indices of the onset of grayout or blackout. Temporal arterial blood flow, however, showed a high correlation with subjective peripheral light loss.

  19. Three-dimensional hybrid grid generation using advancing front techniques

    NASA Technical Reports Server (NTRS)

    Steinbrenner, John P.; Noack, Ralph W.

    1995-01-01

    A new 3-dimensional hybrid grid generation technique has been developed, based on ideas of advancing fronts for both structured and unstructured grids. In this approach, structured grids are first generate independently around individual components of the geometry. Fronts are initialized on these structure grids, and advanced outward so that new cells are extracted directly from the structured grids. Employing typical advancing front techniques, cells are rejected if they intersect the existing front or fail other criteria When no more viable structured cells exist further cells are advanced in an unstructured manner to close off the overall domain, resulting in a grid of 'hybrid' form. There are two primary advantages to the hybrid formulation. First, generating blocks with limited regard to topology eliminates the bottleneck encountered when a multiple block system is used to fully encapsulate a domain. Individual blocks may be generated free of external constraints, which will significantly reduce the generation time. Secondly, grid points near the body (presumably with high aspect ratio) will still maintain a structured (non-triangular or tetrahedral) character, thereby maximizing grid quality and solution accuracy near the surface.

  20. Strategies and advanced techniques for marine pollution studies

    SciTech Connect

    Giam, C.S.; Dou, H.J.M.

    1986-01-01

    Here is a review of strategies and techniques for evaluating marine pollution by hazardous organic compounds. Geo-chemical considerations such as the relationship between the inputs, atmospheric and estuarine transport, and the outputs, sedimentation and degradation, guide the decision on appropriate approaches to pollution monitoring in the marine environment. The latest instrumental methods and standard protocols for analysis of organic compounds are presented, as well as advances in interpretation and correlation of data made possible by the accessibility of commercial data bases.

  1. Technical note: A new surgical technique for ovariohysterectomy during early pregnancy in beef heifers.

    PubMed

    McLean, K J; Dahlen, C R; Borowicz, P P; Reynolds, L P; Crosswhite, M R; Neville, B W; Walden, S D; Caton, J S

    2016-12-01

    We hypothesized that a standing flank ovariohysterectomy procedure could be developed in beef heifers that would provide high quality tissues for addressing critical questions during early pregnancy, while concomitantly keeping livestock stewardship a high priority. To test the hypothesis, we: 1) developed a standing flank ovariohysterectomy procedure for use in beef heifers, and 2) implemented this procedure in a cohort of heifers up to d 50 of pregnancy for tissue collections, documentation of post-surgical recovery, and assessment of feedlot finishing performance. Ovariectomy and cesarean section protocols are well established in research and veterinary medicine and were used as starting points for procedural development. Crossbred Angus heifers ( = 46; ∼ 15 mo of age; BW = 362.3 ± 34.7 kg) were used to develop this new surgical tissue collection technique. Heifers were subjected to the 5-d CO-Synch + CIDR estrous synchronization protocol so ovariohysterectomy occurred at d 16, 22, 28, 34, 40, and 50 of gestation. Key aspects of the standing flank ovariohysterectomy technique included 1) use of local anesthetic for a standing flank incision, 2) locate the uterine and ovarian arteries via blind palpation and ligate them through the broad ligament via an improved clinch knot, 3) cut the ovaries and uterus free from the broad ligament, 4) ligate the cervix and uterine branch of the vaginal artery, and 5) cut through the cervix and remove the reproductive tract. Surgical times, from skin incision to placement of the last suture, were influenced ( = 0.04) by stage of gestation. In pregnant heifers, time decreased from d 22 (120.0 ± 12.0 min) of gestation to d 40 (79.5 ± 12.0 min) of gestation; then increased at d 50 (90.5 ± 14.7 min) of gestation. Using this procedure, we obtained uterine, placental, and embryo/fetal tissues that had experienced limited hypoxia, little or no trauma, and thus were excellent quality for scientific study. All heifers recovered

  2. Single-Portal Versus Two-Portal Knee Arthroscopy: First Clinical Experience With a New Surgical Technique.

    PubMed

    Cooper, Daniel E

    2016-01-01

    This pilot study compared efficacy, morbidity, and complication rates with a new single-portal arthroscopy technique and traditional 2-portal knee arthroscopy. This prospective study evaluated 156 patients who underwent arthroscopic knee surgery, 106 with 2 portals and a traditional arthroscope and instruments and 50 with a single portal and newly designed arthroscopy instruments. Patients who had reconstructive procedures, microfractures, lateral release procedures, advanced osteoarthritis, and revision surgery were excluded, as were obese patients. The same surgeon performed all procedures, and the patient groups had no significant differences in sex, age, types of pathology, surgical treatment, medications given, or rehabilitation protocol. All patients were examined and completed questionnaires 1 week, 1 month, and 3 months postoperatively. The surgeon was blinded to the data. Follow-up was 100%. The single-portal technique was technically feasible for treatment of knee pathology in 49 of 50 patients. The 2-portal technique provided adequate treatment of knee pathology in all 106 cases. No difference was reported in pain level in the recovery room or on postoperative day 2. However, patients in the single-portal group reported less pain on day 4 (P=.04) and day 7 (P=.004) and were less likely to use oral narcotic analgesics (P=.0001). The single-portal group reported better function in activities of daily living at 1 month and less interference with sports participation at 3 months. Complication rates were no different in the 2 groups. The findings showed that the single-portal technique improved functional recovery at 1 month and 3 months postoperatively and may result in less morbidity in some parameters.

  3. One stage hip arthroscopy and periacetabular osteotomy: surgical technique and initial results

    PubMed Central

    Zanotti, Gerardo; Comba, Fernando; Genovesi, Eduardo; Buttaro, Martin; Piccaluga, Francisco

    2017-01-01

    Aim: We purposed to describe the surgical technique and preliminary outcomes of combined arthroscopic and periacetabular osteotomy (PAO) for the treatment of non-arthritic hip dysplasia. Methods: Between May and August 2015, 4 patients (3 female, 1 male) with an average age of 29 years old (range; 22-33) had undergone one-stage hip arthroscopy and periacetabular osteotomy. Primary symptom was pain associated with instability. Upon radiographic examination, mean lateral center-edge angle of Wiberg was 12° (range; 7°-18°). Intra-articular findings were computed and primary outomes were as follows: radiographic angular correction; time to healing after pelvis osteotomy and functional results according to Merle D’Aubigné Score. Results: Minimum follow-up was 6 months whereas maximum was 9 months. Mean surgical time was 98 minutes for hip arthroscopy and 132 minutes for the osteotomy. In all cases, a lesion of the antero-superior labrum and the chondro-labral junction was found and repaired. After correction, overall postoperative center-edge angle was 29° (range; 25°-35°). Bone healing was certified in all cases at 6 months postoperatively. Overall Merle D’Aubigné Score was 17/18 points. Conclusion: Combined treatment of non-arthritic hip dysplasia with hip arthroscopy and PAO obtained good clinical and radiological outcomes. Former arthroscopy enables the diagnosis of cartilage lesions and intra-articular pathology as well as it aids in proceeding or not to an open correction.

  4. The utilization of six sigma and statistical process control techniques in surgical quality improvement.

    PubMed

    Sedlack, Jeffrey D

    2010-01-01

    Surgeons have been slow to incorporate industrial reliability techniques. Process control methods were applied to surgeon waiting time between cases, and to length of stay (LOS) after colon surgery. Waiting times between surgeries were evaluated by auditing the operating room records of a single hospital over a 1-month period. The medical records of 628 patients undergoing colon surgery over a 5-year period were reviewed. The average surgeon wait time between cases was 53 min, and the busiest surgeon spent 291/2 hr in 1 month waiting between surgeries. Process control charting demonstrated poor overall control of the room turnover process. Average LOS after colon resection also demonstrated very poor control. Mean LOS was 10 days. Weibull's conditional analysis revealed a conditional LOS of 9.83 days. Serious process management problems were identified in both analyses. These process issues are both expensive and adversely affect the quality of service offered by the institution. Process control mechanisms were suggested or implemented to improve these surgical processes. Industrial reliability and quality management tools can easily and effectively identify process control problems that occur on surgical services.

  5. Surgical treatment of complex proximal humeral fractures with a technique of nail and osteosuture: "NOS".

    PubMed

    Garret, J; Houdré, H; Cievet-Bonfils, M; Godenèche, Arnaud; Duparc, Fabrice; Roussignol, Xavier

    2017-03-14

    Open reduction and internal fixation of complex proximal humeral fracture represents a surgical challenge. The main objective of this procedure is to anatomically reduce the tuberosities. We propose a standardized and reproducible technique that we apply to all complex displaced 3- and 4-part fractures of patients under 50 years. We use an antero-lateral trans-deltoid approach; the humeral head and the tuberosities are reduced under fluoroscopic control. The tuberosities are stabilized with an inter-tuberosity osteosuture, and we then introduce a thin and straight intra-medullary nail (Telegraph IV FH Orthopedics) at the hinge point of the humeral head. The osteosynthesis of the tuberosities is completed by 3- or 4-self-stable divergent screws in the nail. A dynamic distal locking stabilizes the humeral shaft in rotation and facilitates consolidation thanks to micro movements. The removal of the nail with an arthroscopic shoulder arthrolysis in case of stiffness is possible secondarily.

  6. A Review of Current Concepts in Flexor Tendon Repair: Physiology, Biomechanics, Surgical Technique and Rehabilitation

    PubMed Central

    Rymer, Ben; Theobald, Peter; Thomas, Peter B.M.

    2015-01-01

    Historically, the surgical treatment of flexor tendon injuries has always been associated with controversy. It was not until 1967, when the paper entitled Primary repair of flexor tendons in no man’s land was presented at the American Society of Hand Surgery, which reported excellent results and catalyzed the implementation of this technique into worldwide practice. We present an up to date literature review using PubMed and Google Scholar where the terms flexor tendon, repair and rehabilitation were used. Topics covered included functional anatomy, nutrition, biome-chanics, suture repair, repair site gapping, and rehabilitation. This article aims to provide a comprehensive and complete overview of flexor tendon repairs. PMID:26793293

  7. Ex-vivo partial nephrectomy after living donor nephrectomy: Surgical technique for expanding kidney donor pool

    PubMed Central

    Nyame, Yaw A.; Babbar, Paurush; Aboumohamed, Ahmed A.; Mori, Ryan L.; Flechner, Stuart M.; Modlin, Charles S.

    2017-01-01

    Renal transplantation has profound improvements in mortality, morbidity, and overall quality of life compared to renal replacement therapy. This report aims to illustrate the use of ex-vivo partial nephrectomy in a patient with a renal angiomyolipoma prior to living donor transplantation. The surgical outcomes of the donor nephrectomy and recipient transplantation are reported with 2 years of follow-up. Both the donor and recipient are healthy and without any significant comorbidities. In conclusion, urologic techniques such as partial nephrectomy can be used to expand the living donor pool in carefully selected and well informed transplant recipients. Our experience demonstrated a safe and positive outcome for both the recipient and donor, and is consistent with other reported outcomes in the literature. PMID:28216945

  8. A review of the surgical management of breast cancer: plastic reconstructive techniques and timing implications.

    PubMed

    Rosson, Gedge D; Magarakis, Michael; Shridharani, Sachin M; Stapleton, Sahael M; Jacobs, Lisa K; Manahan, Michele A; Flores, Jaime I

    2010-07-01

    The oncologic management of breast cancer has evolved over the past several decades from radical mastectomy to modern-day preservation of chest and breast structures. The increased rate of mastectomies over recent years made breast reconstruction an integral part of the breast cancer management. Plastic surgery now offers patients a wide variety of reconstruction options from primary closure of the skin flaps to performance of microvascular and autologous tissue transplantation. Well-coordinated partnerships between surgical oncologists, plastic surgeons, and patients address concerns of tumor control, cosmesis, and patients' wishes. The gamut of breast reconstruction options is reviewed, particularly noting state-of-the-art techniques, as well as the advantages and disadvantages of various timing modalities.

  9. A surgical technique for bilateral cochleotomy in the Long-Evans rat.

    PubMed

    Swearengen, J R; Kittell, C L; Davis, J A; Raslear, T G; Beblo, D A; Colleton, C A

    1993-01-01

    A bilateral cochleotomized surgical rat model, needed for a study involving microwave effects, was developed, standardized, and assessed for reproducibility. After a review of the literature concerning attempts and approaches with various species, a technique involving an approach through the external auditory canal was chosen and modified. Using a stereomicroscope, a cutaneous incision in the intertragic notch was made and extended medially along the ventral aspect of the external auditory canal to the depth of the external auditory meatus. The tympanic membrane was ruptured and the malleus removed with splinter forceps, allowing visualization of the cochlea. The lateral wall of the cochlea was penetrated with a 0.024-in. wire gauge drill bit and endolymph was suctioned from the cochlea. A 5-mm piece of 3-O silk suture, inserted into the cochlear opening, maintained patency. Appraisal of the reliability and standardization of the procedure was performed utilizing startleometry. Histology assessed completeness of the procedure and any evidence of cochlear infection.

  10. [Surgical Techniques for Patella Replacement in Cases of Deficient Bone Stock in Revision TKA].

    PubMed

    Ritschl, P; Machacek, F; Strehn, L; Kloiber, J

    2015-06-01

    The patella replacement in revision surgery is a challenge especially in cases of unsufficient bone stock. Depending on the extent of the bone defect, the following videos demonstrate different approaches: Video 1: bone sparing removal of the patella implant: onlay-type patella implants. Video 2: complete cortical bone rim of the patella, residual thickness between 6 to 10 mm: biconvex patella implant. Video 3 and 4: small defects of the cortical bone rim of the patella, residual thickness 1 to 5 mm (patella shell): gull-wing osteotomy, patella bone grafting techniques. Video 5: partial necrosis/defect of the patella shell with incomplete cortical bone rim: porous tantalum patella prosthesis. On account of the various surgical options for different bone defects of the patella, patellectomy and pure patelloplasty should be avoided to prevent functional shortcomings.

  11. Does the Implant Surgical Technique Affect the Primary and/or Secondary Stability of Dental Implants? A Systematic Review

    PubMed Central

    Shadid, Rola Muhammed; Sadaqah, Nasrin Rushdi; Othman, Sahar Abdo

    2014-01-01

    Background. A number of surgical techniques for implant site preparation have been advocated to enhance the implant of primary and secondary stability. However, there is insufficient scientific evidence to support the association between the surgical technique and implant stability. Purpose. This review aimed to investigate the influence of different surgical techniques including the undersized drilling, the osteotome, the piezosurgery, the flapless procedure, and the bone stimulation by low-level laser therapy on the primary and/or secondary stability of dental implants. Materials and methods. A search of PubMed, Cochrane Library, and grey literature was performed. The inclusion criteria comprised observational clinical studies and randomized controlled trials (RCTs) conducted in patients who received dental implants for rehabilitation, studies that evaluated the association between the surgical technique and the implant primary and/or secondary stability. The articles selected were carefully read and classified as low, moderate, and high methodological quality and data of interest were tabulated. Results. Eight clinical studies were included then they were classified as moderate or high methodological quality and control of bias. Conclusions. There is a weak evidence suggesting that any of previously mentioned surgical techniques could influence the primary and/or secondary implant stability. PMID:25126094

  12. Patients' perceptions of recovery after surgical exposure of impacted maxillary teeth treated with an open-eruption surgical-orthodontic technique.

    PubMed

    Chaushu, S; Becker, A; Zeltser, R; Vasker, N; Chaushu, G

    2004-12-01

    This study assessed patient perceptions of immediate post-operative recovery after the surgical exposure of impacted maxillary teeth with an open-eruption technique. Thirty patients (24 females and six males) underwent surgical exposure of 39 impacted maxillary teeth using this technique. After surgery the patients were contacted by telephone daily for 7 days, to complete a health-related quality of life (HRQOL) questionnaire, which assessed their perception of recovery in four main areas: pain, oral function, general activity, and other symptoms. Severe pain was reported by 30 per cent of the patients in the first post-operative day (POD 1), which declined to 6.7 per cent by POD 6. Consumption of analgesics declined gradually over the post-operative days (POD 1: 80 per cent, POD 7: 20 per cent). Difficulty in eating required 5 days to reach minimal levels; enjoying everyday food, 2.5 days; school attendance, limitations in daily routine, swallowing, and speech, 2 days each; swelling, bad taste/smell, 1.5 days each; within 1 day all other measures attained minimal levels. The need for bone removal during the exposure resulted in delayed recovery with regard to the ability to eat. In general, females reported delayed recovery for pain. The present data may serve as basic guidelines against which future studies which assess post-operative management of patients after surgical exposure of impacted teeth by an open-eruption technique may be compared.

  13. Surgical Rehabilitation Techniques in Children with Poor Prognosis Short Bowel Syndrome.

    PubMed

    Dore, Mariela; Junco, Paloma Triana; Andres, Ane M; Sánchez-Galán, Alba; Amesty, Maria Virginia; Ramos, Esther; Prieto, Gerardo; Hernandez, Francisco; Lopez Santamaria, Manuel

    2016-02-01

    Intestinal failure (IF) requires a multidisciplinary management based on nutritional support, surgical and medical rehabilitation, and transplantation. The aim of this study is to review our experience with surgical rehabilitation techniques (SRTs: enteroplasty, Bianchi, Serial Transverse Enteroplasty Procedure [STEP]) in patients with short bowel syndrome (SBS) and poor prognosis due to complex abdominal pathology. We performed a single-center retrospective study of patients with IF evaluated for intestinal transplantation in the Intestinal Rehabilitation Unit who underwent an SRT. Nonparametric tests were used for statistical analysis.A total of 205 patients (107 males/98 females) with mean age of 25 ± 7 months were assessed for IF. A total of 433 laparotomies were performed on 130 patients including intestinal resection, enteroplasties, adhesiolysis, and transit reconstruction. SRT were performed in 22 patients: 12 enteroplasties, 8 STEPs, and 4 Bianchi procedures. All patients were parenteral nutrition (PN) dependent with different stages of liver disease: mild (13), moderate (5), and severe (4). The adaptation rate for patients who underwent enteroplasty, STEP, and Bianchi were 70, 63, and 25%, respectively, although the techniques are not comparable. Overall, intestinal adaptation was achieved in nine (41%) patients, and four (18%) patients showed significant reduction of PN needs. One child did not respond to SRT and did not meet transplantation criteria. The remaining eight (36%) patients were included on the waiting list for transplant: four were transplanted, two are still on the waiting list, and two died. Better outcomes were observed in milder cases of liver disease (mild 77%, moderate 40%, severe 25%) (p < 0.05). Conversely, a trend toward a poorer outcome was observed in cases with ultrashort bowel (p > 0.05). One patient required reoperation after a Bianchi procedure due to intestinal ischemia and six needed further re-STEP or adhesiolysis

  14. [Surgical treatment of anal stenosis following hemorrhoid surgery. Results of 150 combined mucosal advancement and internal sphincterotomy].

    PubMed

    Carditello, Antonio; Milone, Antonino; Stilo, Francesco; Mollo, Francesco; Basile, Maurizio

    2002-01-01

    The aim of the study was to evaluate the efficacy of anoplasty by mucosal advancement combined with internal sphincterotomy for the treatment of iatrogenic anal stenosis. From January 1990 to December 2000, 149 patients with post-haemorrhoidectomy anal strictures underwent internal sphincterotomy and mucosal advancement flap anoplasty. Seventy-one percent of patients were operated on under local anaesthesia by perineal block according to Marti. In 90 percent of the patients, postoperative pain was mild. No significant complications were seen. The mean hospital stay was two days. Ninety-seven percent of patients were well satisfied with the surgical result one year after operation. Current surgical options for the treatment of post-haemorrhoidectomy anal stricture are reported and the advantages of mucosal advancement flap anoplasty outlined.

  15. Role of Recipient-site Preparation Techniques and Post-operative Wound Dressing in the Surgical Management of Vitiligo

    PubMed Central

    Al-Hadidi, Nour; Griffith, James L; Al-Jamal, Mohammed S; Hamzavi, Iltefat

    2015-01-01

    Vitiligo is an acquired skin disorder characterized by the destruction of melanocytes resulting in achromic macules and patches involving the affected skin. Multiple methods of treatments have emerged to manage vitiligo, including medical and surgical techniques. Among the surgical techniques described in the management of vitiligo are minipunch grafting, split-thickness skin grafting, hair follicle transplantation, suction blister grafting, and cultured and non-cultured autologous melanocyte transplantation. However, prior to grafting optimal recipient-site preparation is needed for graft survival and successful repigmentation outcomes. Similarly, post-operative care of the recipient site is vital to yielding a viable graft irrespective of the transplantation technique employed. This article reviews the multiple methods employed to prepare the recipient site in vitiligo surgeries and the post-surgical conditions which optimize graft viability. A pubmed search was conducted utilizing the key words listed below. PMID:26157306

  16. Advanced computer modeling techniques expand belt conveyor technology

    SciTech Connect

    Alspaugh, M.

    1998-07-01

    Increased mining production is continuing to challenge engineers and manufacturers to keep up. The pressure to produce larger and more versatile equipment is increasing. This paper will show some recent major projects in the belt conveyor industry that have pushed the limits of design and engineering technology. Also, it will discuss the systems engineering discipline and advanced computer modeling tools that have helped make these achievements possible. Several examples of technologically advanced designs will be reviewed. However, new technology can sometimes produce increased problems with equipment availability and reliability if not carefully developed. Computer modeling techniques that help one design larger equipment can also compound operational headaches if engineering processes and algorithms are not carefully analyzed every step of the way.

  17. Advanced aeroservoelastic stabilization techniques for hypersonic flight vehicles

    NASA Technical Reports Server (NTRS)

    Chan, Samuel Y.; Cheng, Peter Y.; Myers, Thomas T.; Klyde, David H.; Magdaleno, Raymond E.; Mcruer, Duane T.

    1992-01-01

    Advanced high performance vehicles, including Single-Stage-To-Orbit (SSTO) hypersonic flight vehicles, that are statically unstable, require higher bandwidth flight control systems to compensate for the instability resulting in interactions between the flight control system, the engine/propulsion dynamics, and the low frequency structural modes. Military specifications, such as MIL-F-9490D and MIL-F-87242, tend to limit treatment of structural modes to conventional gain stabilization techniques. The conventional gain stabilization techniques, however, introduce low frequency effective time delays which can be troublesome from a flying qualities standpoint. These time delays can be alleviated by appropriate blending of gain and phase stabilization techniques (referred to as Hybrid Phase Stabilization or HPS) for the low frequency structural modes. The potential of using HPS for compensating structural mode interaction was previously explored. It was shown that effective time delay was significantly reduced with the use of HPS; however, the HPS design was seen to have greater residual response than a conventional gain stablized design. Additional work performed to advance and refine the HPS design procedure, to further develop residual response metrics as a basis for alternative structural stability specifications, and to develop strategies for validating HPS design and specification concepts in manned simulation is presented. Stabilization design sensitivity to structural uncertainties and aircraft-centered requirements are also assessed.

  18. 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

  19. 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.

  20. Retroperitoneal Laparoscopy in Dogs: Access Technique, Working Space, and Surgical Anatomy

    PubMed Central

    Jeong, Junemoe; Ko, Jonghyeok; Lim, Hyunjoo; Kweon, Oh‐Kyeong

    2016-01-01

    Objective To develop and describe a laparoscopic retroperitoneal access technique, investigate working space establishment, and describe the surgical anatomy in the retroperitoneal space as an initial step for clinical application of retroperitoneal laparoscopy in dogs. Study Design Cadaveric and experimental study. Animals Cadaveric (n=8) and healthy (n=6) adult dogs. Methods The retroperitoneal access technique was developed in 3 cadavers based on the human technique and transperitoneal observation. Its application and working space establishment with carbon dioxide (CO2) insufflation alone was evaluated in 5 cadavers by observing with a transperitoneal telescope and in 6 live dogs by repeated computed tomography (CT) scans at pressure of 0, 5, 10, and 15 mmHg. Recordings of retroperitoneoscopy as well as working space volume and linear dimensions measured on CT images were analyzed. Results Retroperitoneal access and working space establishment with CO2 insufflation alone were successfully performed in all 6 live dogs. The only complication observed was in 1 dog that developed subclinical pneumomediastinum. As pressure increased, working space was established from the ipsilateral to the contralateral side, and peritoneal tearing eventually developed. Working space volume increased significantly from 5 mmHg and linear dimensions increased significantly from 0 to 10 mmHg. With pneumo‐retroperitoneum above 5 mmHg, retroperitoneal organs, including kidneys and adrenal glands, were easily visualized. Conclusion The retroperitoneal access technique and working space establishment with CO2 insufflation starting with 5 mmHg and increasing to 10 mmHg provided adequate working space and visualization of retroperitoneal organs, which may allow direct access for retroperitoneal laparoscopy in dogs. PMID:27731512

  1. Testing aspects of advanced coherent electron cooling technique

    SciTech Connect

    Litvinenko, V.; Jing, Y.; Pinayev, I.; Wang, G.; Samulyak, R.; Ratner, D.

    2015-05-03

    An advanced version of the Coherent-electron Cooling (CeC) based on the micro-bunching instability was proposed. This approach promises significant increase in the bandwidth of the CeC system and, therefore, significant shortening of cooling time in high-energy hadron colliders. In this paper we present our plans of simulating and testing the key aspects of this proposed technique using the set-up of the coherent-electron-cooling proof-of-principle experiment at BNL.

  2. Different surgical techniques and L-carnitine supplementation in an experimental varicocele model.

    PubMed

    Akdemir, S; Gurocak, S; Konac, E; Ure, I; Onen, H I; Gonul, I I; Sozen, S; Menevse, A

    2014-10-01

    We aimed to investigate the impact of various varicocelectomy techniques and/or L-carnitine as an adjunct treatment, following the emergence of oxidative stress, on the expression levels of SCF/c-kit signalling pathways in spermatogenesis. Forty-two rats were divided into seven groups: group 1 (G1) control; group 2 (G2) sham; group 3 (G3) varicocele; group 4 (G4) varicocele + varicocelectomy with testicular nonartery sparing; group 5 (G5) same as G4 but with artery sparing; group 6 (G6) same as G4 but with L-carnitine and group 7 (G7) same as G5 with L-carnitine. mRNA expression levels of SCF and c-kit were measured quantitatively using real-time polymerase chain reaction. CASP-3 activity at protein level was determined, and histological evaluation was performed. mRNA expression level of SCF increased in G6 as compared to control group (3.52-folds change; P = 0.035), whereas mRNA expression level of c-kit gene remained the same. We found that in the left testis of G6 group, mRNA expression level of SCF increased 2.2-folds in comparison with the right testis (P < 0.05). There were no statistically significant differences in the CASP-3 protein expression levels between the control and other groups. When Cosentino Score analyses of immunostaining were conducted, we observed no significant differences among groups. Spermatogenic failure could be primarily due to a sertoli cell dysfunction. Although surgical treatment has been the best option for management of varicocele, auxiliary agents like L-carnitine may be considered as supportive treatment regimes in addition to conventional surgical treatments.

  3. Evaluation of a minimally invasive surgical fixation technique for young children with the Concerto Pin cochlear implant system.

    PubMed

    Schnabl, Johannes; Wolf-Magele, Astrid; Pok, Stefan Marcel; Url, Christoph; Zorowka, Patrick; Sprinzl, Georg

    2015-08-01

    In 2011, Med-El (Innsbruck, Austria) introduced a new cochlear implant system, designed to require a minimally invasive surgical technique and allow greater positional flexibility for its fixation on the skull. The Concerto Pin implant system is a good option for patients with thinner bone, such as children and elderly. The aim of this study was to investigate the implant’s stability in children using our minimally invasive surgical technique. This was a prospective, longitudinal study with a single-subject, repeated-examination design. Six children, implanted with a Concerto Pin using our minimally invasive surgical technique between October 2011 and September 2012, were assessed 1, 3 and 6 months after surgery. In each case, the implant remained in a stable position and no adverse events or problems with healing were observed at any time during the investigation. The minimally invasive technique and the method of implant fixation that bypass drilling a deep implant bed constitute a good option for patients with thinner bone, such as children. This clinical study shows the safety and stability of the Concerto Pin implant system using a minimally invasive surgical technique.

  4. Recent Advances in Techniques for Hyperspectral Image Processing

    NASA Technical Reports Server (NTRS)

    Plaza, Antonio; Benediktsson, Jon Atli; Boardman, Joseph W.; Brazile, Jason; Bruzzone, Lorenzo; Camps-Valls, Gustavo; Chanussot, Jocelyn; Fauvel, Mathieu; Gamba, Paolo; Gualtieri, Anthony; Marconcini, Mattia; Tilton, James C.; Trianni, Giovanna

    2009-01-01

    Imaging spectroscopy, also known as hyperspectral imaging, has been transformed in less than 30 years from being a sparse research tool into a commodity product available to a broad user community. Currently, there is a need for standardized data processing techniques able to take into account the special properties of hyperspectral data. In this paper, we provide a seminal view on recent advances in techniques for hyperspectral image processing. Our main focus is on the design of techniques able to deal with the highdimensional nature of the data, and to integrate the spatial and spectral information. Performance of the discussed techniques is evaluated in different analysis scenarios. To satisfy time-critical constraints in specific applications, we also develop efficient parallel implementations of some of the discussed algorithms. Combined, these parts provide an excellent snapshot of the state-of-the-art in those areas, and offer a thoughtful perspective on future potentials and emerging challenges in the design of robust hyperspectral imaging algorithms

  5. Transposition of Great Arteries with Intramural Coronary Artery: Experience with a Modified Surgical Technique

    PubMed Central

    Mishra, Amit; Jain, Anil; Hinduja, Manish; Wadhawa, Vivek; Patel, Ramesh; Vaidhya, Nikunj; Rodricks, Dayesh; Patel, Hardik

    2016-01-01

    Objective: Transposition of the great arteries is a common congenital heart disease. Arterial switch is the gold standard operation for this complex heart disease. Arterial switch operation in the presence of intramural coronary artery is surgically the most demanding even for the most experienced hands. We are presenting our experience with a modified technique for intramural coronary arteries in arterial switch operation. Methods: This prospective study involves 450 patients undergoing arterial switch operation at our institute from April 2006 to December 2013 (7.6 years). Eighteen patients underwent arterial switch operation with intramural coronary artery. The coronary patterns and technique used are detailed in the text. Results: The overall mortality found in the subgroup of 18 patients having intramural coronary artery was 16% (n=3). Our first patient had an accidental injury to the left coronary artery and died in the operating room. A seven-day old newborn died from intractable ventricular arrhythmia fifteen hours after surgery. Another patient who had multiple ventricular septal defects with type B arch interruption died from residual apical ventricular septal defect and sepsis on the eleventh postoperative day. The remainder of the patients are doing well, showing a median follow-up duration of 1235.34±815.26 days (range 369 - 2730). Conclusion: Transposition of the great arteries with intramural coronary artery is demanding in a subset of patients undergoing arterial switch operation. We believe our technique of coronary button dissection in the presence of intramural coronary arteries using coronary shunt is simple and can be a good addition to the surgeons' armamentarium. PMID:27074270

  6. Comparison of two surgical techniques for creating an acute myocardial infarct in rats

    PubMed Central

    Capriglione, Luiz Guilherme Achcar; Barchiki, Fabiane; Ottoboni, Gabriel Sales; Miyague, Nelson Itiro; Suss, Paula Hansen; Rebelatto, Carmen Lúcia Kuniyoshi; Pimpão, Cláudia Turra; Senegaglia, Alexandra Cristina; Brofman, Paulo Roberto

    2014-01-01

    Objective To perform a comparative assessment of two surgical techniques that are used creating an acute myocardial infarc by occluding the left anterior descending coronary artery in order to generate rats with a left ventricular ejection fraction of less than 40%. Methods The study was completely randomized and comprised 89 halothane-anaesthetised rats, which were divided into three groups. The control group (SHAM) comprised fourteen rats, whose left anterior descending coronary artery was not occluded. Group 1 (G1): comprised by 35 endotracheally intubated and mechanically ventilated rats, whose left anterior descending coronary artery was occluded. Group 2 (G2): comprised 40 rats being manually ventilated using a nasal respirator whose left anterior descending coronary artery was occluded. Other differences between the two techniques include the method of performing the thoracotomy and removing the pericardium in order to expose the heart, and the use of different methods and suture types for closing the thorax. Seven days after surgery, the cardiac function of all surviving rats was determined by echocardiography. Results No rats SHAM group had progressed to death or had left ventricular ejection fraction less than 40%. Nine of the 16 surviving G1 rats (56.3%) and six of the 20 surviving G2 rats (30%) had a left ventricular ejection fraction of less than 40%. Conclusion The results indicate a tendency of the technique used in G1 to be better than in G2. This improvement is probably due to the greater duration of the open thorax, which reduces the pressure over time from the surgeon, allowing occlusion of left anterior descending coronary artery with higher accuracy. PMID:25714202

  7. Advanced IMCW Lidar Techniques for ASCENDS CO2 Column Measurements

    NASA Astrophysics Data System (ADS)

    Campbell, Joel; lin, bing; nehrir, amin; harrison, fenton; obland, michael

    2015-04-01

    Global atmospheric carbon dioxide (CO2) measurements for the NASA Active Sensing of CO2 Emissions over Nights, Days, and Seasons (ASCENDS) space mission are critical for improving our understanding of global CO2 sources and sinks. Advanced Intensity-Modulated Continuous-Wave (IM-CW) lidar techniques are investigated as a means of facilitating CO2 measurements from space to meet the ASCENDS measurement requirements. In recent numerical, laboratory and flight experiments we have successfully used the Binary Phase Shift Keying (BPSK) modulation technique to uniquely discriminate surface lidar returns from intermediate aerosol and cloud contamination. We demonstrate the utility of BPSK to eliminate sidelobes in the range profile as a means of making Integrated Path Differential Absorption (IPDA) column CO2 measurements in the presence of optically thin clouds, thereby eliminating the need to correct for sidelobe bias errors caused by the clouds. Furthermore, high accuracy and precision ranging to the surface as well as to the top of intermediate cloud layers, which is a requirement for the inversion of column CO2 number density measurements to column CO2 mixing ratios, has been demonstrated using new hyperfine interpolation techniques that takes advantage of the periodicity of the modulation waveforms. This approach works well for both BPSK and linear swept-frequency modulation techniques. The BPSK technique under investigation has excellent auto-correlation properties while possessing a finite bandwidth. A comparison of BPSK and linear swept-frequency is also discussed in this paper. These results are extended to include Richardson-Lucy deconvolution techniques to extend the resolution of the lidar beyond that implied by limit of the bandwidth of the modulation.

  8. Aesthetic Lateral Canthoplasty Using Tarso-Conjunctival Advancement Technique.

    PubMed

    Lee, Eun Jung; Lew, Dae Hyun; Song, Seung Han; Lee, Myung Chul

    2017-01-01

    Reduced horizontal length of the palpebral fissure is a distinctive characteristic of Asian eyelids, and aesthetic lateral canthal lengthening techniques have been performed for a refinement. The aim of this study is to describe a novel lateral canthoplasty using tarso-conjunctival advancement with a lid margin splitting procedure on the upper eyelids and to report the postoperative results. From December 2011 to June 2014, patients who underwent lateral canthoplasty using the tarso-conjunctival advancement procedure for aesthetic purposes were reviewed retrospectively. The predictor variables were grouped into demographic and operative categories. The primary outcome variables were the distances from the mid-pupillary line to the lateral canthus and the horizontal length of the palpebral aperture (distance from the medial to lateral canthus). Data analyses were performed using descriptive and univariate statistics. Patients who showed increment in objective measurements were considered significant. Aesthetic appearance was also evaluated based on pre- and postoperative clinical photographs. A total of 45 patients were enrolled in this study. Both the distance from the mid-pupil to the lateral canthus (ΔDpupil-lateral; 2.78 ± 0.54 mm, P <0.05) and the palpebral aperture horizontal length (ΔDmedial-lateral 2.93 ± 0.81 mm, P <0.05) increased significantly from pre- to postoperative state. All the patients demonstrated satisfactory results aesthetically during the follow-up. The tarso-conjunctival advancement technique for lateral canthoplasty produced satisfactory aesthetic results with an enlarged palpebral aperture. Future research is required to fully delineate the risk of possible complications, including injury to the eyelashes and meibomian glands.

  9. Advancing the surgical implantation of electronic tags in fish: a gap analysis and research agenda based on a review of trends in intracoelomic tagging effects studies

    SciTech Connect

    Cooke, Steven J.; Woodley, Christa M.; Eppard, M. B.; Brown, Richard S.; Nielsen, Jennifer L.

    2011-03-08

    Early approaches to surgical implantation of electronic tags in fish were often through trial and error, however, in recent years there has been an interest in using scientific research to identify techniques and procedures that improve the outcome of surgical procedures and determine the effects of tagging on individuals. Here we summarize the trends in 108 peer-reviewed electronic tagging effect studies focused on intracoleomic implantation to determine opportunities for future research. To date, almost all of the studies have been conducted in freshwater, typically in laboratory environments, and have focused on biotelemetry devices. The majority of studies have focused on salmonids, cyprinids, ictalurids and centrarchids, with a regional bias towards North America, Europe and Australia. Most studies have focused on determining whether there is a negative effect of tagging relative to control fish, with proportionally fewer that have contrasted different aspects of the surgical procedure (e.g., methods of sterilization, incision location, wound closure material) that could advance the discipline. Many of these studies included routine endpoints such as mortality, growth, healing and tag retention, with fewer addressing sublethal measures such as swimming ability, predator avoidance, physiological costs, or fitness. Continued research is needed to further elevate the practice of electronic tag implantation in fish in order to ensure that the data generated are relevant to untagged conspecifics (i.e., no long-term behavioural or physiological consequences) and the surgical procedure does not impair the health and welfare status of the tagged fish. To that end, we advocate for i) rigorous controlled manipulations based on statistical designs that have adequate power, account for inter-individual variation, and include controls and shams, ii) studies that transcend the laboratory and the field with more studies in marine waters, iii) incorporation of knowledge and

  10. Indication, surgical technique and results of endoscopic fascial release in plantar fasciitis (E FRPF).

    PubMed

    Jerosch, Jörg; Schunck, Jochem; Liebsch, Dietrich; Filler, Tim

    2004-09-01

    The purpose of the present study is to present the surgical technique for, and review our indications and results after, endoscopic fascial release in patients with plantar fasciitis. In five thiel-embalmed human specimens, a biportal technique for endoscopic release of the plantar fascia was established. The aim was here to evaluate the relation between the plantar fascia and the heel spur and to perform a release that would not exceed 50-70% of the diameter of the calcaneoplantar fascia. The endoscopic technique was performed within the last 5 years in ten male and seven female patients. All patients with the clinical entity of plantar fasciitis underwent conservative treatment for at least 6 months. The average age at surgery was 35 years (24-56 years). In the first five patients, surgery was performed under c-arm control. In all patients the operation could be finished endoscopically. The endoscopic portals healed without complications. The time for surgery during the learning curve ranged between 21 and 74 min (average 41 min) and was still longer compared to the open technique. The clinical follow-up ranged between 4 and 48 months (average 18.5 months). Out of 17 patients, 13 improved clinically, and they would choose the treatment option again. In the Ogilvie-Harris score, seven patients showed good and six excellent results. In two patients, the initial results were not satisfactory, because of a bony stress reaction of the calcaneus. This complication was treated by 6 weeks of partial weight bearing, without any further problems. Two other patients developed secondary pain in the lateral column. In spite of the minimal invasive approach it seems to be important to be careful in increasing the weight bearing in early rehabilitation. The technique of the endoscopic plantar fascia release (E FRPF) can be performed in a standardised and reproducible procedure. The follow-up examination showed good midterm results, but a loss of stability of the plantar arch

  11. Vagus nerve stimulation: Surgical technique of implantation and revision and related morbidity.

    PubMed

    Giordano, Flavio; Zicca, Anna; Barba, Carmen; Guerrini, Renzo; Genitori, Lorenzo

    2017-04-01

    Indications for vagus nerve stimulation (VNS) therapy include focal, multifocal epilepsy, drop attacks (tonic/atonic seizures), Lennox-Gastaut syndrome, tuberous sclerosis complex (TSC)-related multifocal epilepsy, and unsuccessful resective surgery. Surgical outcome is about 50-60% for seizures control, and may also improve mood, cognition, and memory. On this basis, VNS has also been proposed for the treatment of major depression and Alzheimer's' disease. The vagus nerve stimulator must be implanted with blunt technique on the left side to avoid cardiac side effects through the classic approach for anterior cervical discectomy. The actual device is composed of a wire with three helical contacts (two active contacts, one anchoring) and a one-pin battery. VNS is usually started 2 weeks after implantation with recommended settings of stimulation (1.0-2.0 mA; 500 μs pulse width; 20-30 Hz; 30 s ON, 5 min OFF). The complications of VNS therapy are early (related to surgery) and late (related to the device and to stimulation of the vagus nerve). Early complications include the following: intraoperative bradycardia and asystole during lead impedance testing, peritracheal hematoma, infections (3-8%), and vagus nerve injury followed by hoarseness, dyspnea, and dysphagia because of left vocal cord paralysis. Delayed morbidity due to the device includes late infections or problems in wound healing; other more rare events are due to late injury of the nerve. Late complications due to nerve stimulation include delayed arrhythmias, laryngopharyngeal dysfunction (hoarseness, dyspnea, and coughing), obstructive sleep apnea, stimulation of phrenic nerve, tonsillar pain mimicking glossopharyngeal neuralgia, and vocal cord damage during prolonged endotracheal intubation. The laryngopharyngeal dysfunction occurs in about 66% of patients and is usually transitory and due to the stimulation of the inferior (recurrent) laryngeal nerve. A true late paralysis of the left vocal cord

  12. Influence of implant shape, surface morphology, surgical technique and bone quality on the primary stability of dental implants.

    PubMed

    Elias, Carlos Nelson; Rocha, Felipe Assis; Nascimento, Ana Lucia; Coelho, Paulo Guilherme

    2012-12-01

    The primary stability of dental implants has been investigated before, but a study of the influence of implant shape, size and surface morphology (machined, acid etched or anodized), surgical technique (press-fit or undersized) and substrate (natural or simulated bone) on the primary stability of dental implants has not been reported. The present work intends to fill this gap. In this work, six different dental implants were inserted into and removed from synthetic and natural bone while measuring the torque. A total of 255 dental implants with three shapes, four sizes and three surface topographies were inserted into pig rib, PTFE and polyurethane. The implant sites were prepared using straight and tapered drills. The primary stability was estimated from the maximum insertion torque. Comparisons between samples were based on the maximum insertion torque (MIT), the maximum removal torque (MRT) and the torque ratio (TR=MRT/MIT). The insertion torque into pig ribs showed larger dispersion. All parameters (shape, size and surface morphology of the implant, surgical technique and substrate type) were found to have a significant influence on primary stability. The insertion of a tapered implant requires a higher torque than the insertion of a straight implant. Surface treatments improve the primary stability. The influence of the surgical technique is smaller than that of implant size and shape. The highest insertion torque was that of anodized tapered implants inserted into undersized sites. Finally, the primary stability of dental implants is highly dependent on implant design, surgical technique and substrate type.

  13. [Clinical experience with a C-section surgical technique in patients with morbid obesity: a case series].

    PubMed

    Hernández Carrazco, Mayra Elena; Rodríguez Torres, Alejandra; Ortiz Pineda, Omar; Rodríguez Torres, Juan; Casas Patiño, Donovan

    2014-07-04

    Obesity is a public health challenge that has crossed into the area of reproductive health. An obese pregnant woman has multiple complications before, during, and after pregnancy. Likewise, cesarean section is more difficult and has slower recovery times in this group of patients. This paper proposes a surgical technique adapted to the morbidly obese pregnant patient that aims to reduce cesarean section complications.

  14. “Two-step” technique with OsiriX™ to evaluate feasibility of C2 pedicle for surgical fixation

    PubMed Central

    Marques, Luis Miguel Sousa; d’Almeida, Gonçalo Neto; Cabral, José

    2016-01-01

    Background: Surgical treatment of craniovertebral junction pathology has evolved considerably in recent decades with the implementation of short atlanto-axial fixation techniques, notwhithstanding increasing neurovascular risks. Also, there is strong evidence that fixation of C2 anatomical pedicle has the best biomechanical profile of the entire cervical spine. However, it is often difficult and misleading, to evaluate anatomical bony and vascular anomalies using the three orthogonal planes (axial, coronal, and sagittal) of CT. Objectives: The authors describe an innovative and simple technique to evaluate the feasibility of C2 pedicle for surgical screw fixation using preoperative planning with the free DICOM (Digital Imaging and Communications in Medicine) software OsiriX™. Materials and Methods: The authors report the applicatin of this novel technique in 5 cases (3 traumatic, 1 Os Odontoideum, and 1 complex congenital malformation) collected from our general case series of the Department in the last 5 years. Results: In this proof of concept study, the pre-operative analysis with the two-step tecnique was detrimental for choosing the surgical tecnique. Detailed post-operative analysis confirmed correct position of C2 screws without cortical breach. There were no complications or mortality reported. Conclusion: This two-step technique is an easy and reliable way to determine the feasibility of C2 pedicle for surgical fixation. The detailed tridimensional radiological preoperative evaluation of craniovertebral junction anatomy is critical to the sucess and safety of this surgeries, and can avoid, to certain degree, expensive intra-operative tridimensional imaging facilities. PMID:27217652

  15. Soft tissue reconstruction for type IV-D duplicated thumb: a new surgical technique.

    PubMed

    Tien, Yin-Chun; Chih, Tsai-Tung; Wang, Tai-Lung; Fu, Yin-Chih; Chen, Jian-Chih

    2007-06-01

    Type IV-D duplicated thumb has the most complex anomalies and difficulties for treatment among polydatyly. Double osteotomy is usually recommended to gain the best cosmetic and functional outcome. However, 4 cases of type IV-D duplicated thumb were treated only by soft tissue procedure in this study. At operation, a conjoined A2 pulley was routinely identified, and the flexor pollicis longus (FPL) was found bifurcated distal to the conjoined pulley in every of these cases. Instead of double osteotomy, a soft tissue procedure that included centralization of FPL and A2 pulley reconstruction was pursued to correct these special anomalies. The overall clinical results were evaluated by a modification of the Tada scoring system based on the range of motion, joint stability, alignment of the remaining thumb, and subjective opinion regarding the reconstructed thumb after an average follow-up of 3.3 years (range, 2.5-4.7 years). According to the scoring system, the results were rated as good in 3 cases and fair in 1 case. From the results, the A2 pulley reconstruction and FPL centralization could prove to be an effective method for the treatment of type IV-D duplicated thumb and could efficiently avoid the residual angular deformities. Therefore, we recommend this soft tissue procedure as an alternative surgical technique to the double-osteotomy procedure for treating a type IV-D duplicated thumb in a very young child, whose bone is still not mature enough for holding the fixing pins.

  16. Blood Conservation Strategies and Liver Transplantation Transfusion-Free Techniques Derived from Jehovah's Witness Surgical Cohorts.

    PubMed

    Sheth, Mansi; Kulkarni, Sujit; Dhanireddy, Kiran; Perez, Alexander; Selby, Rick

    2015-01-01

    Red blood cell and component transfusions are a frequent and widely accepted accompaniment of surgical procedures. Although the risk of specific disease transmission via allogeneic blood transfusions (ABT) is very low, the occurrence of transfusion related immune modulation (TRIM) still remains a ubiquitous concern. Recent studies have shown that ABT are linked to increased morbidity and mortality across various specialties, with negative outcomes directly correlated to number of transfusions. Blood conservation methods are therefore necessary to reduce ABT. Acute normo-volemic hemodilution (ANH) along with pre-operative blood augmentation and intraoperative cell salvage are blood conservation techniques utilized in tertiary and even quaternary (transplantation) surgery in Jehovah's Witnesses with excellent outcomes. The many hematologic complications such as anemia, thrombocytopenia and coagulopathies that occur with liver transplantation present a significant barrier when trying to avoid ABT. Despite this, living donor liver transplantation (LDLT) has been successfully performed in a transfusion-free environment, providing valuable insight into the possibilities of limiting ABT and its associated risks in all patients.

  17. Parasagittal meningiomas: Our surgical experience and the reconstruction technique of the superior sagittal sinus

    PubMed Central

    Ricci, Alessandro; Di Vitantonio, Hambra; De Paulis, Danilo; Del Maestro, Mattia; Gallieni, Massimo; Dechcordi, Soheila Raysi; Marzi, Sara; Galzio, Renato Juan

    2017-01-01

    Background: The radical resection of parasagittal meningiomas without complications and recurrences is the goal of the neurosurgeon. Nowadays, different managements are proposed. This study describes our surgical technique during the lesional excision and the reconstruction of the superior sagittal sinus (SSS). Methods: The total removal (Simpson I and II) of parasagittal meningiomas (WHO grade I and II) was obtained in 75 patients from September 2000 to January 2010. The indocyanine green videoangiography was used before the dural opening and, when necessary, to identify and preserve the cortical veins. The surgery of the SSS was performed in accordance with Sindou's classification, and its reconstruction was achieved through the use of a patch of galea capitis. Results: We had no cases of recurrence and thrombotic occlusion of the SSS in 5 years after the reconstruction. No complications were observed in 65 patients, and no cases of mortality were reported. Neurological focal deficits were observed in 5 patients. A brain swelling and a venous infarction were observed in 1 patient. Only one case of thrombotic occlusion was observed. A cerebrospinal fluid leak was observed in 2 patients, and a systemic complication was found in 1 patient. Conclusion: Several factors contribute to the success of the parasagittal meningioma surgery. We consider the preservation of the cortical veins to be important, and, when possible, we recommend the reconstruction of the anterior third of the SSS. Our experience has led us to believe that until now surgery is a winning choice if practiced by expert hands. PMID:28217380

  18. Gene therapy during cardiac surgery: role of surgical technique to minimize collateral organ gene expression

    PubMed Central

    Katz, Michael G.; Swain, JaBaris D.; Fargnoli, Anthony S.; Bridges, Charles R.

    2013-01-01

    Effective gene therapy for heart failure has not yet been achieved clinically. The aim of this study is to quantitatively assess the cardiac isolation efficiency of the molecular cardiac surgery with recirculating delivery (MCARD™) and to evaluate its efficacy as a means to limit collateral organ gene expression. 1014 genome copies (GC) of recombinant adeno-associated viral vector 6 encoding green fluorescent protein under control of the cytomegalovirus promoter was delivered to the nine arrested sheep hearts. Blood samples were assessed using real-time quantitative polymerase chain reaction (RT QPCR). Collateral organ gene expression was assessed at four-weeks using immunohistochemical staining. The blood vector GC concentration in the cardiac circuit during complete isolation trended from 9.59±0.73 to 9.05±0.65 (log GC/cm3), and no GC were detectable in the systemic circuit (P<0.001). The washing procedure performed prior to relinquishing the cardiac circuit decreased the systemic blood vector GC concentration >800-fold (P<0.001), consistent with >99% isolation efficiency. Conversely, incomplete isolation resulted in equalization of vector GC concentration in the circuits, leading to robust collateral organ gene expression. MCARD™ is an efficient, clinically translatable myocardial delivery platform for cardiac specific gene therapy. The cardiac surgical techniques utilized are critically important to limit collateral organ gene expression. PMID:20861057

  19. Distal fascia lata lengthening: an alternative surgical technique for recalcitrant trochanteric bursitis.

    PubMed

    Pretell, Juan; Ortega, Javier; García-Rayo, Ramón; Resines, Carlos

    2009-10-01

    This article presents a simple technique for fascia lata lengthening that is less aggressive, can be performed under local anaesthetic with little morbidity and disability, and has excellent results. Eleven patients (13 hips) were enrolled in this study. Mean age was 54.6 years, there was one man and ten women. Outcomes were assessed by using a visual analog pain scale, Harris hip score and Lickert scale (satisfaction). There was a mean follow-up time of 43 months (range 15-84). All patients were scored by the Harris hip scale with a mean improvement from 61 (range 48-77) to 91 (range 76-95) after surgery. The mean visual analogue scale (VAS) score improved from 83 (range 60-99) to 13 (range 0-70). We had 12 of 13 patients reporting a good result. Mean surgical time was 15 min, and only one seroma was reported as a complication. No inpatient management was needed. In conclusion, distal "Z" lengthening of the fascia lata appears to be a good alternative for treatment of this condition.

  20. The endoscopic endonasal approach to the Meckel's cave tumors: surgical technique and indications.

    PubMed

    Jouanneau, Emmanuel; Simon, Emile; Jacquesson, Timothée; Sindou, Marc; Tringali, Stéphane; Messerer, Mahmoud; Berhouma, Moncef

    2014-12-01

    Many benign and malignant tumors as well as other inflammatory or vascular diseases may be located in the areas of Meckel's cave or the cavernous sinus. Except for typical features such as for meningiomas, imaging may not by itself be sufficient to choose the best therapeutic option. Thus, even though modern therapy (chemotherapy, radiotherapy, or radiosurgery) dramatically reduces the field of surgery in this challenging location, there is still some place for surgical biopsy or tumor removal in selected cases. Until recently, the microscopic subtemporal extradural approach with or without orbitozygomatic removal was classically used to approach Meckel's cave but with a non-negligible morbidity. Percutaneous biopsy using the Hartel technique has been developed for biopsy of such tumors but may fail in the case of firm tumors, and additionally it is not appropriate for anterior parasellar tumors. With the development of endoscopy, the endonasal route now represents an interesting alternative approach to Meckel's cave as well as the cavernous sinus. Through our experience, we describe the modus operandi and discuss what should be the appropriate indication of the use of the endonasal endoscopic approach for Meckel's cave disease in the armamentarium of the skull base surgeon.

  1. Advanced Techniques for Removal of Retrievable Inferior Vena Cava Filters

    SciTech Connect

    Iliescu, Bogdan; Haskal, Ziv J.

    2012-08-15

    Inferior vena cava (IVC) filters have proven valuable for the prevention of primary or recurrent pulmonary embolism in selected patients with or at high risk for venous thromboembolic disease. Their use has become commonplace, and the numbers implanted increase annually. During the last 3 years, in the United States, the percentage of annually placed optional filters, i.e., filters than can remain as permanent filters or potentially be retrieved, has consistently exceeded that of permanent filters. In parallel, the complications of long- or short-term filtration have become increasingly evident to physicians, regulatory agencies, and the public. Most filter removals are uneventful, with a high degree of success. When routine filter-retrieval techniques prove unsuccessful, progressively more advanced tools and skill sets must be used to enhance filter-retrieval success. These techniques should be used with caution to avoid damage to the filter or cava during IVC retrieval. This review describes the complex techniques for filter retrieval, including use of additional snares, guidewires, angioplasty balloons, and mechanical and thermal approaches as well as illustrates their specific application.

  2. Combined surgical resective and regenerative therapy for advanced peri-implantitis with concomitant soft tissue volume augmentation: a case report.

    PubMed

    Schwarz, Frank; John, Gordon; Sahm, Narja; Becker, Jürgen

    2014-01-01

    This case report presents a 3-year follow-up of the clinical outcomes of a combined surgical therapy for advanced peri-implantitis with concomitant soft tissue volume augmentation using a collagen matrix. One patient suffering from advanced peri-implantitis and a thin mucosal biotype underwent access flap surgery, implantoplasty at buccally and supracrestally exposed implant parts, and augmentation of the intrabony components using a natural bone mineral and a native collagen membrane after surface decontamination. A collagen matrix was applied to the wound area to increase soft tissue volume and support transmucosal healing. The following clinical parameters were recorded over a period of 3 years: bleeding on probing (BOP), probing depth (PD), mucosal recession (MR), clinical attachment level (CAL), and width of keratinized mucosa (KM). At 36 months, the combined surgical procedure was associated with a clinically important reduction in mean BOP (100%), PD (4.3 ± 0.5 mm), and CAL (4.4 ± 0.4 mm). Site-level analysis of the buccal aspects pointed to an increase in MR (-1.0 ± 0.4 mm) and a decrease in KM (-1.3 ± 0.5 mm) values at 12 months. However, a regain in mucosal height and KM was noted at 24 months, even reaching respective baseline values after 36 months of healing. The presented combined surgical procedure was effective in controlling an advanced peri-implantitis lesion without compromising the overall esthetic outcome in the long term.

  3. Advanced Synchrotron Techniques at High Pressure Collaborative Access Team (HPCAT)

    NASA Astrophysics Data System (ADS)

    Shen, G.; Sinogeikin, S. V.; Chow, P.; Kono, Y.; Meng, Y.; Park, C.; Popov, D.; Rod, E.; Smith, J.; Xiao, Y.; Mao, H.

    2012-12-01

    High Pressure Collaborative Access Team (HPCAT) is dedicated to advancing cutting-edge, multidisciplinary, high-pressure science and technology using synchrotron radiation at Sector 16 of the Advanced Photon Source (APS) of Argonne National Laboratory. At HPCAT an array of novel x-ray diffraction and spectroscopic techniques has been integrated with high pressure and extreme temperature instrumentation for studies of structure and materials properties at extreme conditions.. HPCAT consists of four active independent beamlines performing a large range of various experiments at extreme conditions. 16BM-B beamline is dedicated to energy dispersive and white Laue X-ray diffraction. The majority of experiments are performed with a Paris-Edinburgh large volume press (to 7GPa and 2500K) and include amorphous and liquid structure measurement, white beam radiography, elastic sound wave velocity measurement of amorphous solid materials, with viscosity and density measurement of liquid being under development. 16BM-D is a monochromatic diffraction beamline for powder and single crystal diffraction at high pressure and high (resistive heating) / low (cryostats) temperature. The additional capabilities include high-resolution powder diffraction and x-ray absorption near edge structure (XANES) spectroscopy. The insertion device beamline of HPCAT has two undulators in canted mode (operating independently) and LN cooled Si monochromators capable of providing a large range of energies. 16IDB is a microdiffraction beamline mainly focusing on high-pressure powder and single crystal diffraction in DAC at high temperatures (double-sided laser heating and resistive heating) and low temperature (various cryostats). The modern instrumentation allows high-quality diffraction at megabar pressures from light element, fast experiments with pulsed laser heating, fast dynamic experiments with Pilatus detector, and so on. 16ID-D beamline is dedicated to x-ray scattering and spectroscopy research

  4. Accelerating orthodontic tooth movement: A new, minimally-invasive corticotomy technique using a 3D-printed surgical template

    PubMed Central

    Giansanti, Matteo

    2016-01-01

    Background A reduction in orthodontic treatment time can be attained using corticotomies. The aggressive nature of corticotomy due to the elevation of muco-periosteal flaps and to the duration of the surgery raised reluctance for its employ among patients and dental community. This study aims to provide detailed information on the design and manufacture of a 3D-printed CAD-CAM (computer-aided design and computer-aided manufacturing) surgical guide which can aid the clinician in achieving a minimally-invasive, flapless corticotomy. Material and Methods An impression of dental arches was created; the models were digitally-acquired using a 3D scanner and saved as STereoLithography ( STL ) files. The patient underwent cone beam computed tomography (CBCT): images of jaws and teeth were transformed into 3D models and saved as an STL file. An acrylic template with the design of a surgical guide was manufactured and scanned. The STLs of jaws, scanned casts, and acrylic templates were matched. 3D modeling software allowed the view of the 3D models from different perspectives and planes with perfect rendering. The 3D model of the acrylic template was transformed into a surgical guide with slots designed to guide, at first, a scalpel blade and then a piezoelectric cutting insert. The 3D STL model of the surgical guide was printed. Results This procedure allowed the manufacturing of a 3D-printed CAD/CAM surgical guide, which overcomes the disadvantages of the corticotomy, removing the need for flap elevation. No discomfort, early surgical complications or unexpected events were observed. Conclusions The effectiveness of this minimally-invasive surgical technique can offer the clinician a valid alternative to other methods currently in use. Key words:Corticotomy, orthodontics, CAD/CAM, minimally invasive, surgical template, 3D printer. PMID:27031067

  5. Systematic review of surgical treatment techniques for adult and pediatric patients with pectus excavatum

    PubMed Central

    2014-01-01

    This compares outcome measures of current pectus excavatum (PEx) treatments, namely the Nuss and Ravitch procedures, in pediatric and adult patients. Original investigations that stratified PEx patients based on current treatment and age (pediatric = 0–21; adult 17–99) were considered for inclusion. Outcome measures were: operation duration, analgesia duration, blood loss, length of stay (LOS), outcome ratings, complications, and percentage requiring reoperations. Adult implant patients (18.8%) had higher reoperation rates than adult Nuss or Ravitch patients (5.3% and 3.3% respectively). Adult Nuss patients had longer LOS (7.3 days), more strut/bar displacement (6.1%), and more epidural analgesia (3 days) than adult Ravitch patients (2.9 days, 0%, 0 days). Excluding pectus bar and strut displacements, pediatric and adult Nuss patients tended to have higher complication rates (pediatric - 38%; adult - 21%) compared to pediatric and adult Ravitch patients (12.5%; 8%). Pediatric Ravitch patients clearly had more strut displacements than adult Ravitch patients (0% and 6.4% respectively). These results suggest significantly better results in common PEx surgical repair techniques (i.e. Nuss and Ravitch) than uncommon techniques (i.e. Implants and Robicsek). The results suggest slightly better outcomes in pediatric Nuss procedure patients as compared with all other groups. We recommend that symptomatic pediatric patients with uncomplicated PEx receive the Nuss procedure. We suggest that adult patients receive the Nuss or Ravitch procedure, even though the long-term complication rates of the adult Nuss procedure require more investigation. PMID:24506826

  6. Optimal Suturing Technique and Number of Sutures for Surgical Implantation of Acoustic Transmitters in Juvenile Salmonids

    SciTech Connect

    Deters, Katherine A.; Brown, Richard S.; Boyd, James W.; Eppard, M. B.; Seaburg, Adam

    2012-01-02

    The size reduction of acoustic transmitters has led to a reduction in the length of incision needed to implant a transmitter. Smaller suture knot profiles and fewer sutures may be adequate for closing an incision used to surgically implant an acoustic microtransmitter. As a result, faster surgery times and reduced tissue trauma could lead to increased survival and decreased infection for implanted fish. The objective of this study was to assess the effects of five suturing techniques on mortality, tag and suture retention, incision openness, ulceration, and redness in juvenile Chinook salmon Oncorhynchus tshawytscha implanted with acoustic microtransmitters. Suturing was performed by three surgeons, and study fish were held at two water temperatures (12°C and 17°C). Mortality was low and tag retention was high for all treatments on all examination days (7, 14, 21, and 28 days post-surgery). Because there was surgeon variation in suture retention among treatments, further analyses included only the one surgeon who received feedback training in all suturing techniques. Incision openness and tissue redness did not differ among treatments. The only difference observed among treatments was in tissue ulceration. Incisions closed with a horizontal mattress pattern had more ulceration than other treatments among fish held for 28 days at 17°C. Results from this study suggest that one simple interrupted 1 × 1 × 1 × 1 suture is adequate for closing incisions on fish under most circumstances. However, in dynamic environments, two simple interrupted 1 × 1 × 1 × 1 sutures should provide adequate incision closure. Reducing bias in survival and behavior tagging studies is important when making comparisons to the migrating salmon population. Therefore, by minimizing the effects of tagging on juvenile salmon (reduced tissue trauma and reduced surgery time), researchers can more accurately estimate survival and behavior.

  7. [Arthrodesis of the elbow joint. Indications, surgical technique and clinical results].

    PubMed

    Moghaddam-Alvandi, A; Dremel, E; Güven, F; Heppert, V; Wagner, C; Studier-Fischer, S; Grützner, P A; Biglari, B

    2010-04-01

    Arthrodesis of the elbow joint (EA) is a rare salvage procedure which is disliked by both surgeons and patients. The aim of this study was to analyze the indications, the operation techniques and the outcome of EA in patients treated at our clinic. Between January 1997 and December 2005 a total of 20 patients with a mean age of 55 years (range 27-85 years) were treated with EA at our clinic. In 18 patients a compression plate was used as surgical technique. In 18 out of the 20 patients the operation was performed post-traumatically after infection, bone and tissue defects and painful loss of motion. Of these patients, 16 could be followed up for an average time of 66 months. The outcome was evaluated based on the degree of pain, range of motion, radiographic findings and grip strength measured with the Jamar dynamometer. All patients had a solid and fused EA, the average angle was 89 degrees (range 80-110 degrees) and the grip strength was reduced by 27% compared to the unaffected side. The patients achieved 56 points in the Morrey score, 38.29 points in the DASH (disabilities of the arm, shoulder and hand) score and 80 points in the Constant-Murley score. The indication of EA depends on several factors, therefore it is essential to take the patients' functional requirements into consideration and the best arthrodesis angle should be validated pre-operatively. In these cases the patients can regain good grip strength and a high level of stability within defined functional limitations.

  8. The CORONIS Trial. International study of caesarean section surgical techniques: a randomised fractional, factorial trial

    PubMed Central

    2007-01-01

    Background Caesarean section is one of the most commonly performed operations on women throughout the world. Rates have increased in recent years – about 20–25% in many developed countries. Rates in other parts of the world vary widely. A variety of surgical techniques for all elements of the caesarean section operation are in use. Many have not yet been rigorously evaluated in randomised controlled trials, and it is not known whether any are associated with better outcomes for women and babies. Because huge numbers of women undergo caesarean section, even small differences in post-operative morbidity rates between techniques could translate into improved health for substantial numbers of women, and significant cost savings. Design CORONIS is a multicentre, fractional, factorial randomised controlled trial and will be conducted in centres in Argentina, Ghana, India, Kenya, Pakistan and Sudan. Women are eligible if they are undergoing their first or second caesarean section through a transverse abdominal incision. Five comparisons will be carried out in one trial, using a 2 × 2 × 2 × 2 × 2 fractional factorial design. This design has rarely been used, but is appropriate for the evaluation of several procedures which will be used together in clinical practice. The interventions are: • Blunt versus sharp abdominal entry • Exteriorisation of the uterus for repair versus intra-abdominal repair • Single versus double layer closure of the uterus • Closure versus non-closure of the peritoneum (pelvic and parietal) • Chromic catgut versus Polyglactin-910 for uterine repair The primary outcome is death or maternal infectious morbidity (one or more of the following: antibiotic use for maternal febrile morbidity during postnatal hospital stay, antibiotic use for endometritis, wound infection or peritonitis) or further operative procedures; or blood transfusion. The sample size required is 15,000 women in total; at least 7,586 women in each comparison

  9. Arthroscopic grafting of scaphoid nonunion - surgical technique and preliminary findings from 23 cases.

    PubMed

    Cognet, J-M; Louis, P; Martinache, X; Schernberg, F

    2017-02-01

    We report our experience with the arthroscopic treatment of 23 cases of scaphoid nonunion. We explain the surgical technique and describe the different steps needed to achieve bone union. We report our initial clinical and radiological results. This was a prospective non-randomized study. Inclusion criteria were a scaphoid nonunion without radiocarpal arthritis, without any time limit and without any selection as to nonunion location. Before the operation, patients underwent an X-Ray and CT scan or MRI. Schernberg's classification was used to evaluate the location of the nonunion. Internal fixation was performed with a screw or K-wires. Bone grafts were taken from the dorsal side of the distal radius using a T-Lok™ bone marrow biopsy needle (Argon Medical Devices, Plano, TX, USA). A CT scan was performed 3 months after the operation to determine whether union was achieved. Pain, strength and range of motion were evaluated before and after the operation. The patients' smoking habits were also documented. The average follow-up was 17.3 months (4-41). There were 20 men and 3 women with an average age of 26 years (17-63). The average duration of nonunion before the operation was 17 months (6-60). Based on Schernberg's classification, there was one type I, 12 type II and 10 type III nonunions. Wrist strength increased from 32 to 41kg. Union was obtained in all patients after an average of 4 months (3-12). Numerous treatments have been described for treating scaphoid nonunion: Matti-Russe, Fisk-Fernadez bone graft, vascularized bone graft, bone substitutes, etc. The success rate varies depending on the technique and study design. We have described an arthroscopic technique for treating scaphoid nonunion with very promising preliminary results. Arthroscopic debridement is needed to ensure good quality bone at the graft site, while preserving extrinsic vascularization. Traction is used during the operation to restore the scaphoid height, once debridement has been

  10. Step-by-step surgical technique for mandibular reconstruction with fibular free flap: application of digital technology in virtual surgical planning.

    PubMed

    Succo, G; Berrone, M; Battiston, B; Tos, P; Goia, F; Appendino, P; Crosetti, E

    2015-06-01

    At present, mandibular reconstruction with a fibular free flap is the gold standard for functional and esthetic rehabilitation after oncological surgery. The purpose of this study was to describe the computer-assisted mandibular reconstruction procedure adopting the customized solution Synthes ProPlan CMF. The study reports five consecutive patients with benign or malignant disease requiring mandibular reconstruction using a microvascular fibular free flap, pre-operative virtual planning, construction of cutting guides and customized laser pre-bent titanium plates. The surgical technique is discussed in a step-by-step fashion. The average post-operative hospital stay was 18 ± 3 days. Ischemia time was recorded in all five cases, with an average of 75 ± 8 min. No problems were encountered in any surgical step and there were no major complications. Excellent precision of cutting guides and a good fit of pre-bent plates were found on both the mandible and fibula. There was excellent precision in bone to bone contact and position between mandible and fibula graft. Measurement data from the pre-operative and post-operative CT scans were compared. The average difference (Δ) between programed segment lengths and CT control segment lengths was 0.098 ± 0.077 cm. Microsurgical mandibular reconstruction using a virtual surgical planning yields significantly shorter ischemia times and allows more precise osteotomies. The technology is becoming increasingly recognized for its ability to optimize surgical outcomes and minimize operating time. Considering that the extent of resection can be wider than predicted, this results in safer modeling of the fibula only after frozen sections have demonstrated the radicality of resection.

  11. Surgical correction of blepharoptosis using a modified levator aponeurosis-Müller muscle complex reinsertion technique.

    PubMed

    Liu, Haipeng; Shao, Ying; Zhang, Duo

    2014-01-01

    The purpose of this study was to evaluate the outcomes after ptosis correction surgery using a modified levator aponeurosis-Müller muscle complex reinsertion technique. In this clinical study, 75 eyelids of 49 patients with congenital blepharoptosis were treated with the modified technique. The results, including complications, were followed up and evaluated. Operation was performed via anterior transcutaneous incision. After separating the preseptal orbicularis oculi muscle, the levator complex, including Müller muscle and the levator aponeurosis, was visualized. The levator complex was cut into 2 parts at the top of the conjunctival fornix to create an upper portion and a lower portion. The detached lower portion of the complex flap combined with the tarsal plate was advanced superiorly and reinserted into the posterior aspect of the upper portion of the complex flap by using 3 horizontal mattress sutures. Preoperative ptosis severity was compared with the degree of ptosis correction using the Cochran-Mantel-Haenszel test. Preoperative levator function was compared with the degree of ptosis correction and the postoperative levator function using Fisher exact test for paired data. Sufficient postoperative correction of ptosis was achieved in 78.7% of eyelids. Postoperative levator function of more than 4 mm was achieved in 82.7% of all eyelids that underwent surgery. We conclude that the modified levator aponeurosis-Müller muscle complex reinsertion technique is effective for correcting congenital blepharoptosis, especially in patients with fair to good (>4 mm) preoperative levator function.

  12. Pilot study: evaluation of the use of the convergent interview technique in understanding the perception of surgical design and simulation

    PubMed Central

    2013-01-01

    Background It is important to understand the perceived value of surgical design and simulation (SDS) amongst surgeons, as this will influence its implementation in clinical settings. The purpose of the present study was to examine the application of the convergent interview technique in the field of surgical design and simulation and evaluate whether the technique would uncover new perceptions of virtual surgical planning (VSP) and medical models not discovered by other qualitative case-based techniques. Methods Five surgeons were asked to participate in the study. Each participant was interviewed following the convergent interview technique. After each interview, the interviewer interpreted the information by seeking agreements and disagreements among the interviewees in order to understand the key concepts in the field of SDS. Results Fifteen important issues were extracted from the convergent interviews. Conclusion In general, the convergent interview was an effective technique in collecting information about the perception of clinicians. The study identified three areas where the technique could be improved upon for future studies in the SDS field. PMID:23782771

  13. WE-G-204-08: Optimized Digital Radiographic Technique for Lost Surgical Devices/Needle Identification

    SciTech Connect

    Gorman, A; Seabrook, G; Brakken, A; Dubois, M; Marn, C; Wilson, C; Jacobson, D; Liu, Y

    2015-06-15

    Purpose: Small surgical devices and needles are used in many surgical procedures. Conventionally, an x-ray film is taken to identify missing devices/needles if post procedure count is incorrect. There is no data to indicate smallest surgical devices/needles that can be identified with digital radiography (DR), and its optimized acquisition technique. Methods: In this study, the DR equipment used is a Canon RadPro mobile with CXDI-70c wireless DR plate, and the same DR plate on a fixed Siemens Multix unit. Small surgical devices and needles tested include Rubber Shod, Bulldog, Fogarty Hydrogrip, and needles with sizes 3-0 C-T1 through 8-0 BV175-6. They are imaged with PMMA block phantoms with thickness of 2–8 inch, and an abdomen phantom. Various DR techniques are used. Images are reviewed on the portable x-ray acquisition display, a clinical workstation, and a diagnostic workstation. Results: all small surgical devices and needles are visible in portable DR images with 2–8 inch of PMMA. However, when they are imaged with the abdomen phantom plus 2 inch of PMMA, needles smaller than 9.3 mm length can not be visualized at the optimized technique of 81 kV and 16 mAs. There is no significant difference in visualization with various techniques, or between mobile and fixed radiography unit. However, there is noticeable difference in visualizing the smallest needle on a diagnostic reading workstation compared to the acquisition display on a portable x-ray unit. Conclusion: DR images should be reviewed on a diagnostic reading workstation. Using optimized DR techniques, the smallest needle that can be identified on all phantom studies is 9.3 mm. Sample DR images of various small surgical devices/needles available on diagnostic workstation for comparison may improve their identification. Further in vivo study is needed to confirm the optimized digital radiography technique for identification of lost small surgical devices and needles.

  14. Advanced Fibre Bragg Grating and Microfibre Bragg Grating Fabrication Techniques

    NASA Astrophysics Data System (ADS)

    Chung, Kit Man

    Fibre Bragg gratings (FBGs) have become a very important technology for communication systems and fibre optic sensing. Typically, FBGs are less than 10-mm long and are fabricated using fused silica uniform phase masks which become more expensive for longer length or non-uniform pitch. Generally, interference UV laser beams are employed to make long or complex FBGs, and this technique introduces critical precision and control issues. In this work, we demonstrate an advanced FBG fabrication system that enables the writing of long and complex gratings in optical fibres with virtually any apodisation profile, local phase and Bragg wavelength using a novel optical design in which the incident angles of two UV beams onto an optical fibre can be adjusted simultaneously by moving just one optical component, instead of two optics employed in earlier configurations, to vary the grating pitch. The key advantage of the grating fabrication system is that complex gratings can be fabricated by controlling the linear movements of two translation stages. In addition to the study of advanced grating fabrication technique, we also focus on the inscription of FBGs written in optical fibres with a cladding diameter of several ten's of microns. Fabrication of microfibres was investigated using a sophisticated tapering method. We also proposed a simple but practical technique to filter out the higher order modes reflected from the FBG written in microfibres via a linear taper region while the fundamental mode re-couples to the core. By using this technique, reflection from the microfibre Bragg grating (MFBG) can be effectively single mode, simplifying the demultiplexing and demodulation processes. MFBG exhibits high sensitivity to contact force and an MFBG-based force sensor was also constructed and tested to investigate their suitability for use as an invasive surgery device. Performance of the contact force sensor packaged in a conforming elastomer material compares favourably to one

  15. Total hip replacement in an ipsilateral above-the-knee amputation: surgical technique, rehabilitation, and review of the literature.

    PubMed

    Malagelada, Francesc; Coll Rivas, Moisès; Jiménez Obach, Albert; Auleda, Jaume; Guirao, Lluis; Pleguezuelos, Eulogio

    2013-03-01

    In this article, we present a case report of a 62-year-old patient who previously underwent an above-the-knee amputation for vascular disease and we performed a total hip replacement on him because of hip osteoarthritis. As the only postoperative complication, the patient developed a methicillin-resistant Staphylococcus aureus surgical site infection, which was successfully treated. The surgical technique and the postoperative rehabilitation program are described in detail in an attempt to detect and face the challenges that patients with major lower limb amputations may present. The literature is reviewed and all known cases of hip replacements in amputees are presented.

  16. Parapharyngeal metastases from thyroid cancer: surgical management of two cases with minimally-invasive video-assisted technique.

    PubMed

    Giordano, L; Pilolli, F; Toma, S; Bussi, M

    2015-10-01

    Metastases to parapharyngeal or retropharyngeal lymph nodes are rare in well-differentiated thyroid cancers. A review of English literature found only 112 cases reported in the last two decades, with an incidence of parapharyngeal lymph nodes metastases ranging from 0.43 to 2.5%. Surgical resection is the most effective treatment for patients with parapharyngeal lymph node metastasis from thyroid carcinoma. We describe two cases of thyroid cancer parapharyngeal lymph node metastases that were surgically removed using a traditional transcervical approach, with the help of a minimally-invasive video-assisted technique. A video-assisted minimally-invasive transcervical approach is a new technique for excision of sizable benign tumours and selected malignant tumours. The endoscopic technique allows clear identification of critical surgical landmarks that guide the dissection through the correct cleavage plane in a nearly bloodless surgical field, thus decreasing the rate of complications. In both patients postoperative follow-up showed no sequelae and recurrence after 20 and 15 months from surgery.

  17. Far lateral microdiscectomy: a minimally-invasive surgical technique for the treatment of far lateral lumbar disc herniation

    PubMed Central

    Phan, Kevin; Dunn, Alexander E.; Rao, Prashanth J.

    2016-01-01

    Lumbar disc herniation arises when the annulus fibrosus of the vertebral disc fails, thus allowing displacement of the nucleus pulposus and other tissue. The term far lateral is used variably in the literature and usually refers to an extraforaminal displacement in the peridiscal zone peripheral to the sagittal plane of the most lateral part of the pedicle at the same level. Non-surgical treatments of far lateral disc herniation include physical therapy, anti-inflammatory medication, and corticosteroid injections. Where these conservative measures fail, surgical intervention may be required. Several surgical techniques for the treatment of far lateral herniations have been investigated, including total or medial facetectomy, laminectomy, hemilaminectomy, approaches through the pars interarticularis, and lateral approaches between the transverse processes via the intertransverse muscle and ligament. We present our far lateral microdiscectomy technique which involves accessing the nerve root lateral to the foramen through a small paramedian incision and use of an operating microscope. Far lateral microdiscectomy offers the prospect of better long-term results than other surgical techniques because of less extensive muscle dissection and preservation of the integrity of the facet joint. PMID:27683697

  18. New advanced surface modification technique: titanium oxide ceramic surface implants: long-term clinical results

    NASA Astrophysics Data System (ADS)

    Szabo, Gyorgy; Kovacs, Lajos; Barabas, Jozsef; Nemeth, Zsolt; Maironna, Carlo

    2001-11-01

    The purpose of this paper is to discuss the background to advanced surface modification technologies and to present a new technique, involving the formation of a titanium oxide ceramic coating, with relatively long-term results of its clinical utilization. Three general techniques are used to modify surfaces: the addition or removal of material and the change of material already present. Surface properties can also be changed without the addition or removal of material, through the laser or electron beam thermal treatment. The new technique outlined in this paper relates to the production of a corrosion-resistant 2000-2500 A thick, ceramic oxide layer with a coherent crystalline structure on the surface of titanium implants. The layer is grown electrochemically from the bulk of the metal and is modified by heat treatment. Such oxide ceramic-coated implants have a number of advantageous properties relative to implants covered with various other coatings: a higher external hardness, a greater force of adherence between the titanium and the oxide ceramic coating, a virtually perfect insulation between the organism and the metal (no possibility of metal allergy), etc. The coated implants were subjected to various physical, chemical, electronmicroscopic, etc. tests for a qualitative characterization. Finally, these implants (plates, screws for maxillofacial osteosynthesis and dental root implants) were applied in surgical practice for a period of 10 years. Tests and the experience acquired demonstrated the good properties of the titanium oxide ceramic-coated implants.

  19. Surgical Efficacy Among Laparoscopic Ultrasonic Dissectors: Are We Advancing Safely? A Review of Literature.

    PubMed

    Devassy, Rajesh; Gopalakrishnan, Sreelatha; De Wilde, Rudy Leon

    2015-10-01

    The specialty of laparoscopy has evolved with the advent of new technologies over the last few years. Energy-based devices and Ultrasonic dissectors are used with a lot of factors in play-including ergonomics and economics during surgery. Here an attempt is based to review the surgical efficacy and safety of these dissectors with importance to plume production and lateral thermal damage. The factors contributing to adversities to the dissectors are also to be noted. The strategy adopted was aimed at finding relevant studies from PubMed from 1995 to 2014. The basic principle of plume production and thermal damage are studied in this review. Factors contributing to the same that can lead to adversities during laparoscopic surgeries are identified. Summarizing key points that increase lateral thermal damage and plume production amongst different ultrasonic shears and suggesting a technique to identify the right balance between the existing dissectors was possible. The RF Device and USS are both useful and widely used and are more safer than monopolar devices. RF Device is considerably slower than USS, as it cannot achieve coagulation and cutting at the same time. Although USS definitely improvises dissection and has less thermal injury than RF Device, the clinical implications in balancing dissection efficacy with hemostasis need to be investigated further. The ideal haemostatic energy-based shear device would be one with excellent hemostatic results and visual acuity while allowing none or minimal thermal energy escape at the point of application. In our current setting, a combined use of both RF and USS device usage as applied in the particular situations has potential.

  20. Advanced Cytologic Techniques for the Detection of Malignant Pancreatobiliary Strictures

    PubMed Central

    Moreno Luna, Laura E.; Kipp, Benjamin; Halling, Kevin C.; Sebo, Thomas J.; Kremers., Walter K.; Roberts, Lewis R.; Barr Fritcher, Emily G.; Levy, Michael J.; Gores, Gregory J.

    2006-01-01

    Background & Aims Two advanced cytologic techniques for detecting aneuploidy, digital image analysis (DIA) and fluorescence in situ hybridization (FISH) have recently been developed to help identify malignant pancreatobiliary strictures. The aim of this study was to assess the clinical utility of cytology, DIA, and FISH for the identification of malignant pancreatobiliary strictures. Methods Brush cytologic specimens from 233 consecutive patients undergoing ERCP for pancreatobiliary strictures were examined by all three techniques. Strictures were stratified as proximal (n=33) or distal (n=114) based on whether they occurred above or below the cystic duct, respectively. Strictures in patients with PSC (n=86) were analyzed separately. Results Despite the stratification, the performances of the tests were similar. Routine cytology has a low sensitivity (5–20%) but 100% specificity. Because of the high specificity for cytology, we assessed the performance of the other tests when routine cytology was negative. In this clinical context, FISH had an increased sensitivity (35–60%) when assessing for chromosomal gains (polysomy) while preserving the specificity of cytology. The sensitivity and specificity of DIA was intermediate as compared to routine cytology and FISH, but was additive to FISH values demonstrating only trisomy of chromosome 7 or chromosome 3. Conclusions These findings suggest that FISH and DIA increase the sensitivity for the diagnosis of malignant pancreatobiliary tract strictures over that obtained by conventional cytology while maintaining an acceptable specificity. PMID:17030177

  1. The Role of Minimally Invasive Surgical Techniques in the Management of Large-gland Benign Prostatic Hypertrophy

    PubMed Central

    Sivarajan, Ganesh; Borofsky, Michael S; Shah, Ojas; Lingeman, James E; Lepor, Herbert

    2015-01-01

    Lower urinary tract symptoms (LUTS) secondary to benign prostatic hypertrophy (BPH) are among the most common medical issues for aging men. Population-based studies suggest that 13.8% of men in their 40s and more than 40% of men over age 60 have BPH. When LUTS are refractory to medical therapy and bothersome enough to warrant surgical intervention, transurethral resection of the prostate and open simple prostatectomy have been the historical reference-standard procedures for decades. Both procedures are highly effective and offer durable improvements in urinary functional outcomes. However, they also have the potential for considerable perioperative complications and morbidity. In an effort to limit surgical morbidity, a variety of minimally invasive surgical techniques to treat BPH have been introduced. Herein we present a comprehensive, evidence-based review of the efficacy and safety profile of modern minimally invasive treatments for large-gland BPH. PMID:26543428

  2. Pulley Reconstruction As Part of the Surgical Treatment for de Quervain Disease: Surgical Technique with Medium-Term Results.

    PubMed

    van der Wijk, Jacobien; Goubau, Jean F; Mermuys, Koen; van Hoonacker, Petrus; Vanmierlo, Bert; Kerckhove, Diederick; Berghs, Bart

    2015-08-01

    Background Simple decompression of the first extensor compartment is commonly used for treating de Quervain disease, with the possible complication of subluxation of the tendons of the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) over the radial styloid. To prevent this painful subluxation of the tendons, several methods of reconstructing the pulley have been proposed. Questions/Purposes The purpose of our study was to evaluate a new technique for reconstructing the first extensor compartment following a release for de Quervain disease. Patients and Methods A retrospective study (mean length 40.4 months) was performed in 45 patients. The outcome assessment involved two different questionnaires and ultrasound evaluation of any tendon subluxation. Results None of the patients required reoperation for tendon instability or incomplete decompression of the first extensor compartment. Two patients experienced clicking around the radial styloid after surgery. This was not related to the amount of volar migration of the tendons. Conclusions We believe the reconstruction proposed here is an effective method of preventing painful subluxation of the APL and EPB following a release of the first extensor compartment.

  3. Pulley Reconstruction As Part of the Surgical Treatment for de Quervain Disease: Surgical Technique with Medium-Term Results

    PubMed Central

    van der Wijk, Jacobien; Goubau, Jean F.; Mermuys, Koen; van Hoonacker, Petrus; Vanmierlo, Bert; Kerckhove, Diederick; Berghs, Bart

    2015-01-01

    Background Simple decompression of the first extensor compartment is commonly used for treating de Quervain disease, with the possible complication of subluxation of the tendons of the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) over the radial styloid. To prevent this painful subluxation of the tendons, several methods of reconstructing the pulley have been proposed. Questions/Purposes The purpose of our study was to evaluate a new technique for reconstructing the first extensor compartment following a release for de Quervain disease. Patients and Methods A retrospective study (mean length 40.4 months) was performed in 45 patients. The outcome assessment involved two different questionnaires and ultrasound evaluation of any tendon subluxation. Results None of the patients required reoperation for tendon instability or incomplete decompression of the first extensor compartment. Two patients experienced clicking around the radial styloid after surgery. This was not related to the amount of volar migration of the tendons. Conclusions We believe the reconstruction proposed here is an effective method of preventing painful subluxation of the APL and EPB following a release of the first extensor compartment. PMID:26261747

  4. Limb Angular Deformity Correction Using Dyna-ATC: Surgical Technique, Calculation Method, and Clinical Outcome

    PubMed Central

    Park, Hoon; Kim, Hyun Woo; Park, Hui-Wan

    2011-01-01

    Purpose Dyna-ATC is a unilateral external fixator with angulator, lengthener, and translator, which allows for angular correction and compensation of the secondary displacement during angular correction. The purpose of this study is to introduce surgical technique and calculation methods and to evaluate the clinical outcome of angular deformity correction using Dyna-ATC. Materials and Methods The amounts of secondary displacement were calculated with the distances between axis of correction of angulation, Center of Rotational Angulation, and osteotomy and the amount of angular deformity. The rate of angular correction was determined to distract the corticotomy at 1 mm/day. Clinical and radiographic evaluation was performed on 13 patients who underwent deformity correction using Dyna-ATC. There were 8 proximal tibia vara, 1 tibia valga, 2 varus and 4 valgus deformities on distal femur. One patient underwent pelvic support femoral reconstruction. Concomitant lengthening was combined in all femur cases. Mean age at surgery was 17.5 years (7 to 64). Results All but one achieved bony healing and normal alignment with the index procedure. Mean mechanical axis deviation improved from 31.9 mm to 3.0 mm. The average amount of angular correction was 11.0° on tibiae and 10.0° on femora. The average length gain on femora was 6.4 cm, and the healing index averaged to 1.1 mo/cm. One patient underwent quadricepsplasty and one patient had three augmentation surgeries due to poor new bone formation. Conclusion We believe that Dyna-ATC is a useful alternative to bulky ring fixators for selective patients with angular deformity less than 30 degrees in the coronal plane around the knee joint. PMID:21786448

  5. Recent Advances in Seismic Wavefront Tracking Techniques and Their Applications

    NASA Astrophysics Data System (ADS)

    Sambridge, M.; Rawlinson, N.; Hauser, J.

    2007-12-01

    In observational seismology, wavefront tracking techniques are becoming increasingly popular as a means of predicting two point traveltimes and their associated paths. Possible applications include reflection migration, earthquake relocation and seismic tomography at a wide variety of scales. Compared with traditional ray based techniques such as shooting and bending, wavefront tracking has the advantage of locating traveltimes between the source and every point in the medium; in many cases, improved efficiency and robustness; and greater potential for tracking multiple arrivals. In this presentation, two wavefront tracking techniques will be considered: the so-called Fast Marching Method (FMM), and a wavefront construction (WFC) scheme. Over the last several years, FMM has become a mature technique in seismology, with a number of improvements to the underlying theory and the release of software tools that allow it to be used in a variety of applications. At its core, FMM is a grid based solver that implicitly tracks a propagating wavefront by seeking finite difference solutions to the eikonal equation along an evolving narrow band. Recent developments include the use of source grid refinement to improve accuracy, the introduction of a multi-stage scheme to allow reflections and refractions to be tracked in layered media, and extension to spherical coordinates. Implementation of these ideas has led to a number of different applications, including teleseismic tomography, wide-angle reflection and refraction tomography, earthquake relocation, and ambient noise imaging using surface waves. The WFC scheme represents the wavefront surface as a set of points in 6-D phase space; these points are advanced in time using local initial value ray tracing in order to form a sequence of wavefront surfaces that fill the model volume. Surface refinement and simplification techniques inspired by recent developments in computer graphics are used to maintain a fixed density of nodes

  6. Management of a coronally advanced lingual flap in regenerative osseous surgery: a case series introducing a novel technique.

    PubMed

    Ronda, Marco; Stacchi, Claudio

    2011-01-01

    One of the crucial factors in the success of guided bone regeneration procedures is the correct management of the soft tissues. This allows for stable primary wound closure without tension, which can result in premature exposure of the augmentation area, jeopardizing the final outcome. The use of vertical and periosteal incisions to passivate buccal and lingual flaps in the posterior mandible is often limited by anatomical factors. This paper reports on a series of 69 consecutive cases introducing a novel surgical technique to release and advance the lingual flap coronally in a safe and predictable manner.

  7. The effect of systemic metronidazole after non-surgical treatment in moderate and advanced periodontitis in young adults.

    PubMed

    Söder, P O; Frithiof, L; Wikner, S; Wouters, F; Engström, P E; Rubin, B; Nedlich, U; Söder, B

    1990-05-01

    The effect of adjunctive systemic metronidazole was studied in patients with moderate and advanced periodontitis recalcitrant to comprehensive non-surgical treatment. The material originated from a randomly selected part of the population aged 31 to 40 years. After non-surgical treatment of 149 patients, 98 with persisting pathological pockets greater than or equal to 5 mm (52 men and 46 women) became the subjects for the study. Clinical parameters were registered and pocket contents subjected to laboratory analysis. The subjects were randomized into two groups according to a code list known only by the manufacturer and the statistician. The test group took three 400 mg metronidazole tablets daily for 1 week and the control group took placebo tablets. Reassessment 6 months later showed statistically significant clinical improvement, with a reduction in the number of sites greater than or equal to 5 mm in both test and control groups. Complete healing, with no pockets greater than or equal to 5 mm, was noted in 30% of the test group and 9% of the control group. The difference is statistically significant and shows the supplementary effect of adjunctive metronidazole in non-surgical treatment of moderate and advanced periodontitis.

  8. Surgical Technique of Corrective Osteotomy for Malunited Distal Radius Fracture Using the Computer-Simulated Patient Matched Instrument.

    PubMed

    Murase, Tsuyoshi

    2016-06-01

    The conventional corrective osteotomy for malunited distal radius fracture that employs dorsal approach and insertion of a trapezoidal bone graft does not always lead to precise correction or result in a satisfactory surgical outcome. Corrective osteotomy using a volar locking plate has recently become an alternative technique. In addition, the use of patient-matched instrument (PMI) via computed tomography simulation has been developed and is expected to simplify surgical procedures and improve surgical precision. The use of PMI makes it possible to accurately position screw holes prior to the osteotomy and simultaneously perform the correction and place the volar locking plate once the osteotomy is completed. The bone graft does not necessarily require a precise block form, and the problem of the extensor tendon contacting the dorsal plate is avoided. Although PMI placement and soft tissue release technique require some degree of specialized skill, they comprise a very useful surgical procedure. On the other hand, because patients with osteoporosis are at risk of peri-implant fracture, tandem ulnar shortening surgery should be considered to avoid excessive lengthening of the radius.

  9. For 3D laparoscopy: a step toward advanced surgical navigation: how to get maximum benefit from 3D vision.

    PubMed

    Kunert, Wolfgang; Storz, Pirmin; Kirschniak, Andreas

    2013-02-01

    The authors are grateful for the interesting perspectives given by Buchs and colleagues in their letter to the editor entitled "3D Laparoscopy: A Step Toward Advanced Surgical Navigation." Shutter-based 3D video systems failed to become established in the operating room in the late 1990s. To strengthen the starting conditions of the new 3D technology using better monitors and high definition, the authors give suggestions for its practical use in the clinical routine. But first they list the characteristics of single-channeled and bichanneled 3D laparoscopes and describe stereoscopic terms such as "comfort zone," "stereoscopic window," and "near-point distance." The authors believe it would be helpful to have the 3D pioneers assemble and share their experiences with these suggestions. Although this letter discusses "laparoscopy," it would also be interesting to collect experiences from other surgical disciplines, especially when one is considering whether to opt for bi- or single-channeled optics.

  10. Growth and physiological responses to surgical and gastric radio transmitter implantation techniques in subyearling chinook salmon (Oncorhynchus tshawytscha)

    USGS Publications Warehouse

    Martinelli, T.L.; Hansel, H.C.; Shively, R.S.

    1998-01-01

    We examined the effects of surgical and gastric transmitter implantation techniques on the growth, general physiology and behavior of 230 subyearling chinook salmon (Oncorhynchus tshawytscha, Walbaum) (100 mm-154 mm fork length). The transmitter weighed 1.3 g in air (0.9 g in water) and comprised, on average, 6% of the body weight of the fish (in air). Individuals were randomly assigned to an experimental group (control, surgical or gastric) and a sampling period (day 5 or day 21). Relative growth rate was expressed as% body weight gained/day. General condition was assessed by necropsy. Physiological response variables included hematocrit, leucocrit and plasma protein concentration. The mean relative growth rates of control, surgical and gastric fish were not significantly different at day 5. By day 21, the gastric group had a significantly lower relative growth rate (1.3%) as compared to the surgical group (1.8%) and the control group (1.9%) (P = 0.0001). Mean hematocrit values were significantly lower in the surgical (41.8%) and gastric (42.2%) groups as compared to controls (47.3%) at day 5 (P = 0.01), but all were within normal range for salmonids. No significant differences in hematocrit values were detected at day 21. Leucocrit values for all groups were ??? 1% in 99% of the fish. Both tagged groups had significantly lower mean plasma protein levels as compared to controls at day 5 (P = 0.001) and day 21 (P = 0.0001). At day 21 the gastric group (64.4 g 100 m1-1) had significantly lower mean plasma protein levels than the surgical group (68.8 g 100 ml-1) (P = 0.0001). Necropsies showed decreasing condition of gastrically tagged fish over time, and increasing condition of surgical fish. Paired releases of surgically and gastrically implanted yearling chinook salmon in the lower Columbia River in spring, 1996 revealed few significant differences in migration behavior through two reservoirs. We conclude that gastrically implanted fish show decreased growth and

  11. Advances in Poly(4-aminodiphenylaniline) Nanofibers Preparation by Electrospinning Technique.

    PubMed

    Della Pina, C; Busacca, C; Frontera, P; Antonucci, P L; Scarpino, L A; Sironi, A; Falletta, E

    2016-05-01

    Polyaniline (PANI) nanofibers are drawing a great deal of interest from academia and industry due to their multiple applications, especially in biomedical field. PANI nanofibers were successfully electrospun for the first time by MacDiarmid and co-workers at the beginning of the millennium and since then many efforts have been addressed to improve their quality. However, traditional PANI prepared from aniline monomer shows some drawbacks, such as presence of toxic (i.e., benzidine) and inorganic (salts and metals) co-products, that complicate polymer post-treatment, and low solubility in common organic solvents, making hard its processing by electrospinning technique. Some industrial sectors, such as medical and biomedical, need to employ materials free from toxic and polluting species. In this regard, the oxidative polymerization of N-(4-aminophenyl)aniline, aniline dimer, to produce poly(4-aminodiphenylaniline), P4ADA, a kind of PANI, represents an innovative alternative to the traditional synthesis because the obtained polymer results free from carcinogenic and/or polluting co-products, and, moreover, more soluble than traditional PANI. This latter feature can be exploited to obtain P4ADA nanofibers by electrospinning technique. In this paper we report the advances obtained in the P4ADA nanofibers electrospinnig. A comparison among polyethylene oxide (PEO), polymethyl methacrylate (PMMA) and polystyrene (PS), as the second polymer to facilitate the electrospinning process, is shown. In order to increase the conductivity of P4ADA nanofibers, two strategies were adopted and compared: selective insulating binder removal from electrospun nanofibers by a rinsing tratment, afterwards optimizing the minimum amount of binder necessary for the electrospinning process. Moreover, the effect of PEO/P4ADA weight ratio on the fibers morphology and conductivity was highlighted.

  12. A review of hemorheology: Measuring techniques and recent advances

    NASA Astrophysics Data System (ADS)

    Sousa, Patrícia C.; Pinho, Fernando T.; Alves, Manuel A.; Oliveira, Mónica S. N.

    2016-02-01

    Significant progress has been made over the years on the topic of hemorheology, not only in terms of the development of more accurate and sophisticated techniques, but also in terms of understanding the phenomena associated with blood components, their interactions and impact upon blood properties. The rheological properties of blood are strongly dependent on the interactions and mechanical properties of red blood cells, and a variation of these properties can bring further insight into the human health state and can be an important parameter in clinical diagnosis. In this article, we provide both a reference for hemorheological research and a resource regarding the fundamental concepts in hemorheology. This review is aimed at those starting in the field of hemodynamics, where blood rheology plays a significant role, but also at those in search of the most up-to-date findings (both qualitative and quantitative) in hemorheological measurements and novel techniques used in this context, including technical advances under more extreme conditions such as in large amplitude oscillatory shear flow or under extensional flow, which impose large deformations comparable to those found in the microcirculatory system and in diseased vessels. Given the impressive rate of increase in the available knowledge on blood flow, this review is also intended to identify areas where current knowledge is still incomplete, and which have the potential for new, exciting and useful research. We also discuss the most important parameters that can lead to an alteration of blood rheology, and which as a consequence can have a significant impact on the normal physiological behavior of blood.

  13. Arthroscopic-Assisted Acromioclavicular Joint Reconstruction Using the TightRope Device With Allograft Augmentation: Surgical Technique

    PubMed Central

    Frank, Rachel M.; Trenhaile, Scott W.

    2015-01-01

    Surgical management of acromioclavicular (AC) joint separations remains challenging, especially in the revision setting. Most commonly, Rockwood type I and II injuries are managed nonoperatively whereas type IV, V, and VI injuries are managed with surgery. Type III separations are more controversial, with evidence supporting both nonoperative and operative treatment options. Multiple different arthroscopic techniques have been described; however, there is no current gold standard. AC joint reconstruction with the TightRope device (Arthrex, Naples, FL) with the patient in the lateral decubitus position is a method of restoring joint stability that allows for a minimally invasive, low-profile fixation construct using a single drill hole through the clavicle. Allograft augmentation of this fixation construct helps to eliminate the stress risers potentially created by this device while increasing overall repair construct stability. The purpose of this article is to describe the surgical technique for arthroscopic AC joint reconstruction using a TightRope device with allograft augmentation. PMID:26759765

  14. Indication of pre-surgical radiochemotherapy enhances psychosocial morbidity among patients with resectable locally advanced rectal cancer.

    PubMed

    Bencova, V; Krajcovicova, I; Svec, J

    2016-01-01

    Patients with cancer experience stress-determined psychosocial comorbidities and behavioural alterations. Patients expectation to be cured by the first line surgery and their emotional status can be negatively influenced by the decision to include neoadjuvant long-course radiotherapy prior to surgical intervention. From the patient's perspective such treatment algorithmindicates incurability of the disease. The aim of this study was to analyse the extent and dynamics of stress and related psychosocial disturbances among patients with resectable rectal cancer to whom the neoadjuvant radiochemotherapy before surgery has been indicated.Three standardised assessment tools evaluating psychosocial morbidity of rectal cancer patients have been implemented: The EORTC QLQ C30-3, the EORTC QLQ CR29 module and the HADS questionnaires previously tested for internal consistency were answered by patients before and after long-course radiotherapy and after surgery and the scores of clinical and psychosocial values were evaluated by means of the EORTC and HADS manuals. The most profound psychosocial distress was experienced by patients after the decision to apply neoadjuvant radiotherapy and concomitant chemotherapy before surgical intervention. The involvement of pre-surgical radiotherapy into the treatment algorithm increased emotional disturbances (anxiety, feelings of hopelessness) and negatively influenced patient's treatment adherence and positive expectations from the healing process. The negative psychosocial consequences appeared to be more enhanced in female patients. Despite provided information about advances of neoadjuvant radiotherapy onto success of surgical intervention, the emotional and cognitive disorders improved only slightly. The results clearly indicate that addressed communication and targeted psychosocial support has to find place before pre-surgical radiochemotherapy and as a standard part through the trajectory of the entire multimodal rectal cancer

  15. Advances in the Surgical Management of Resectable and Borderline Resectable Pancreas Cancer.

    PubMed

    Helmink, Beth A; Snyder, Rebecca A; Idrees, Kamran; Merchant, Nipun B; Parikh, Alexander A

    2016-04-01

    Successful surgical resection offers the only chance for cure in patients with pancreatic cancer. However, pancreatic resection is feasible in less than 20% of the patients. In this review, the current state of surgical management of pancreatic cancer is discussed. The definition of resectability based on cross-sectional imaging and the technical aspects of surgery, including vascular resection and/or reconstruction, management of aberrant vascular anatomy and extent of lymphadenectomy, are appraised. Furthermore, common pancreatic resection-specific postoperative complications and their management are reviewed.

  16. Advanced Techniques for Power System Identification from Measured Data

    SciTech Connect

    Pierre, John W.; Wies, Richard; Trudnowski, Daniel

    2008-11-25

    Time-synchronized measurements provide rich information for estimating a power-system's electromechanical modal properties via advanced signal processing. This information is becoming critical for the improved operational reliability of interconnected grids. A given mode's properties are described by its frequency, damping, and shape. Modal frequencies and damping are useful indicators of power-system stress, usually declining with increased load or reduced grid capacity. Mode shape provides critical information for operational control actions. This project investigated many advanced techniques for power system identification from measured data focusing on mode frequency and damping ratio estimation. Investigators from the three universities coordinated their effort with Pacific Northwest National Laboratory (PNNL). Significant progress was made on developing appropriate techniques for system identification with confidence intervals and testing those techniques on field measured data and through simulation. Experimental data from the western area power system was provided by PNNL and Bonneville Power Administration (BPA) for both ambient conditions and for signal injection tests. Three large-scale tests were conducted for the western area in 2005 and 2006. Measured field PMU (Phasor Measurement Unit) data was provided to the three universities. A 19-machine simulation model was enhanced for testing the system identification algorithms. Extensive simulations were run with this model to test the performance of the algorithms. University of Wyoming researchers participated in four primary activities: (1) Block and adaptive processing techniques for mode estimation from ambient signals and probing signals, (2) confidence interval estimation, (3) probing signal design and injection method analysis, and (4) performance assessment and validation from simulated and field measured data. Subspace based methods have been use to improve previous results from block processing

  17. Pediatric Cardiopulmonary Resuscitation: Advances in Science, Techniques, and Outcomes

    PubMed Central

    Topjian, Alexis A.; Berg, Robert A.; Nadkarni, Vinay M.

    2009-01-01

    More than 25% of children survive to hospital discharge after in-hospital cardiac arrests, and 5% to 10% survive after out-of-hospital cardiac arrests. This review of pediatric cardiopulmonary resuscitation addresses the epidemiology of pediatric cardiac arrests, mechanisms of coronary blood flow during cardiopulmonary resuscitation, the 4 phases of cardiac arrest resuscitation, appropriate interventions during each phase, special resuscitation circumstances, extracorporeal membrane oxygenation cardiopulmonary resuscitation, and quality of cardiopulmonary resuscitation. The key elements of pathophysiology that impact and match the timing, intensity, duration, and variability of the hypoxic-ischemic insult to evidence-based interventions are reviewed. Exciting discoveries in basic and applied-science laboratories are now relevant for specific subpopulations of pediatric cardiac arrest victims and circumstances (eg, ventricular fibrillation, neonates, congenital heart disease, extracorporeal cardiopulmonary resuscitation). Improving the quality of interventions is increasingly recognized as a key factor for improving outcomes. Evolving training strategies include simulation training, just-in-time and just-in-place training, and crisis-team training. The difficult issue of when to discontinue resuscitative efforts is addressed. Outcomes from pediatric cardiac arrests are improving. Advances in resuscitation science and state-of-the-art implementation techniques provide the opportunity for further improvement in outcomes among children after cardiac arrest. PMID:18977991

  18. Recommended advanced techniques for waterborne pathogen detection in developing countries.

    PubMed

    Alhamlan, Fatimah S; Al-Qahtani, Ahmed A; Al-Ahdal, Mohammed N

    2015-02-19

    The effect of human activities on water resources has expanded dramatically during the past few decades, leading to the spread of waterborne microbial pathogens. The total global health impact of human infectious diseases associated with pathogenic microorganisms from land-based wastewater pollution was estimated to be approximately three million disability-adjusted life years (DALY), with an estimated economic loss of nearly 12 billion US dollars per year. Although clean water is essential for healthy living, it is not equally granted to all humans. Indeed, people who live in developing countries are challenged every day by an inadequate supply of clean water. Polluted water can lead to health crises that in turn spread waterborne pathogens. Taking measures to assess the water quality can prevent these potential risks. Thus, a pressing need has emerged in developing countries for comprehensive and accurate assessments of water quality. This review presents current and emerging advanced techniques for assessing water quality that can be adopted by authorities in developing countries.

  19. Dissecting cell adhesion architecture using advanced imaging techniques

    PubMed Central

    Morton, Penny E

    2011-01-01

    Cell adhesion to extracellular matrix proteins or to other cells is essential for the control of embryonic development, tissue integrity, immune function and wound healing. Adhesions are tightly spatially regulated structures containing over one hundred different proteins that coordinate both dynamics and signaling events at these sites. Extensive biochemical and morphological analysis of adhesion types over the past three decades has greatly improved understanding of individual protein contributions to adhesion signaling and, in some cases, dynamics. However, it is becoming increasingly clear that these diverse macromolecular complexes contain a variety of protein sub-networks, as well as distinct sub-domains that likely play important roles in regulating adhesion behavior. Until recently, resolving these structures, which are often less than a micron in size, was hampered by the limitations of conventional light microscopy. However, recent advances in optical techniques and imaging methods have revealed exciting insight into the intricate control of adhesion structure and assembly. Here we provide an overview of the recent data arising from such studies of cell:matrix and cell:cell contact and an overview of the imaging strategies that have been applied to study the intricacies and hierarchy of proteins within adhesions. PMID:21785274

  20. Nanocrystalline materials: recent advances in crystallographic characterization techniques

    PubMed Central

    Ringe, Emilie

    2014-01-01

    Most properties of nanocrystalline materials are shape-dependent, providing their exquisite tunability in optical, mechanical, electronic and catalytic properties. An example of the former is localized surface plasmon resonance (LSPR), the coherent oscillation of conduction electrons in metals that can be excited by the electric field of light; this resonance frequency is highly dependent on both the size and shape of a nanocrystal. An example of the latter is the marked difference in catalytic activity observed for different Pd nanoparticles. Such examples highlight the importance of particle shape in nanocrystalline materials and their practical applications. However, one may ask ‘how are nanoshapes created?’, ‘how does the shape relate to the atomic packing and crystallography of the material?’, ‘how can we control and characterize the external shape and crystal structure of such small nanocrystals?’. This feature article aims to give the reader an overview of important techniques, concepts and recent advances related to these questions. Nucleation, growth and how seed crystallography influences the final synthesis product are discussed, followed by shape prediction models based on seed crystallography and thermodynamic or kinetic parameters. The crystallographic implications of epitaxy and orientation in multilayered, core-shell nanoparticles are overviewed, and, finally, the development and implications of novel, spatially resolved analysis tools are discussed. PMID:25485133

  1. REVIEW ARTICLE: Emission measurement techniques for advanced powertrains

    NASA Astrophysics Data System (ADS)

    Adachi, Masayuki

    2000-10-01

    Recent developments in high-efficiency low-emission powertrains require the emission measurement technologies to be able to detect regulated and unregulated compounds with very high sensitivity and a fast response. For example, levels of a variety of nitrogen compounds and sulphur compounds should be analysed in real time in order to develop aftertreatment systems to decrease emission of NOx for the lean burning powertrains. Also, real-time information on the emission of particulate matter for the transient operation of diesel engines and direct injection gasoline engines is invaluable. The present paper reviews newly introduced instrumentation for such emission measurement that is demanded for the developments in advanced powertrain systems. They include Fourier transform infrared spectroscopy, mass spectrometry and fast response flame ionization detection. In addition, demands and applications of the fuel reformer developments for fuel cell electric vehicles are discussed. Besides the detection methodologies, sample handling techniques for the measurement of concentrations emitted from low emission vehicles for which the concentrations of the pollutants are significantly lower than the concentrations present in ambient air, are also described.

  2. Development of advanced strain diagnostic techniques for reactor environments.

    SciTech Connect

    Fleming, Darryn D.; Holschuh, Thomas Vernon,; Miller, Timothy J.; Hall, Aaron Christopher; Urrea, David Anthony,; Parma, Edward J.,

    2013-02-01

    The following research is operated as a Laboratory Directed Research and Development (LDRD) initiative at Sandia National Laboratories. The long-term goals of the program include sophisticated diagnostics of advanced fuels testing for nuclear reactors for the Department of Energy (DOE) Gen IV program, with the future capability to provide real-time measurement of strain in fuel rod cladding during operation in situ at any research or power reactor in the United States. By quantifying the stress and strain in fuel rods, it is possible to significantly improve fuel rod design, and consequently, to improve the performance and lifetime of the cladding. During the past year of this program, two sets of experiments were performed: small-scale tests to ensure reliability of the gages, and reactor pulse experiments involving the most viable samples in the Annulated Core Research Reactor (ACRR), located onsite at Sandia. Strain measurement techniques that can provide useful data in the extreme environment of a nuclear reactor core are needed to characterize nuclear fuel rods. This report documents the progression of solutions to this issue that were explored for feasibility in FY12 at Sandia National Laboratories, Albuquerque, NM.

  3. Nanocrystalline materials: recent advances in crystallographic characterization techniques.

    PubMed

    Ringe, Emilie

    2014-11-01

    Most properties of nanocrystalline materials are shape-dependent, providing their exquisite tunability in optical, mechanical, electronic and catalytic properties. An example of the former is localized surface plasmon resonance (LSPR), the coherent oscillation of conduction electrons in metals that can be excited by the electric field of light; this resonance frequency is highly dependent on both the size and shape of a nanocrystal. An example of the latter is the marked difference in catalytic activity observed for different Pd nanoparticles. Such examples highlight the importance of particle shape in nanocrystalline materials and their practical applications. However, one may ask 'how are nanoshapes created?', 'how does the shape relate to the atomic packing and crystallography of the material?', 'how can we control and characterize the external shape and crystal structure of such small nanocrystals?'. This feature article aims to give the reader an overview of important techniques, concepts and recent advances related to these questions. Nucleation, growth and how seed crystallography influences the final synthesis product are discussed, followed by shape prediction models based on seed crystallography and thermodynamic or kinetic parameters. The crystallographic implications of epitaxy and orientation in multilayered, core-shell nanoparticles are overviewed, and, finally, the development and implications of novel, spatially resolved analysis tools are discussed.

  4. A New Apparatus and Surgical Technique for the Dual Perfusion of Human Tumor Xenografts in Situ in Nude Rats

    PubMed Central

    Dauchy, Robert T; Dauchy, Erin M; Mao, Lulu; Belancio, Victoria P; Hill, Steven M; Blask, David E

    2012-01-01

    We present a new perfusion system and surgical technique for simultaneous perfusion of 2 tissue-isolated human cancer xenografts in nude rats by using donor blood that preserves a continuous flow. Adult, athymic nude rats (Hsd:RH-Foxn1rnu) were implanted with HeLa human cervical or HT29 colon adenocarcinomas and grown as tissue-isolated xenografts. When tumors reached an estimated weight of 5 to 6 g, rats were prepared for perfusion with donor blood and arteriovenous measurements. The surgical procedure required approximately 20 min to complete for each tumor, and tumors were perfused for a period of 150 min. Results showed that tumor venous blood flow, glucose uptake, lactic acid release, O2 uptake and CO2 production, uptake of total fatty acid and linoleic acid and conversion to the mitogen 13-HODE, cAMP levels, and activation of several marker kinases were all well within the normal physiologic, metabolic, and signaling parameters characteristic of individually perfused xenografts. This new perfusion system and technique reduced procedure time by more than 50%. These findings demonstrate that 2 human tumors can be perfused simultaneously in situ or ex vivo by using either rodent or human blood and suggest that the system may also be adapted for use in the dual perfusion of other organs. Advantages of this dual perfusion technique include decreased anesthesia time, decreased surgical manipulation, and increased efficiency, thereby potentially reducing the numbers of laboratory animals required for scientific investigations. PMID:22546915

  5. Extended endoscopic endonasal transsphenoidal approach for retrochiasmatic craniopharyngioma: Surgical technique and results

    PubMed Central

    Sankhla, Suresh K.; Jayashankar, Narayan; Khan, Ghulam M.

    2015-01-01

    Objective: Surgical treatment of retrochiasmatic craniopharyngioma still remains a challenge. While complete removal of the tumor with preservation of the vital neurovascular structures is often the goal of the treatment, there is no optimal surgical approach available to achieve this goal. Transcranial and transsphenoidal microsurgical approaches, commonly used in the past, have considerable technical limitations. The extended endonasal endoscopic surgical route, obtained by removal of tuberculum sellae and planum sphenoidale, offers direct midline access to the retrochiasmatic space and provides excellent visualization of the undersurface of the optic chiasm. In this report, we describe the technical details of the extended endoscopic approach, and review our results using this approach in the surgical management of retrochiasmatic craniopharyngiomas. Methods: Fifteen children, including 9 girls and 6 boys, aged 8 to 15 years underwent surgery using extended endoscopic transsphenoidal approach between 2008 and 2014. Nine patients had a surgical procedure done previously and presented with recurrence of symptoms and regrowth of their residual tumors. Results: A gross total or near total excision was achieved in 10 (66.7%) patients, subtotal resection in 4 (26.7%), and partial removal in 1 (6.7%) patient. Postoperatively, headache improved in 93.3%, vision recovered in 77.3%, and the hormonal levels stabilised in 66.6%. Three patients (20%) developed postoperative CSF leaks which were managed conservatively. Three (20%) patients with diabetes insipidus and 2 (13.3%) with panhypopituitarism required long-term hormonal replacement therapy. Conclusions: Our early experience suggests that the extended endonasal endoscopic approach is a reasonable option for removal of the retrochiasmal craniopharyngiomas. Compared to other surgical approaches, it provides better opportunities for greater tumor removal and visual improvement without any increase in risks. PMID:26962333

  6. Palliative Surgical Approach in Advanced Nonresponsive Mucinous Ovarian Cancer: A Rare Case Report

    PubMed Central

    Agarwal, Manika; Kumar, Ritesh; Topno, Noor; Mishra, Shweta; Dhirasaria, Ashish; Singh, A Santa

    2016-01-01

    Advanced mucinous ovarian cancer is a separate entity and has different biological behaviour. There is a wide range of therapeutic challenges and dilemmas in the management of these patients. The authors present a case of advanced ovarian mucinous cystadenocarcinoma with pseudomyxoma peritonei who had poor response to standard neoadjuvant chemotherapy. This case is highlighted to emphasize the challenges in the decision making for the management of advanced mucinous ovarian cancer. PMID:27162429

  7. Application of microsatellite PCR techniques in the identification of mixed up tissue specimens in surgical pathology.

    PubMed

    Gras, E; Matias-Guiu, X; Catasus, L; Arguelles, R; Cardona, D; Prat, J

    2000-03-01

    A fragment of tumour was erroneously mixed up with an endometrial biopsy. Micro-satellite polymerase chain reaction (PCR) clearly demonstrated the extraneous nature of the fragment. Micro-satellite PCR may be useful for the identification of mis-labelled or mismatched tissue fragments in surgical pathology specimens.

  8. ADVANCED TECHNIQUES FOR RESERVOIR SIMULATION AND MODELING OF NONCONVENTIONAL WELLS

    SciTech Connect

    Louis J. Durlofsky; Khalid Aziz

    2004-08-20

    Nonconventional wells, which include horizontal, deviated, multilateral and ''smart'' wells, offer great potential for the efficient management of oil and gas reservoirs. These wells are able to contact larger regions of the reservoir than conventional wells and can also be used to target isolated hydrocarbon accumulations. The use of nonconventional wells instrumented with downhole inflow control devices allows for even greater flexibility in production. Because nonconventional wells can be very expensive to drill, complete and instrument, it is important to be able to optimize their deployment, which requires the accurate prediction of their performance. However, predictions of nonconventional well performance are often inaccurate. This is likely due to inadequacies in some of the reservoir engineering and reservoir simulation tools used to model and optimize nonconventional well performance. A number of new issues arise in the modeling and optimization of nonconventional wells. For example, the optimal use of downhole inflow control devices has not been addressed for practical problems. In addition, the impact of geological and engineering uncertainty (e.g., valve reliability) has not been previously considered. In order to model and optimize nonconventional wells in different settings, it is essential that the tools be implemented into a general reservoir simulator. This simulator must be sufficiently general and robust and must in addition be linked to a sophisticated well model. Our research under this five year project addressed all of the key areas indicated above. The overall project was divided into three main categories: (1) advanced reservoir simulation techniques for modeling nonconventional wells; (2) improved techniques for computing well productivity (for use in reservoir engineering calculations) and for coupling the well to the simulator (which includes the accurate calculation of well index and the modeling of multiphase flow in the wellbore

  9. An Alternative Surgical Technique for Repair of Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery

    PubMed Central

    Kim, Young-su; Lee, Mina; Cho, Yang Hyun; Yang, Ji-Hyuk; Jun, Tae-Gook

    2014-01-01

    Background For the surgical management of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), there have been various techniques that reduce the tension and kinking of the coronary artery during reimplantation to the aorta. The aim of this study is to describe the results of our modified technique of coronary reimplantation for the treatment of ALCAPA. Methods Between October 2003 and February 2011, seven patients underwent coronary reimplantation with the modified technique (tubing formation with the sinus wall of the pulmonary artery and trapdoor formation at the site of implantation in the aorta). The median follow-up duration was 52 months (range, 4 to 72 months). Clinical outcomes and serial echocardiographic data were reviewed. Results There was no mortality. One patient had a small amount of cerebral hemorrhage postoperatively and improved without any sequelae. Another patient had left diaphragm palsy and underwent diaphragm plication. Follow-up echocardiogram showed that all patients had normal ventricular function without chamber enlargement. Conclusion Our modified technique (tubing formation with the sinus wall of the pulmonary artery and trapdoor formation at the site of implantation in the aorta) demonstrated successful clinical outcomes. We conclude that this surgical technique can be a potential alternative for the treatment of ALCAPA. PMID:25207218

  10. Weldability and joining techniques for advanced fossil energy system alloys

    SciTech Connect

    Lundin, C.D.; Qiao, C.Y.P.; Liu, W.; Yang, D.; Zhou, G.; Morrison, M.

    1998-05-01

    The efforts represent the concerns for the basic understanding of the weldability and fabricability of the advanced high temperature alloys so necessary to affect increases in the efficiency of the next generation Fossil Energy Power Plants. The effort was divided into three tasks with the first effort dealing with the welding and fabrication behavior of 310HCbN (HR3C), the second task details the studies aimed at understanding the weldability of a newly developed 310TaN high temperature stainless (a modification of 310 stainless) and Task 3 addressed the cladding of austenitic tubing with Iron-Aluminide using the GTAW process. Task 1 consisted of microstructural studies on 310HCbN and the development of a Tube Weldability test which has applications to production welding techniques as well as laboratory weldability assessments. In addition, the evaluation of ex-service 310HCbN which showed fireside erosion and cracking at the attachment weld locations was conducted. Task 2 addressed the behavior of the newly developed 310 TaN modification of standard 310 stainless steel and showed that the weldability was excellent and that the sensitization potential was minimal for normal welding and fabrication conditions. The microstructural evolution during elevated temperature testing was characterized and the second phase particles evolved upon aging were identified. Task 3 details the investigation undertaken to clad 310HCbN tubing with Iron Aluminide and developed welding conditions necessary to provide a crack free cladding. The work showed that both a preheat and a post-heat was necessary for crack free deposits and the effect of a third element on the cracking potential was defined together with the effect of the aluminum level for optimum weldability.

  11. Current surgical instrument labeling techniques may increase the risk of unintentionally retained foreign objects: a hypothesis

    PubMed Central

    2013-01-01

    Background Marking of surgical instruments is essential to ensure their proper identification after sterile processing. The National Quality Forum defines unintentionally retained foreign objects in a surgical patient as a serious reportable event also called "never event." Presentation of the hypothesis We hypothesize that established practices of surgical instrument identification using unkempt tape labels and plastic tags may expose patients to "never events" from retained disintegrating labels. Testing of the hypothesis We demonstrate the near miss of a "never event" during a surgical case in which the breakage of an instrument label remained initially unwitnessed. A fragment of the plastic label was accidentally found in the wound upon closing. Further clinical testing of the occurrence of this "never event" appears not feasible. As the name implies a patient should never be exposed to the risk of fragmenting labels. Implication of the hypothesis Current practice does not mandate verifying intact instrument markers as part of the instrument count. The clinical confirmation of our hypothesis mandates a change in perioperative practice: Mechanical labels need to undergo routine inspection and maintenance. The perioperative count must not only verify the quantity of surgical instruments but also the intactness of labels to ensure that no part of an instrument is left behind. Proactive maintenance of taped and dipped labels should be performed routinely. The implementation of newer labeling technologies - such as laser engraved codes - appears to eliminate risks seen in traditional mechanical labels. This article reviews current instrument marking technologies, highlights shortcomings and recommends safe instrument handling and marking practices implementing newer available technologies. PMID:24079615

  12. Advancing medical-surgical nursing practice: improving management of the changing patient condition.

    PubMed

    Monroe, Heidi; Plylar, Peggy; Krugman, Mary

    2014-01-01

    Higher patient acuities and more novice nurses on medical-surgical units have Educators focused on achieving positive outcomes with changes in patient condition. An educational program was developed to enhance nurses' knowledge, skill, and confidence in assessing hemodynamics, recognizing early signs of instability, and administering vasoactive medications. The program was successful with significant knowledge improvement as well as an increased use of the Medical Emergency Team while maintaining a low number of code calls.

  13. Basal Cell Carcinoma of the Outer Nose: Overview on Surgical Techniques and Analysis of 312 Patients

    PubMed Central

    Wollina, Uwe; Bennewitz, Annett; Langner, Dana

    2014-01-01

    Background: Basal cell carcinoma of the nose is common, with a potential of local recurrence and high-risk features. Materials and Methods: We provide a review on anatomy of the nose, tumour surgery and defect closure on the nose. We analysed our own patients with nasal BCC of a 24 months period. Results: We identified 321 patients with nasal BCC. There was a predominance of female patients of 1.2 to 1. The mean age was 74.8 years. Slow Mohs technique was employed for all tumours until 3D tumour-free margins were achieved. That resulted on average in 1.8 ± 0.7 Mohs stages. The most common histologic types were solitary (n = 182), morpheic (79), and micronodular (20), Perineural infiltration was evident in 56 tumours. Primary closure after mobilisation of soft tissue was possible in 105 BCCs. Advancement flaps were used in 91 tumours, rotation flaps in 47, transposition flaps in 34 tumours, and combined procedures in 6 cases. In 36 patients full-thickness skin grafting was performed. In two patients healing by second intention was preferred. Partial flap loss was seen in four patients (1.4%). All of them had significant underlying pathologies. None of the tumours treated showed a relapse during the observation time. However, this is a limitation of the present study since follow-up was on average only 10 months. Conclusions: BCCs of the nose are common. Only 3D-controlled micrographic surgery (Mohs or slow Mohs) guarantee a high rate of complete tumour removal and a very low risk of recurrence. PMID:25538434

  14. Surgical treatment of adult moyamoya disease with combined STA-MCA bypass and EDAS: demonstration of technique in video presentation.

    PubMed

    Li, Yiping; Cikla, Ulas; Baggott, Christopher; Yilmaz, Tevfik; Chao, Clifford; Baskaya, Mustafa K

    2015-01-01

    The natural history of Moyamoya disease (MD) is variable. Moyamoya disease in children mostly presents with progressive ischemic complications and in adulthood it tends to present with hemorrhage. Surgical strategies depend on augmenting cerebral blood flow to the anterior cerebral circulation. Revascularization is the mainstay treatment for MD. We introduce a 31 year old female with a history of MD and leftsided revascularization as a child, who presented with headache, confusion, and worsening left sided weakness. Cranial computed tomography (CT) showed a right sided putaminal hemorrhage. Cerebral angiogram with selective external runs revealed MD, hypoplastic parietal branch of the superficial temporal artery (STA) on the right side and previous revascularization on the left side. Thus, our decision was made to perform a bypass with the frontal branch of the STA to an M3-M4 segment of the middle cerebral artery and an encephaloduroarteriomyosynangiosis with the parietal branch of the STA. The patient's postoperative course was uneventful. Postoperative CT angiogram confirmed patency of bypass. This technique provides immediate revascularization and seems to provide risk reduction for ischemic and hemorrhagic stroke. We review the natural history and surgical treatment of MD along with a case presentation in which surgical technique is demonstrated in video.

  15. Inferior Alveolar Nerve Lateralization and Transposition for Dental Implant Placement. Part I: a Systematic Review of Surgical Techniques

    PubMed Central

    Juodzbalys, Gintaras

    2015-01-01

    ABSTRACT Objectives The purpose of this first part of a two-part series was to review the literature concerning the indications, contraindications, advantages, disadvantages and surgical techniques of the lateralization and transposition of the inferior alveolar nerve, followed by the placement of an implant in an edentulous atrophic posterior mandible. Material and Methods A comprehensive review of the current literature was conducted according to the PRISMA guidelines by accessing the NCBI PubMed and PMC database, academic sites and books. The articles were searched from January 1997 to July 2014 and comprised English-language articles that included adult patients between 18 and 80 years old with minimal residual bone above the mandibular canal who had undergone inferior alveolar nerve (IAN) repositioning with a minimum 6 months of follow-up. Results A total of 16 studies were included in this review. Nine were related to IAN transposition, 4 to IAN lateralization and 3 to both transposition and lateralization. Implant treatment results and complications were presented. Conclusions Inferior alveolar nerve lateralization and transposition in combination with the installation of dental implants is sometimes the only possible procedure to help patients to obtain a fixed prosthesis, in edentulous atrophic posterior mandibles. With careful pre-operative surgical and prosthetic planning, imaging, and extremely precise surgical technique, this procedure can be successfully used for implant placement in edentulous posterior mandibular segments. PMID:25937873

  16. The importance of drug-induced sedation endoscopy (D.I.S.E.) techniques in surgical decision making: conventional versus target controlled infusion techniques-a prospective randomized controlled study and a retrospective surgical outcomes analysis.

    PubMed

    De Vito, Andrea; Agnoletti, Vanni; Zani, Gianluca; Corso, Ruggero Massimo; D'Agostino, Giovanni; Firinu, Elisabetta; Marchi, Chiara; Hsu, Ying-Shuo; Maitan, Stefano; Vicini, Claudio

    2017-02-17

    Drug-Induced Sedation Endoscopy (DISE) consists of the direct observation of the upper airways during sedative-induced sleep, allowing the identification of the sites of pharyngeal collapse, which is the main pathological event in Obstructive Sleep Apnea (OSA). The Authors have compared Target Controlled Infusion (TCI) sedation endoscopy (TCI-DISE) technique to conventional DISE (CDISE), performed by a manual bolus injection of sedative agent, to recreate accurately and safely snoring and apnea patterns comparable to natural sleep. The authors conducted a prospective, randomized, long-term study and a retrospective analysis of surgical outcomes. The apnea-event observation and its correlation with pharyngeal collapse patterns is the primary endpoint; secondary endpoints are defined as stability and safety of sedation plan of DISE-TCI technique. From January 2009 to January 2011, OSA patients were included in the study and randomly allocated into two groups: the bolus injection conventional DISE group and the TCI-DISE group. Third endpoint is to compare the surgical outcomes enrolling OSA patients from January 2009 to June 2015. We recorded the complete apnea-event at oropharynx and hypopharynx levels in 15/50 pts in conventional DISE group (30%) and in 99/123 pts in TCI-DISE group (81%) (p < 0.0001). Four pts needed oxygen in conventional DISE group because a severe desaturation occurred during the first bolus of propofol (1 mg/kg) (p = 0.4872 ns). We recorded instability of the sedation plan in 13 patients of conventional DISE group (65%) and 1 patient of the TCI-DISE group (5%) (p = 0.0001). In 37 TCI-DISE group surgical patients we reported a significant reduction of postoperative AHI (from 42.7 ± 20.2 to 11.4 ± 10.3) in comparison with postoperative AHI in 15 C-DISE group surgical patients (from 41.3 ± 23.4 to 20.4 ± 15.5) (p = 0.05). Our results suggest the DISE-TCI technique as first choice in performing sleep

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

    PubMed

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

    2013-09-01

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

  18. [Outcome of treatment with surgical resection of the remaining tumor after modified M-VAC treatment for advanced urothelial carcinoma].

    PubMed

    Narita, Shintaro; Nakano, Masahiro; Matsuzaki, Masato; Watanabe, Jyunichi; Morikawa, Hiroshi; Murata, Hirokatsu; Oda, Hiroyuki; Komatsu, Hideki

    2005-03-01

    We retrospectively evaluated the effect of the surgical resection of the remaining tumor after modified M-VAC (methotrexate, vinblastine, doxorubicin and cisplatin) (m-M-VAC) treatment for locally advanced or metastatic urothelial carcinoma. In m-M-VAC therapy, methotrexate and vinblastine on 15 and 22 days were omitted from the classical M-VAC to avoid the discontinuation and the dose reduction, and duration of 1 course was shortened to 21 days from 28 days of the classical M-VAC. Seven patients with locally invasive or metastatic carcinoma of the renal pelvis, ureter, and bladder, 6 males and 1 female, with a median age 64.1 years, ranging from 49 to 77 years received m-M-VAC chemotherapy without severe side effects. In all patients, the residual viable carcinoma was completely resected and they achieved complete remission. The median survival time was 20 months (range, 7 to 61). Five of these 7 patients were still alive. Two patients had no recurrence and achieved long-term survival (survival duration; 61 and 39 months). Although further studies and long-term follow up are required, these results suggest that patients who present with locally advanced or metastatic urothelial carcinoma may benefit from surgical resection after m-M-VAC.

  19. Investigation of joining techniques for advanced austenitic alloys

    SciTech Connect

    Lundin, C.D.; Qiao, C.Y.P.; Kikuchi, Y.; Shi, C.; Gill, T.P.S.

    1991-05-01

    Modified Alloys 316 and 800H, designed for high temperature service, have been developed at Oak Ridge National Laboratory. Assessment of the weldability of the advanced austenitic alloys has been conducted at the University of Tennessee. Four aspects of weldability of the advanced austenitic alloys were included in the investigation.

  20. Intraepithelial T Cells and Tumor Proliferation: Impact on the Benefit from Surgical Cytoreduction in Advanced Serous Ovarian Cancer

    PubMed Central

    Adams, Sarah F.; Levine, Douglas A.; Cadungog, Mark G.; Hammond, Rachel; Facciabene, Andrea; Olvera, Narciso; Rubin, Stephen C.; Boyd, Jeff; Gimotty, Phyllis A.; Coukos, George

    2009-01-01

    Background We sought to determine whether tumor-infiltrating lymphocytes and/or tumor mitotic activity could identify subgroups of patients with advanced serous epithelial ovarian cancer who would maximally benefit from aggressive surgical cytoreduction. Methods Snap-frozen specimens from 134 consecutive patients with stage III or IV serous or poorly differentiated ovarian adenocarcinoma undergoing primary debulking surgery from a single US institution were characterized based on CD3+, CD8+, FoxP3+ tumor infiltrating lymphocytes, and Ki67 expression. Kaplan-Meier survival curves were estimated and compared using a log-rank statistic. A multivariate Cox model was used to estimate adjusted hazard ratios (HR). Interactions were modeled using recursive partitioning based on maximal prognostic differentiation. Results Brisk intraepithelial CD8+ cells (p=0.035) and low Ki67 expression (p=0.042) portended prolonged survival. T cell infiltration was more likely to occur in tumors with high proliferation index. Patients whose tumors exhibited low Ki67 expression and high intraepithelial CD8+ frequency had a 5-year survival rate of 73.3%. Patients with aggressive tumor behavior, i.e. whose tumors exhibited low frequency of intraepithelial CD8+ T cells or high Ki67 expression were more likely to draw benefit from aggressive surgical cytoreduction. Survival was similar for patients with brisk CD8+ T cells who had optimal or suboptimal debulking. Likewise, survival was similar for patients with low Ki67 expression who had optimal or suboptimal debulking. Conclusions These novel interactions of T cells, tumor proliferation index and surgical treatment reveal for the first time that biological prognosticators may be useful for surgical decision making in ovarian cancer. PMID:19472394

  1. Time-Dependent Effect of Chlorhexidine Surgical Prep

    DTIC Science & Technology

    2011-10-15

    Time-dependent effect of chlorhexidine surgical prep D.J. Stinner*, C.A. Krueger, B.D. Masini, J.C. Wenke United States Army Institute of Surgical ...2011 by J.A. Child Available online 15 October 2011 Keywords: Chlorhexidine Surgical site infection s u m m a r y Despite continued advances in...preoperative preventive measures and aseptic technique, surgical site infections remain a problem. The purpose of this study was to evaluate the time

  2. Cartilage repair: A review of Stanmore experience in the treatment of osteochondral defects in the knee with various surgical techniques.

    PubMed

    Vijayan, S; Bentley, G; Briggs, Twr; Skinner, Ja; Carrington, Rwj; Pollock, R; Flanagan, Am

    2010-07-01

    Articular cartilage damage in the young adult knee, if left untreated, it may proceed to degenerative osteoarthritis and is a serious cause of disability and loss of function. Surgical cartilage repair of an osteochondral defect can give the patient significant relief from symptoms and preserve the functional life of the joint. Several techniques including bone marrow stimulation, cartilage tissue based therapy, cartilage cell seeded therapies and osteotomies have been described in the literature with varying results. Established techniques rely mainly on the formation of fibro-cartilage, which has been shown to degenerate over time due to shear forces. The implantation of autologous cultured chondrocytes into an osteochondral defect, may replace damaged cartilage with hyaline or hyaline-like cartilage. This clinical review assesses current surgical techniques and makes recommendations on the most appropriate method of cartilage repair when managing symptomatic osteochondral defects of the knee. We also discuss the experience with the technique of autologous chondrocyte implantation at our institution over the past 11 years.

  3. Cartilage repair: A review of Stanmore experience in the treatment of osteochondral defects in the knee with various surgical techniques

    PubMed Central

    Vijayan, S; Bentley, G; Briggs, TWR; Skinner, JA; Carrington, RWJ; Pollock, R; Flanagan, AM

    2010-01-01

    Articular cartilage damage in the young adult knee, if left untreated, it may proceed to degenerative osteoarthritis and is a serious cause of disability and loss of function. Surgical cartilage repair of an osteochondral defect can give the patient significant relief from symptoms and preserve the functional life of the joint. Several techniques including bone marrow stimulation, cartilage tissue based therapy, cartilage cell seeded therapies and osteotomies have been described in the literature with varying results. Established techniques rely mainly on the formation of fibro-cartilage, which has been shown to degenerate over time due to shear forces. The implantation of autologous cultured chondrocytes into an osteochondral defect, may replace damaged cartilage with hyaline or hyaline-like cartilage. This clinical review assesses current surgical techniques and makes recommendations on the most appropriate method of cartilage repair when managing symptomatic osteochondral defects of the knee. We also discuss the experience with the technique of autologous chondrocyte implantation at our institution over the past 11 years. PMID:20697474

  4. Posttraumatic progressive cubitus varus deformity managed by lateral column shortening: A novel surgical technique.

    PubMed

    Srivastava, Amit; Jain, Anil-Kumar; Dhammi, Ish Kumar; Haq, Rehan-Ul

    2016-08-01

    The outward angulation of elbow with supinated forearm is cubitus varus deformity. This deformity is often seen as sequelae of malunited supracondylar fracture of humerus in paediatric age group of 5e8 years. The deformity is usually non-progressive, but in cases of physeal injury or congenital bony bar formation in the medial condyle of humerus, the deformity is progressive and can be grotesque in appearance. Various types of osteotomies are defined for standard non-progressive cubitus varus deformity, while multiple surgeries are required for progressive deformity until skeletal maturity. In this study we described a novel surgical approach and osteotomy of distal humerus in a 5 years old boy having grotesque progressive cubitus varus deformity, achieving good surgical outcome.

  5. Achilles tendon reattachment after surgical treatment of insertional tendinosis using the suture bridge technique: a case series.

    PubMed

    Witt, Bryan L; Hyer, Christopher F

    2012-01-01

    Achilles tendinopathy is a clinical diagnosis characterized as a triad of symptoms including pain, swelling, and impaired performance of the diseased tendon. Achilles tendinopathy is divided into Achilles tendonitis and tendinosis based on histopathological examination. Achilles tendinosis is viewed microscopically as disorganized collagen, abnormal neovascularization, necrosis, and mucoid degeneration. Insertional Achilles tendinosis is a degenerative process of the tendon at the junction of the tendon and calcaneus. This disease is initially treated conservatively with activity modification, custom orthotic devices, heel lifts, and immobilization. After 3 to 6 months of conservative therapy has failed to alleviate symptoms, surgical management is indicated. Surgical management of insertional Achilles tendinosis includes Achilles tendon debridement, calcaneal exostosis ostectomy, and retrocalcaneal bursa excision. In this case series, we present 4 patients who underwent surgical management of insertional Achilles tendinosis with complete tendon detachment. All patients underwent reattachment of the Achilles tendon with the suture bridge technique. The Arthrex SutureBridge(®) (Arthrex, Inc., Naples, FL) device uses a series of 4 suture anchors and FiberWire(®) (Arthrex Inc.) to reattach the Achilles tendon to its calcaneal insertion. This hourglass pattern of FiberWire(®) provides a greater area of tendon compression, consequently allowing greater stability and possible earlier return to weightbearing activities. The patients were followed up for approximately 2 years' duration. There were no intraoperative or postoperative complications. At final follow-up there was no evidence of Achilles tendon ruptures or device failures. All patients were able to return to their activities of daily living without the use of assistive devices. The patients' average visual analog pain scale was 1 (range 0 to 4), and their average foot functional index score was 3.41 (range 0

  6. An in-use microbiological comparison of two surgical hand disinfection techniques in cardiothoracic surgery: hand rubbing versus hand scrubbing.

    PubMed

    Carro, C; Camilleri, L; Traore, O; Badrikian, L; Legault, B; Azarnoush, K; Dualé, C; De Riberolles, C

    2007-09-01

    Surgical site infection after heart surgery increases morbidity and mortality. The method of presurgical hand disinfection could influence the infection risk. From February to April 2003, we compared the microbiological efficacy of hand-rubbing (R) and hand-scrubbing (S) procedures. The surgical team alternately used hand-scrubbing or hand-rubbing techniques every two weeks. Fingertip impressions were taken before and immediately after hand disinfection, every 2h and at the end of the operation. Acceptability of hand rubbing was assessed by a questionnaire. Mean durations of surgical procedures were 259+/-68 and 244+/-69min for groups S and R respectively (P=0.43). Bacterial counts immediately after hand disinfection were comparable with the two techniques, but significantly lower in group R at the end of surgery. No differences were observed between the percentages of negative samples taken after 2h, 4h and at the end of surgery between the two groups. Bacterial skin flora reduction immediately after hand disinfection, after 2h and 4h of operating time and at the end of surgery was better in group R, but the difference was not statistically significant. Before surgery, the hand-rubbing method with alcohol solution preceded by hand washing with mild neutral soap is as effective as hand scrubbing to reduce bacterial counts on hands. It decreased the bacterial counts both immediately after hand disinfection and at the end of long cardiothoracic surgical procedures. The acceptability of hand rubbing was excellent and it can be considered to be a valid alternative to the conventional hand-scrubbing protocol.

  7. In vitro biomechanical evaluation of four surgical techniques for fusion of equine centrodistal and tarsometatarsal joints.

    PubMed

    Biedrzycki, Adam H; Grant, Barrie G; Nemke, Brett; Morello, Samantha L; Markel, Mark D

    2016-10-01

    OBJECTIVE To evaluate the biomechanical properties of 4 methods for fusion of the centrodistal and tarsometatarsal joints in horses and compare them among each other and with control tarsi. SAMPLE 24 sets of paired tarsi without substantial signs of osteoarthritis harvested from equine cadavers. PROCEDURES Test constructs (n = 6/type) were prepared from 1 tarsus from each pair to represent surgical drilling; 2 medially to laterally placed kerf-cut cylinders (MLKCs); a single large, dorsally applied kerf-cut cylinder (DKC); and a dorsomedially applied locking compression plate (DMLCP). Constructs and their contralateral control tarsi were evaluated in 4-point bending in the dorsoplantar, lateromedial, and mediolateral directions; internal and external rotation; and axial compression. Bending, torsional, and axial stiffness values were calculated. RESULTS Mean stiffness values were consistently lower for surgical drilling constructs than for contralateral control tarsi. Over all biomechanical testing, surgical drilling significantly reduced joint stability. The MLKC constructs had superior biomechanical properties to those of control tarsi for 4-point bending but inferior properties for external and internal rotation. The DMLCP and DKC constructs were superior to control tarsi in dorsoplantar, rotational, and axial compression directions only; DMLCP constructs had no superior stiffness in lateromedial or mediolateral directions. Only the DKC constructs had greater stiffness in the mediolateral direction than did control tarsi. Over all biomechanical testing, DMLCP and DKC constructs were superior to the other constructs. CONCLUSIONS AND CLINICAL RELEVANCE These biomechanical results suggested that a surgical drilling approach to joint fusion may reduce tarsal stability in horses without clinical osteoarthritis, compared with stability with no intervention, whereas the DMLCP and DKC approaches may significantly enhance stability.

  8. Vaginal-sparing ventral buccal mucosal graft urethroplasty for female urethral stricture: A novel modification of surgical technique

    PubMed Central

    Gani, Johan; Chee, Justin

    2016-01-01

    Purpose To present a novel modification of surgical technique to treat female urethral stricture (FUS) by a vaginal-sparing ventral buccal mucosal urethroplasty. Recurrent FUS represents an uncommon, though difficult clinical scenario to manage definitively. A variety of surgical techniques have been described to date, yet a lack of consensus on the optimal procedure persists. Materials and Methods We present a 51-year-old female with urethral stricture involving the entire urethra. Suspected etiology was iatrogenic from cystoscopy 17 years prior. Since then, the patient had undergone at least 25 formal urethral dilations and periods of self-dilation. In lithotomy position, the urethra was dilated to accommodate forceps, and ventral urethrotomy carried out sharply, exposing a bed of periurethral tissue. Buccal mucosa was harvested, and a ventral inlay technique facilitated by a nasal speculum, was used to place the graft from the proximal urethra/bladder neck to urethral meatus without a vaginal incision. Graft was sutured into place, and urethral Foley catheter inserted. Results The vaginal-sparing ventral buccal mucosal graft urethroplasty was deemed successful as of last follow-up. Flexible cystoscopy demonstrated patency of the repair at 6 months. At 10 months of follow-up, the patient was voiding well, with no urinary incontinence. No further interventions have been required. Conclusions This case describes a novel modification of surgical technique for performing buccal mucosal urethroplasty for FUS. By avoiding incision of the vaginal mucosa, benefits may include reduced: morbidity, urinary incontinence, and wound complications including urethro-vaginal fistula. PMID:27437540

  9. Surgical hand antisepsis in veterinary practice: evaluation of soap scrubs and alcohol based rub techniques.

    PubMed

    Verwilghen, Denis R; Mainil, Jacques; Mastrocicco, Emilie; Hamaide, Annick; Detilleux, Johann; van Galen, Gaby; Serteyn, Didier; Grulke, Sigrid

    2011-12-01

    Recent studies have shown that hydro-alcoholic solutions are more efficient than traditional medicated soaps in the pre-surgical hand antisepsis of human surgeons but there is little veterinary literature on the subject. The aim of this study was to compare the efficiency of medicated soaps and a hydro-alcoholic solution prior to surgery using an in-use testing method in a veterinary setting. A preliminary trial was performed that compared the mean log(10) number of bacterial colony forming units (CFU) and the reduction factors (RF) between two 5-min hand-scrubbing sessions using different soaps, namely, povidone iodine (PVP) and chlorhexidine gluconate (CHX), and the 1.5-min application of a hydro-alcoholic rub. A clinical in-use trial was then used to compare the hydro-alcoholic rub and CHX in a surgical setting. Sampling was performed using finger printing on agar plates. The hydro-alcoholic rub and CHX had a similar immediate effect, although the sustained effect was significantly better for the hydro-alcoholic rub, while PVP had a significantly lower immediate and sustained effect. The hydro-alcoholic rub showed good efficiency in the clinical trial and could be considered as a useful alternative method for veterinary surgical hand antisepsis.

  10. The surgical correction of mandibular prognathism using rigid internal fixation--a report of a new technique together with its long-term stability.

    PubMed Central

    Reitzik, M.

    1988-01-01

    A historical review of the literature for the surgical correction of mandibular prognathism is presented, together with a list of ideal conditions for the successful treatment of this condition. This is a report of a new surgical technique which satisfies the majority of these principles and demonstrates stability at the osteotomy site. PMID:3207331

  11. Anatomic Location of PET-Positive Aortocaval Nodes in Patients with Locally Advanced Cervical Cancer: Implications for Surgical Staging

    PubMed Central

    Frumovitz, Michael; Ramirez, Pedro T.; Macapinlac, Homer A.; Klopp, Ann H.; Nick, Alpa M.; Ramondetta, Lois M.; Jhingran, Anuja

    2014-01-01

    Objective Pathologic evaluation of aortocaval nodes in patients with locally advanced cervical cancer in an effort to better tailor radiotherapy has gained popularity. We sought to determine which aortocaval nodes should be sampled during surgical staging procedures. Methods From 2004 to 2011, 246 patients with locally advanced cervical cancer underwent positron emission tomography (PET) before definitive chemoradiation. We reviewed the imaging studies to determine the location of PET-positive aortocaval nodes in relationship to the inferior mesenteric artery (IMA). Results Forty-two patients (17%) had PET images suggesting aortocaval metastasis. Ten patients had stage IB, 1 had stage IIA, 13 had stage IIB, 13 had stage IIIB, and 5 had stage IV disease. Of these 42 patients, 39 (93%) had FDG-avid pelvic nodes, 1 (2%) had PET-negative pelvic nodes but FDG-avid common iliac nodes, and 2 (5%) had direct spread to the aortocaval nodes. Three patients (7%) had FDG-avid aortocaval nodes above the IMA without FDG-avid nodes between the aortic bifurcation and IMA. All 3 of these patients also had FDG-avid nodes in the pelvis. Nineteen patients (45%) had FDG-avid nodes above and below the IMA, and 20 (48%) had FDG-avid nodes below the IMA only. Conclusions This hypothesis-generating study revealed that a small number of patients have PET-positive aortocaval nodes above the IMA only. For patients undergoing surgical staging for locally advanced cervical cancer, dissection to the renal vessels may be necessary. A future international, randomized study will prospectively evaluate the locations of pathologically positive aortocaval lymph nodes. PMID:22810967

  12. Surgical treatment of excessive gingival display using lip repositioning technique and laser gingivectomy as an alternative to orthognathic surgery.

    PubMed

    Gabrić Pandurić, Dragana; Blašković, Marko; Brozović, Juraj; Sušić, Mato

    2014-02-01

    Excessive gingival display (EGD) is a condition in which an overexposure of the maxillary gingiva (>3 mm) is present during smiling. The proper diagnosis and determination of its etiology are essential for the selection of the right treatment modality. Different techniques have been used in cases of hyperactive upper lip: botulinum toxin injections, lip elongations with rhinoplasties, lip muscle detachments, myotomies, and lip repositions. This report presents a case of a young woman with an EGD larger than 10 mm during smiling caused by altered passive eruption, vertical maxillary excess, and a hyperactive upper lip that was treated with a modified lip repositioning technique and laser gingivectomy because she strongly refused orthognathic surgical treatment. A novel addition to the technique is proposed, a reversible trial accomplished just by applying sutures on the borders of the future split-thickness flap, marked using diode laser, before starting the flap incision.

  13. [No interrupted surgical defects of the white upper lip: repair by a combined advancement and rotation flap in the lip subunit].

    PubMed

    Guillot, P

    2013-01-01

    A solid understanding of anatomy, basic surgical principles, and tissue movement is essential when undertaking the reconstruction of facial cutaneous surgical defects. Aesthetic facial reconstruction requires understanding ability to use the tissue adjacent to the defect to create a reconstruction that preserves the function of the area and the cosmetic facial units and subunits. The closure of non interrupted white upper lip defects by using a combined advancement and rotation flap is preferred for defects not overtaking 2.5 cm in diameter.

  14. Recent advances in sample preparation techniques for effective bioanalytical methods.

    PubMed

    Kole, Prashant Laxman; Venkatesh, Gantala; Kotecha, Jignesh; Sheshala, Ravi

    2011-01-01

    This paper reviews the recent developments in bioanalysis sample preparation techniques and gives an update on basic principles, theory, applications and possibilities for automation, and a comparative discussion on the advantages and limitation of each technique. Conventional liquid-liquid extraction (LLE), protein precipitation (PP) and solid-phase extraction (SPE) techniques are now been considered as methods of the past. The last decade has witnessed a rapid development of novel sample preparation techniques in bioanalysis. Developments in SPE techniques such as selective sorbents and in the overall approach to SPE, such as hybrid SPE and molecularly imprinted polymer SPE, have been addressed. Considerable literature has been published in the area of solid-phase micro-extraction and its different versions, e.g. stir bar sorptive extraction, and their application in the development of selective and sensitive bioanalytical methods. Techniques such as dispersive solid-phase extraction, disposable pipette extraction and micro-extraction by packed sorbent offer a variety of extraction phases and provide unique advantages to bioanalytical methods. On-line SPE utilizing column-switching techniques is rapidly gaining acceptance in bioanalytical applications. PP sample preparation techniques such as PP filter plates/tubes offer many advantages like removal of phospholipids and proteins in plasma/serum. Newer approaches to conventional LLE techniques (salting-out LLE) are also covered in this review article.

  15. Holospinal epidural abscess of the spinal axis: two illustrative cases with review of treatment strategies and surgical techniques.

    PubMed

    Smith, Gabriel A; Kochar, Arshneel S; Manjila, Sunil; Onwuzulike, Kaine; Geertman, Robert T; Anderson, James S; Steinmetz, Michael P

    2014-08-01

    Despite the increasing prevalence of spinal infections, the subcategory of holospinal epidural abscesses (HEAs) is extremely infrequent and requires unique management. Panspinal imaging (preferably MRI), modern aggressive antibiotic therapy, and prompt surgical intervention remain the standard of care for all spinal axis infections including HEAs; however, the surgical decision making on timing and extent of the procedure still remain ill defined for HEAs. Decompression including skip laminectomies or laminoplasties is described, with varied clinical outcomes. In this review the authors present the illustrative cases of 2 patients with HEAs who were treated using skip laminectomies and epidural catheter irrigation techniques. The discussion highlights different management strategies including the role of conservative (nonsurgical) management in these lesions, especially with an already identified pathogen and the absence of mass effect on MRI or significant neurological defects. Among fewer than 25 case reports of HEA published in the past 25 years, the most important aspect in deciding a role for surgery is the neurological examination. Nearly 20% were treated successfully with medical therapy alone if neurologically intact. None of the reported cases had an associated cranial infection with HEA, because the dural adhesion around the foramen magnum prevented rostral spread of infection. Traditionally a posterior approach to the epidural space with irrigation is performed, unless an extensive focal ventral collection is causing cord compression. Surgical intervention for HEA should be an adjuvant treatment strategy for all acutely deteriorating patients, whereas aspiration of other infected sites like a psoas abscess can determine an infective pathogen, and appropriate antibiotic treatment may avoid surgical intervention in the neurologically intact patient.

  16. Bariatric surgery for morbid obesity: pre-operative assessment, surgical techniques and post-operative monitoring.

    PubMed

    Breznikar, Brane; Dinevski, D

    2009-01-01

    This observational clinical analysis included 246 patients who underwent surgery for adjustable gastric banding (AGB), laparoscopic sleeve gastrectomy (LSG), or gastric bypass (GBP) between May 2005 and December 2008. The most frequent surgical procedure was for AGB (73.2% of patients). A thorough psychological evaluation of the patients was carried out, and pre- and post-operative psychological and dietary support was offered. A total of 111/120 (92.5%) AGB patients, 21/30 (70.0%) LSG patients and 8/36 (22.2%) GBP patients have been monitored for at least 1 year, and their mean weight losses (percentage excess weight loss) were 24.7 kg (52.4%), 46.0 kg (57.9%) and 40.5 kg (77.9%), respectively. The AGB procedure was associated with the fewest complications but is not appropriate for all patients. Good pre-operative psychological evaluation has been shown to be necessary for successful outcomes and, in the super-obese, we prefer to use LSG. Surgeons should learn the skills needed to perform laparoscopic Roux-en-Y GBP as it is likely to become the standard-of-care for the surgical treatment of obesity. The best outcomes following bariatric surgery are achieved with a multidisciplinary approach, including participation in a support group guided by a psychologist.

  17. Advanced froth flotation techniques for fine coal cleaning

    SciTech Connect

    Yoon, R.H.; Luttrell, G.H.

    1994-12-31

    Advanced column flotation cells offer many potential advantages for the treatment of fine coal. The most important of these is the ability to achieve high separation efficiencies using only a single stage of processing. Unfortunately, industrial flotation columns often suffer from poor recovery, low throughput and high maintenance requirements as compared to mechanically-agitated conventional cells. These problems can usually be attributed to poorly-designed air sparging systems. This article examines the problems of air sparging in greater detail and offers useful guidelines for designing bubble generators for industrial flotation columns. The application of these principles in the design of a successful advanced fine coal flotation circuit is also presented.

  18. Advanced visualization platform for surgical operating room coordination: distributed video board system.

    PubMed

    Hu, Peter F; Xiao, Yan; Ho, Danny; Mackenzie, Colin F; Hu, Hao; Voigt, Roger; Martz, Douglas

    2006-06-01

    One of the major challenges for day-of-surgery operating room coordination is accurate and timely situation awareness. Distributed and secure real-time status information is key to addressing these challenges. This article reports on the design and implementation of a passive status monitoring system in a 19-room surgical suite of a major academic medical center. Key design requirements considered included integrated real-time operating room status display, access control, security, and network impact. The system used live operating room video images and patient vital signs obtained through monitors to automatically update events and operating room status. Images were presented on a "need-to-know" basis, and access was controlled by identification badge authorization. The system delivered reliable real-time operating room images and status with acceptable network impact. Operating room status was visualized at 4 separate locations and was used continuously by clinicians and operating room service providers to coordinate operating room activities.

  19. Techniques for development of safety-related software for surgical robots.

    PubMed

    Varley, P

    1999-12-01

    Regulatory bodies require evidence that software controlling potentially hazardous devices is developed to good manufacturing practices. Effective techniques used in other industries assume long timescales and high staffing levels and can be unsuitable for use without adaptation in developing electronic healthcare devices. This paper discusses a set of techniques used in practice to develop software for a particular innovative medical product, an endoscopic camera manipulator. These techniques include identification of potential hazards and tracing their mitigating factors through the project lifecycle.

  20. Analytic Syntax: A Technique for Advanced Level Reading

    ERIC Educational Resources Information Center

    Berman, Ruth

    1975-01-01

    The technique explained here can increase a foreign student's awareness of English grammatical and rhetorical structures. Structural paraphrase is a syntactic reformulation of difficult phrases with minimal vocabulary changes. The technique is illustrated and suggestions are given for class presentation. (CHK)

  1. Recent advances in microscopic techniques for visualizing leukocytes in vivo

    PubMed Central

    Jain, Rohit; Tikoo, Shweta; Weninger, Wolfgang

    2016-01-01

    Leukocytes are inherently motile and interactive cells. Recent advances in intravital microscopy approaches have enabled a new vista of their behavior within intact tissues in real time. This brief review summarizes the developments enabling the tracking of immune responses in vivo. PMID:27239292

  2. Bricklaying Curriculum: Advanced Bricklaying Techniques. Instructional Materials. Revised.

    ERIC Educational Resources Information Center

    Turcotte, Raymond J.; Hendrix, Laborn J.

    This curriculum guide is designed to assist bricklaying instructors in providing performance-based instruction in advanced bricklaying. Included in the first section of the guide are units on customized or architectural masonry units; glass block; sills, lintels, and copings; and control (expansion) joints. The next two units deal with cut,…

  3. Advanced NDE techniques for quantitative characterization of aircraft

    NASA Technical Reports Server (NTRS)

    Heyman, Joseph S.; Winfree, William P.

    1990-01-01

    Recent advances in nondestructive evaluation (NDE) at NASA Langley Research Center and their applications that have resulted in quantitative assessment of material properties based on thermal and ultrasonic measurements are reviewed. Specific applications include ultrasonic determination of bolt tension, ultrasonic and thermal characterization of bonded layered structures, characterization of composite materials, and disbonds in aircraft skins.

  4. A non-surgical uterine lavage technique in large cats intended for treatment of uterine infection-induced infertility.

    PubMed

    Hildebrandt, T B; Göritz, F; Boardman, W; Strike, T; Strauss, G; Jewgenow, K

    2006-10-01

    This paper presents the successful use of a non-surgical, transcervical uterine lavage technique for the treatment of uterine infection-induced infertility in three female large cats. We developed a non-surgical uterine lavage technique, which allowed repeated flushing of the uterine lumen and installation of therapeutic antibiotics. The entire procedure was performed under general anaesthesia (duration of anesthesia ranged from 40 to 70 min). It was successfully applied in a Sumatran tiger (Panthera tigris sumatrae), a Corbett tiger (Panthera tigris corbetti) and an Amur leopard (Panthera pardus orientalis). The tigers were treated only once, whereas the leopard received four uterine treatments, due to re-infection after mating. Decisions to conduct uterine treatments were based on detection of uterine fluid during previous transrectal ultrasound examinations. The catheter was guided into the vagina, with the aid of an endoscope, passing the urethra, and then into the uterus, with the aid of transrectal ultrasonography. Both uterine horns were separately flushed with approximately 300 mL of cell medium M199, followed by an antibiotic infusion. Upon ultrasonographic re-examination, the topical uterine treatments resulted in an apparent decline in the inflammatory and/or degenerative processes. The Corbett tiger had the most severe uterine alterations, in addition to an aseptic pyometra. As a result, she was treated 1 month prior to ovariohysterectomy (in order to reduce the surgical risk). The Sumatran tiger was artificially inseminated twice after hormone-induced estrus, and the Amur leopard expressed a spontaneous estrus and re-initiated mating behaviour.

  5. Neoadjuvant Therapy of DOF Regimen Plus Bevacizumab Can Increase Surgical Resection Ratein Locally Advanced Gastric Cancer: A Randomized, Controlled Study.

    PubMed

    Ma, Junxun; Yao, Sheng; Li, Xiao-Song; Kang, Huan-Rong; Yao, Fang-Fang; Du, Nan

    2015-10-01

    Locally advanced gastric cancer (LAGC) is best treated with surgical resection. Bevacizumab in combination with chemotherapy has shown promising results in treating advanced gastric cancer. This study aimed to investigate the efficacy of neoadjuvant chemotherapy using the docetaxel/oxaliplatin/5-FU (DOF) regimen and bevacizumab in LAGC patients.Eighty LAGC patients were randomized to receive DOF alone (n = 40) or DOF plus bevacizumab (n = 40) as neoadjuvant therapy before surgery. The lesions were evaluated at baseline and during treatment. Circulating tumor cells (CTCs) were counted using the FISH test. Patients were followed up for 3 years to analyze the disease-free survival (DFS) and overall survival (OS).The total response rate was significantly higher in the DOF plus bevacizumab group than the DOF group (65% vs 42.5%, P = 0.0436). The addition of bevacizumab significantly increased the surgical resection rate and the R0 resection rate (P < 0.05). The DOF plus bevacizumab group showed significantly greater reduction in CTC counts after neoadjuvant therapy in comparison with the DOF group (P = 0.0335). Although the DOF plus bevacizumab group had significantly improved DFS than the DOF group (15.2 months vs 12.3 months, P = 0.013), the 2 groups did not differ significantly in OS (17.6 ± 1.8 months vs 16.4 ± 1.9 months, P = 0.776. Cox proportional model analysis showed that number of metastatic lymph nodes, CTC reduction, R0 resection, and neoadjuvant therapy are independent prognostic factors for patients with LAGC.Neoadjuvant of DOF regimen plus bevacizumab can improve the R0 resection rate and DFS in LAGC. These beneficial effects might be associated with the reduction in CTC counts.

  6. The Future of Rheumatoid Arthritis and Hand Surgery - Combining Evolutionary Pharmacology and Surgical Technique

    PubMed Central

    M, Malahias; H, Gardner; S, Hindocha; A, Juma; Khan, W

    2012-01-01

    Rheumatoid arthritis is a systemic autoimmune disease of uncertain aetiology, which is characterized primarily by synovial inflammation with secondary skeletal destructions. Rheumatoid Arthritis is diagnosed by the presence of four of the seven diagnostic criteria, defined by The American College of Rheumatology. Approximately half a million adults in the United Kingdom suffer from rheumatoid arthritis with an age prevalence between the second and fourth decades of life; annually approximately 20,000 new cases are diagnosed. The management of Rheumatoid Arthritis is complex; in the initial phase of the disease it primarily depends on pharmacological management. With disease progression, surgical input to correct deformity comes to play an increasingly important role. The treatment of this condition is also intimately coupled with input from both the occupational therapists and physiotherapy. PMID:22423304

  7. Comparison of a CO2 (Carbon Dioxide) Laser and Tissue Glue with Conventional Surgical Techniques in Circumcision

    PubMed Central

    Mungnirandr, Akkrapol; Wiriyakamolphan, Suwanna; Ruangtrakool, Ravit; Ngerncham, Monawat; Tumrongsombutsakul, Sureerat; Leumcharoen, Bungorn

    2015-01-01

    Introduction: CO2 (Carbon Dioxide) laser application in circumcision, for cutting and coagulation, has been reported to have excellent results. Also, tissue glue has been reported to have advantages over sutures for approximation of wound edges. Most previous studies focused on comparisons between CO2 laser and scalpel, or between tissue glue and sutures. This study prospectively compared the results and complications CO2 laser and tissue glue, with standard surgical techniques in circumcision. Methods: Thirty boys were prospectively divided into two groups. Group 1 (n = 17) underwent circumcision by scalpel with approximation of the wound edges using chromic catgut sutures. Group 2 (n = 13) underwent circumcision with CO2 laser and approximation of the wound edges using tissue glue. Patient age, indications for surgery, operative time, wound swelling, bleeding, wound infection, local irritation, pain score, and cosmetic appearance were recorded. Results: Group 1 had a significantly longer operative time (P= 0.011), higher rate of local irritation (P= 0.016), and poorer cosmetic appearance (P< 0.001) than group 2. Bleeding only occurred in one patient in group 1. There were no significant differences in pain score, wound infection rate, or cost of surgery between the two groups. Conclusions: CO2 laser and tissue glue have advantages over standard surgical techniques in circumcision, with a significantly shorter operative time, lower rate of local irritation, and better cosmetic appearance. The cost of surgery is similar between the two groups. PMID:25699165

  8. The influence of surgical technique on early posttransplant atrial fibrillation – comparison of biatrial, bicaval, and total orthotopic heart transplantation

    PubMed Central

    Rivinius, Rasmus; Helmschrott, Matthias; Ruhparwar, Arjang; Erbel, Christian; Gleissner, Christian A; Darche, Fabrice F; Thomas, Dierk; Bruckner, Tom; Katus, Hugo A; Doesch, Andreas O

    2017-01-01

    Purpose Early posttransplant atrial fibrillation (AF) has been associated with worse clinical outcomes after heart transplantation (HTX). The type of surgical technique may constitute a relevant risk factor for AF. Patients and methods This retrospective single-center study included 530 adult patients. Patients were stratified by surgical technique (biatrial, bicaval, or total orthotopic HTX) and early posttransplant heart rhythm (AF or sinus rhythm). Univariate and multivariate analyses were performed to evaluate risk factors for AF. Results A total of 161 patients received biatrial HTX (30.4%), 115 bicaval HTX (21.7%), and 254 total orthotopic HTX (47.9%). Sixty-one of 530 patients developed early posttransplant AF (11.5%). Patients with AF showed a statistically inferior 5-year survival compared to those with sinus rhythm (P<0.0001). Total orthotopic HTX had the lowest rate of AF (total orthotopic HTX [6.3%], bicaval HTX [14.8%], biatrial HTX [17.4%], P=0.0012). Multivariate analysis showed pretransplant valvular heart disease (P=0.0372), posttransplant enlarged left atrium (P=0.0066), posttransplant mitral regurgitation (P=0.0370), and non-total orthotopic HTX (P=0.0112) as risk factors for AF. Conclusion Early posttransplant AF was associated with increased mortality (P<0.0001). Total orthotopic HTX showed the lowest rate of AF compared to biatrial or bicaval HTX (P=0.0012). PMID:28331331

  9. Point-cloud-to-point-cloud technique on tool calibration for dental implant surgical path tracking

    NASA Astrophysics Data System (ADS)

    Lorsakul, Auranuch; Suthakorn, Jackrit; Sinthanayothin, Chanjira

    2008-03-01

    Dental implant is one of the most popular methods of tooth root replacement used in prosthetic dentistry. Computerize navigation system on a pre-surgical plan is offered to minimize potential risk of damage to critical anatomic structures of patients. Dental tool tip calibrating is basically an important procedure of intraoperative surgery to determine the relation between the hand-piece tool tip and hand-piece's markers. With the transferring coordinates from preoperative CT data to reality, this parameter is a part of components in typical registration problem. It is a part of navigation system which will be developed for further integration. A high accuracy is required, and this relation is arranged by point-cloud-to-point-cloud rigid transformations and singular value decomposition (SVD) for minimizing rigid registration errors. In earlier studies, commercial surgical navigation systems from, such as, BrainLAB and Materialize, have flexibility problem on tool tip calibration. Their systems either require a special tool tip calibration device or are unable to change the different tool. The proposed procedure is to use the pointing device or hand-piece to touch on the pivot and the transformation matrix. This matrix is calculated every time when it moves to the new position while the tool tip stays at the same point. The experiment acquired on the information of tracking device, image acquisition and image processing algorithms. The key success is that point-to-point-cloud requires only 3 post images of tool to be able to converge to the minimum errors 0.77%, and the obtained result is correct in using the tool holder to track the path simulation line displayed in graphic animation.

  10. Swine (Sus scrofa) as a Model of Postinfarction Mitral Regurgitation and Techniques to Accommodate Its Effects during Surgical Repair

    PubMed Central

    Sarin, Eric L; Shi, Weiwei; Duara, Rajnish; Melone, Todd A; Kalra, Kanika; Strong, Ashley; Girish, Apoorva; McIver, Bryant V; Thourani, Vinod H; Guyton, Robert A; Padala, Muralidhar

    2016-01-01

    Mitral regurgitation (MR) is a common heart-valve lesion after myocardial infarction in humans. Because it is considered a risk factor for accelerated heart failure and death, various surgical approaches and catheter-based devices to correct it are in development. Lack of a reproducible animal model of MR after myocardial infarction and reliable techniques to perform open-heart surgery in these diseased models led to the use of healthy animals to test new devices. Thus, most devices that are deemed safe in healthy animals have shown poor results in human efficacy studies, hampering progress in this area of research. Here we report our experience with a swine model of postinfarction MR, describe techniques to induce regurgitation and perform open-heart surgery in these diseased animals, and discuss our outcomes, complications, and solutions. PMID:27538860

  11. Swine (Sus scrofa) as a Model of Postinfarction Mitral Regurgitation and Techniques to Accommodate Its Effects during Surgical Repair.

    PubMed

    Sarin, Eric L; Shi, Weiwei; Duara, Rajnish; Melone, Todd A; Kalra, Kanika; Strong, Ashley; Girish, Apoorva; McIver, Bryant V; Thourani, Vinod H; Guyton, Robert A; Padala, Muralidhar

    2016-01-01

    Mitral regurgitation (MR) is a common heart-valve lesion after myocardial infarction in humans. Because it is considered a risk factor for accelerated heart failure and death, various surgical approaches and catheter-based devices to correct it are in development. Lack of a reproducible animal model of MR after myocardial infarction and reliable techniques to perform open-heart surgery in these diseased models led to the use of healthy animals to test new devices. Thus, most devices that are deemed safe in healthy animals have shown poor results in human efficacy studies, hampering progress in this area of research. Here we report our experience with a swine model of postinfarction MR, describe techniques to induce regurgitation and perform open-heart surgery in these diseased animals, and discuss our outcomes, complications, and solutions.

  12. The traumatic lower extremity amputee: surgical challenges and advances in prosthetics.

    PubMed

    Cannada, Lisa K; Vaidya, Rahul; Covey, Dana C; Hanna, Kathryn; Dougherty, Paul

    2013-01-01

    The mangled lower extremity is a challenging injury to treat. Orthopaedic surgeons treating patients with these severe injuries must have a clear understanding of contemporary advantages and disadvantages of limb salvage versus amputation. It is helpful to review the acute management of mangled extremity injuries in the civilian and military populations, to be familiar with current postoperative protocols, and to recognize recent advances in prosthetic devices.

  13. Backscattered Electron Microscopy as an Advanced Technique in Petrography.

    ERIC Educational Resources Information Center

    Krinsley, David Henry; Manley, Curtis Robert

    1989-01-01

    Three uses of this method with sandstone, desert varnish, and granite weathering are described. Background information on this technique is provided. Advantages of this type of microscopy are stressed. (CW)

  14. Advanced Statistical Signal Processing Techniques for Landmine Detection Using GPR

    DTIC Science & Technology

    2014-07-12

    based ground penetrating radars for the detection of subsurface objects that are low in metal content and hard to detect. The derived techniques...penetrating radars for the detection of subsurface objects that are low in metal content and hard to detect. The derived techniques include the exploitation...5.00 4.00 3.00 9.00 T. Glenn, J. Wilson, D. Ho. A MULTIMODAL MATCHING PURSUITS DISSIMILARITY MEASURE APPLIED TO LANDMINE/CLUTTER DISCRIMINATION

  15. Electroextraction and electromembrane extraction: Advances in hyphenation to analytical techniques

    PubMed Central

    Oedit, Amar; Ramautar, Rawi; Hankemeier, Thomas

    2016-01-01

    Electroextraction (EE) and electromembrane extraction (EME) are sample preparation techniques that both require an electric field that is applied over a liquid‐liquid system, which enables the migration of charged analytes. Furthermore, both techniques are often used to pre‐concentrate analytes prior to analysis. In this review an overview is provided of the body of literature spanning April 2012–November 2015 concerning EE and EME, focused on hyphenation to analytical techniques. First, the theoretical aspects of concentration enhancement in EE and EME are discussed to explain extraction recovery and enrichment factor. Next, overviews are provided of the techniques based on their hyphenation to LC, GC, CE, and direct detection. These overviews cover the compounds and matrices, experimental aspects (i.e. donor volume, acceptor volume, extraction time, extraction voltage, and separation time) and the analytical aspects (i.e. limit of detection, enrichment factor, and extraction recovery). Techniques that were either hyphenated online to analytical techniques or show high potential with respect to online hyphenation are highlighted. Finally, the potential future directions of EE and EME are discussed. PMID:26864699

  16. Advanced millimeter-wave security portal imaging techniques

    NASA Astrophysics Data System (ADS)

    Sheen, David M.; Bernacki, Bruce E.; McMakin, Douglas L.

    2012-03-01

    Millimeter-wave (mm-wave) imaging is rapidly gaining acceptance as a security tool to augment conventional metal detectors and baggage x-ray systems for passenger screening at airports and other secured facilities. This acceptance indicates that the technology has matured; however, many potential improvements can yet be realized. The authors have developed a number of techniques over the last several years including novel image reconstruction and display techniques, polarimetric imaging techniques, array switching schemes, and high-frequency high-bandwidth techniques. All of these may improve the performance of new systems; however, some of these techniques will increase the cost and complexity of the mm-wave security portal imaging systems. Reducing this cost may require the development of novel array designs. In particular, RF photonic methods may provide new solutions to the design and development of the sequentially switched linear mm-wave arrays that are the key element in the mm-wave portal imaging systems. Highfrequency, high-bandwidth designs are difficult to achieve with conventional mm-wave electronic devices, and RF photonic devices may be a practical alternative. In this paper, the mm-wave imaging techniques developed at PNNL are reviewed and the potential for implementing RF photonic mm-wave array designs is explored.

  17. Advanced Endovascular Approaches in the Management of Challenging Proximal Aortic Neck Anatomy: Traditional Endografts and the Snorkel Technique

    PubMed Central

    Quatromoni, Jon G.; Orlova, Ksenia; Foley, Paul J.

    2015-01-01

    Advances in endovascular technology, and access to this technology, have significantly changed the field of vascular surgery. Nowhere is this more apparent than in the treatment of abdominal aortic aneurysms (AAAs), in which endovascular aneurysm repair (EVAR) has replaced the traditional open surgical approach in patients with suitable anatomy. However, approximately one-third of patients presenting with AAAs are deemed ineligible for standard EVAR because of anatomic constraints, the majority of which involve the proximal aneurysmal neck. To overcome these challenges, a bevy of endovascular approaches have been developed to either enhance stent graft fixation at the proximal neck or extend the proximal landing zone to allow adequate apposition to the aortic wall and thus aneurysm exclusion. This article is composed of two sections that together address new endovascular approaches for treating aortic aneurysms with difficult proximal neck anatomy. The first section will explore advancements in the traditional EVAR approach for hostile neck anatomy that maximize the use of the native proximal landing zone; the second section will discuss a technique that was developed to extend the native proximal landing zone and maintain perfusion to vital aortic branches using common, off-the-shelf components: the snorkel technique. While the techniques presented differ in terms of approach, the available clinical data, albeit limited, support the notion that they may both have roles in the treatment algorithm for patients with challenging proximal neck anatomy. PMID:26327748

  18. Coal and char studies by advanced EMR techniques

    SciTech Connect

    Belford, R.L.; Clarkson, R.B.; Odintsov, B.M.

    1999-03-31

    Advanced magnetic resonance (EMR) methods are used to examine properties of coals, chars, and molecular species related to constituents of coal. During this grant period, further progress was made on proton NMR and low-frequency dynamic nuclear polarization (DNP) to examine the interaction between fluids such as water and the surface of suspended char particles. Effects of char particle size and type on water nuclear spin relaxation, T2, were measured and modeled.

  19. Coal and char studies by advanced EMR techniques

    SciTech Connect

    Belford, R.L.; Clarkson, R.B.; Odintsov, B.M.

    1998-09-30

    Advanced magnetic resonance (EMR) methods are used to examine properties of coals, chars, and molecular species related to constituents of coal. During this grant period, further progress was made on proton NMR and low-frequency dynamic nuclear polarization (DNP) to examine the interaction between fluids such as water and the surface of suspended char particles. Effects of char particle size on water nuclear spin relaxation, T2, were measured.

  20. Influence of two different surgical techniques on the difficulty of impacted lower third molar extraction and their post-operative complications

    PubMed Central

    Ohanyan, Ani; Kechagias, Nikos; Tsekos, Antonis; Vahtsevanos, Konstantinos

    2015-01-01

    Background Post-operative complications of various degrees of severity are commonly observed in third molar impaction surgery. For this reason, a surgical procedure that decreases the trauma of bone and soft tissues should be a priority for surgeons. In the present study, we compare the efficacy and the post-operative complications of patients to whom two different surgical techniques were applied for impacted lower third molar extraction. Material and Methods Patients of the first group underwent the classical bur technique, while patients of the second group underwent another technique, in which an elevator was placed on the buccal surface of the impacted molar in order to luxate the alveolar socket more easily. Results Comparing the two techniques, we observed a statistically significant decrease in the duration of the procedure and in the need for tooth sectioning when applying the second surgical technique, while the post-operative complications were similar in the two groups. We also found a statistically significant lower incidence of lingual nerve lesions and only a slightly higher frequency of sharp mandibular bone irregularities in the second group, which however was not statistically significant. Conclusions The results of our study indicate that the surgical technique using an elevator on the buccal surface of the tooth seems to be a reliable method to extract impacted third molars safely, easily, quickly and with the minimum trauma to the surrounding tissues. Key words:Mandibular third molar, impacted, surgical technique, extraction, elevator. PMID:26116843

  1. Data mining techniques for assisting the diagnosis of pressure ulcer development in surgical patients.

    PubMed

    Su, Chao-Ton; Wang, Pa-Chun; Chen, Yan-Cheng; Chen, Li-Fei

    2012-08-01

    Pressure ulcer is a serious problem during patient care processes. The high risk factors in the development of pressure ulcer remain unclear during long surgery. Moreover, past preventive policies are hard to implement in a busy operation room. The objective of this study is to use data mining techniques to construct the prediction model for pressure ulcers. Four data mining techniques, namely, Mahalanobis Taguchi System (MTS), Support Vector Machines (SVMs), decision tree (DT), and logistic regression (LR), are used to select the important attributes from the data to predict the incidence of pressure ulcers. Measurements of sensitivity, specificity, F(1), and g-means were used to compare the performance of four classifiers on the pressure ulcer data set. The results show that data mining techniques obtain good results in predicting the incidence of pressure ulcer. We can conclude that data mining techniques can help identify the important factors and provide a feasible model to predict pressure ulcer development.

  2. [The Omega "Omega" pulley plasty: a new technique for the surgical management of the De Quervain's disease].

    PubMed

    Bakhach, J; Sentucq-Rigal, J; Mouton, P; Boileau, R; Panconi, B; Guimberteau, J-C

    2006-02-01

    The Omega "Omega" pulley plasty: a new technique for the surgical management of the De Quervain's disease. The De Quervain tenosynovitis is an inadequacy into the first extensor compartment between the osteo-fibrous tunnel and the tendons. This mechanical conflict generates a tenosynovitis of the extensor pollicis brevis and the abductor pollicis longus tendons. This is generally expressed by a tenderness on the radial side of the wrist over the radial styloid process. The medical management consists on corticoids infiltrations of the first extensor compartment, the avoidance of repetitive and stress movements of the first ray with the use of a rest splint. The surgical approach is considered with the recurrence of the painful symptoms. This well-known pathology is reputated to require a simple section of the pulley. Our post-operative complications have been reported in the literature of this classical surgical solution. These complications concern an incomplete release of the extensor pollicis brevis and the abductor pollicis longus tendons particularly when an extensor sub-compartment exists and was overlooked, an irritation of the collateral branches of the sensitive radial nerve or the occurrence of a nevroma after a nerve injury and the most serious complication is a palmar subluxation of the extensor tendons which can occur with the thumb extended and the wrist flexed. In rare cases, this subluxation can be really painful and requires a surgical management with secondary reconstruction of the pulley. This reconstruction necessitates distal pedicle flaps from the dorsal retinaculum or the brachioradialis tendon. To prevent these complications, Codega and Kapandji described techniques of reconstruction of the pulley after its release. More recently, Le Viet reported a procedure using the anterior flap of the pulley; fixed to the dermis it will work as a barrier and maintain the tendons sliding on the radial styloid groove. These techniques require to divide

  3. Application of Active Learning Techniques to an Advanced Course

    NASA Astrophysics Data System (ADS)

    Knop, R. A.

    2004-05-01

    The New Faculty Workshop provided a wealth of techniques as well as an overriding philosophy for the teaching of undergraduate Physics and Astronomy courses. The focus of the workshop was active learning, summarized in ``Learner-Centered Astronomy Teaching" by Slater & Adams: it's not what you do in class that matters, it's what the students do. Much of the specific focus of the New Faculty Workshop is on teaching the large, introductory Physics classes that many of the faculty present are sure to teach, both algebra-based and calculus-based. Many of these techniques apply directly and with little modification to introductory Astronomy courses. However, little direct attention is given to upper-division undergraduate, or even graduate, courses. In this presentation, I will share my experience in attempting to apply some of the techniques discussed at the New Faculty Workshop to an upper-division course in Galactic Astrophysics at Vanderbilt University during the Spring semester of 2004.

  4. The bumper technique for advancing a large profile microcatheter.

    PubMed

    Kellner, Christopher P; Chartrain, Alexander G; Schwegel, Claire; Oxley, Thomas J; Shoirah, Hazem; Mocco, J

    2017-03-09

    Operators commonly encounter difficulty maneuvering a microcatheter beyond the distal lip of wide neck aneurysms and aneurysms in challenging locations. Few techniques have been described to guide operators in these particular situations. In this case report of a 56-year-old woman with a 16 mm ophthalmic artery aneurysm, the microcatheter continually snagged the distal aneurysm lip, preventing delivery of a flow diverter into the distal parent vessel. In troubleshooting this obstacle, a second microguidewire was introduced alongside the microcatheter and was used to cover the distal lip of the aneurysm to prevent further snagging. The second guidewire successfully deflected the microcatheter into the distal vessel, a technique that we have aptly dubbed the 'bumper technique'.

  5. Nondestructive Evaluation of Thick Concrete Using Advanced Signal Processing Techniques

    SciTech Connect

    Clayton, Dwight A; Barker, Alan M; Santos-Villalobos, Hector J; Albright, Austin P; Hoegh, Kyle; Khazanovich, Lev

    2015-09-01

    The purpose of the U.S. Department of Energy Office of Nuclear Energy’s Light Water Reactor Sustainability (LWRS) Program is to develop technologies and other solutions that can improve the reliability, sustain the safety, and extend the operating lifetimes of nuclear power plants (NPPs) beyond 60 years [1]. Since many important safety structures in an NPP are constructed of concrete, inspection techniques must be developed and tested to evaluate the internal condition. In-service containment structures generally do not allow for the destructive measures necessary to validate the accuracy of these inspection techniques. This creates a need for comparative testing of the various nondestructive evaluation (NDE) measurement techniques on concrete specimens with known material properties, voids, internal microstructure flaws, and reinforcement locations.

  6. Transcranial Doppler: Techniques and advanced applications: Part 2

    PubMed Central

    Sharma, Arvind K.; Bathala, Lokesh; Batra, Amit; Mehndiratta, Man Mohan; Sharma, Vijay K.

    2016-01-01

    Transcranial Doppler (TCD) is the only diagnostic tool that can provide continuous information about cerebral hemodynamics in real time and over extended periods. In the previous paper (Part 1), we have already presented the basic ultrasound physics pertaining to TCD, insonation methods, and various flow patterns. This article describes various advanced applications of TCD such as detection of right-to-left shunt, emboli monitoring, vasomotor reactivity (VMR), monitoring of vasospasm in subarachnoid hemorrhage (SAH), monitoring of intracranial pressure, its role in stoke prevention in sickle cell disease, and as a supplementary test for confirmation of brain death. PMID:27011639

  7. Brain development in preterm infants assessed using advanced MRI techniques.

    PubMed

    Tusor, Nora; Arichi, Tomoki; Counsell, Serena J; Edwards, A David

    2014-03-01

    Infants who are born preterm have a high incidence of neurocognitive and neurobehavioral abnormalities, which may be associated with impaired brain development. Advanced magnetic resonance imaging (MRI) approaches, such as diffusion MRI (d-MRI) and functional MRI (fMRI), provide objective and reproducible measures of brain development. Indices derived from d-MRI can be used to provide quantitative measures of preterm brain injury. Although fMRI of the neonatal brain is currently a research tool, future studies combining d-MRI and fMRI have the potential to assess the structural and functional properties of the developing brain and its response to injury.

  8. Application of advanced coating techniques to rocket engine components

    NASA Technical Reports Server (NTRS)

    Verma, S. K.

    1988-01-01

    The materials problem in the space shuttle main engine (SSME) is reviewed. Potential coatings and the method of their application for improved life of SSME components are discussed. A number of advanced coatings for turbine blade components and disks are being developed and tested in a multispecimen thermal fatigue fluidized bed facility at IIT Research Institute. This facility is capable of producing severe strains of the degree present in blades and disk components of the SSME. The potential coating systems and current efforts at IITRI being taken for life extension of the SSME components are summarized.

  9. Acute coronary syndromes without persistent st-segment elevation: advances in surgical revascularization.

    PubMed

    Zoffoli, Giampaolo; Nicolini, Francesco; Beghi, Cesare; Budillon, Alessandro Maria; Agostinelli, Andrea; Borrello, Bruno; Cagnoni, Giovanni; Frassetto, Guido; Fragnito, Claudio; Gherli, Tiziano

    2005-09-01

    Coronary artery bypass grafting (CABG) still plays a fundamental role in the management of acute coronary syndromes. The aim of this study is to report the experience of our center in the treatment of patients with acute coronary sindromes without persistent ST elevation urgently operated on with CABG, and to discuss surgical problems related. Two-hundred and six patients were urgently operated on for CABG for acute coronary syndromes without persistent ST-segment elevation from January 2001 to February 2003. The majority of them had three vessel coronary disease (72%) and left main stem disease occurred in 20% of the patients. Mean LVEF (left ventricular ejection fraction) was 54 +/- 12% whereas 9% of the patients had a LVEF < 40%. Twenty-one patients (10%) received glycoprotein IIb/IIIa receptor inhibitors and 35 (17%) received intravenous heparin therapy before surgery. Mean interval time between the onset of symptoms and surgery was 16 +/- 10 days (range 4-50). In-hospital mortality was 2% (4 patients). Perioperative AMI (acute myocardial infarction) occurred in 4% (8 patients) and a transient low cardiac output syndrome in 27 patients (13%). Bleeding requiring surgery occurred in 1% of the patients. Transient respiratory insufficiency was present in 12 patients (6%) and acute renal failure in 8 patients (4%). Mean I.C.U. time was 2.4 days (1-17). Urgent CABG for acute coronary syndromes shows a low risk for in-hospital mortality and morbidity. In acute patients arterial grafts are not detrimental for the outcome, but are recommended in the absence of contraindications to improve long-term results. In spite of recent developments in cardioplegic cardiac arrest, optimal myocardial protection against perioperative myocardial infarction still remains a challenge.

  10. Arthroscopic contact Nd:YAG laser meniscectomy: basic science, surgical technique, and clinical follow up

    NASA Astrophysics Data System (ADS)

    O'Brien, Stephen J.; Fealy, Stephen V.; Gibney, Mary A.; Miller, Drew V.; Kelly, Anne M.

    1990-06-01

    Recent basic science studies (5) have provided a scientific foundation for the use of the Contact Nd:YAG Laser as an arthroscopic tool for xneniscal resection and acroxnioplasty of the shoulder in a saline medium. This study prospectively evaluates the results of a three stage laboratory investigation as well as the clinical results of arthroscopic xneniscal resection. Fifteen patients with meniscal tears underwent subtotal meniscectomies utilizing a Contact Nd:YAG Laser (Surgical Laser Technologies; Malvern, Pennsylvania) . This was done in a saline medium with an average laser wattage of 25 W, (range 20 W to 30 W). Patients were evaluated postoperatively with reference to subjective and objective parameters at one week and four weeks postoperatively. Patients were evaluated with regard to wound healing, intraarticular swelling and pain. Assessment of technical parameters such as ease of resection, time of resection and instrument access were compared to conventional instruments. All fifteen patients were rated as having clinically excellent results based on pain relief, wound healing and swelling. In addition, although there was increased time with setting up the laser and calibrating it, there was not an increase in time for meniscal resection. Little, or no, secondary "trimmuning" was necessary with the laser. Increased accessibility was noted due to the small size of the laser. Arthroscopic Contact Nd:YAG Laser surgery is a safe and effective tool for menisca]. resection and coagulation in arthroscopic acromioplasties. It provides significant advantages over conventional cutting instruments with regard to accessibility and reduced need for secondary instruments.

  11. Sensitivity of knee soft-tissues to surgical technique in total knee arthroplasty.

    PubMed

    Schirm, Andreas C; Jeffcote, Benjamin O; Nicholls, Rochelle L; Jakob, Hilaire; Kuster, Markus S

    2011-06-01

    Restricted range of motion and excessive laxity are both potential complications of total knee arthroplasty (TKA). During TKA surgery, the surgeon is frequently faced with the question of how tightly to implant the prosthesis. The most common method of altering implantation tightness is to vary the thickness of the polyethylene inlay after the bone cuts have been made and the trial components inserted. We have sought to quantify how altering the polyethylene thickness may affect post-operative soft tissue tension for a range of prosthetic designs. Four different prosthetic designs were implanted into fresh-frozen cadaveric knee joints. All four designs were implanted in the standard manner, with a 100 Newton distraction force used to set soft tissue balance. The tibiofemoral force was then recorded at 15° intervals throughout the passive flexion range. After the standard implantation of each prosthesis, the tibial component was raised or lowered to mimic increasing and decreasing the polyethylene thickness by 2mm and the force measurements repeated. Tibiofemoral force in extension correlated with implantation tightness for all prosthesis designs. Between 15° and 90° of knee flexion, all four designs were insensitive to changes in implantation tightness. Beyond 90° the effect was more notable in rotating platform mobile-bearing and cruciate-retaining prostheses than in posterior-stabilised mobile-bearing designs. The findings of this research may be useful in assisting surgical decision-making during the implantation of TKA prostheses.

  12. Current concepts in plasticity and nerve transfers: relationship between surgical techniques and outcomes.

    PubMed

    Socolovsky, Mariano; Malessy, Martijn; Lopez, Dan; Guedes, Fernando; Flores, Leandro

    2017-03-01

    OBJECTIVE Neuroplasticity is analyzed in this article as the capacity of the CNS to adapt to external and internal stimuli. It is being increasingly recognized as an important factor for the successful outcome of nerve transfers. Better-known factors are the number of axons that cross the coaptation site, the time interval between trauma and repair, and age. Neuroplasticity is mediated initially by synaptic and neurotransmitter changes. Over time, the activation of previously existing but lowly active connections in the brain cortex contributes further. Dendritic sprouting and axonal elongation might also take place but are less likely to be prominent. METHODS The authors reviewed different factors that play roles in neuroplasticity and functional regeneration after specific nerve transfers. RESULTS The authors found that these different factors include, among others, the distance between cortical areas of the donor and receptor neurons, the presence versus absence of preexisting lowly active interneuronal connections, gross versus fine movement restoration, rehabilitation, brain trauma, and age. CONCLUSIONS The potential for plasticity should be taken into consideration by surgeons when planning surgical strategy and postoperative rehabilitation, because its influence on results cannot be denied.

  13. Benefits of advanced software techniques for mission planning systems

    NASA Technical Reports Server (NTRS)

    Gasquet, A.; Parrod, Y.; Desaintvincent, A.

    1994-01-01

    The increasing complexity of modern spacecraft, and the stringent requirement for maximizing their mission return, call for a new generation of Mission Planning Systems (MPS). In this paper, we discuss the requirements for the Space Mission Planning and the benefits which can be expected from Artificial Intelligence techniques through examples of applications developed by Matra Marconi Space.

  14. Advances in reduction techniques for tire contact problems

    NASA Technical Reports Server (NTRS)

    Noor, Ahmed K.

    1995-01-01

    Some recent developments in reduction techniques, as applied to predicting the tire contact response and evaluating the sensitivity coefficients of the different response quantities, are reviewed. The sensitivity coefficients measure the sensitivity of the contact response to variations in the geometric and material parameters of the tire. The tire is modeled using a two-dimensional laminated anisotropic shell theory with the effects of variation in geometric and material parameters, transverse shear deformation, and geometric nonlinearities included. The contact conditions are incorporated into the formulation by using a perturbed Lagrangian approach with the fundamental unknowns consisting of the stress resultants, the generalized displacements, and the Lagrange multipliers associated with the contact conditions. The elemental arrays are obtained by using a modified two-field, mixed variational principle. For the application of reduction techniques, the tire finite element model is partitioned into two regions. The first region consists of the nodes that are likely to come in contact with the pavement, and the second region includes all the remaining nodes. The reduction technique is used to significantly reduce the degrees of freedom in the second region. The effectiveness of the computational procedure is demonstrated by a numerical example of the frictionless contact response of the space shuttle nose-gear tire, inflated and pressed against a rigid flat surface. Also, the research topics which have high potential for enhancing the effectiveness of reduction techniques are outlined.

  15. In Situ Techniques for Monitoring Electrochromism: An Advanced Laboratory Experiment

    ERIC Educational Resources Information Center

    Saricayir, Hakan; Uce, Musa; Koca, Atif

    2010-01-01

    This experiment employs current technology to enhance and extend existing lab content. The basic principles of spectroscopic and electroanalytical techniques and their use in determining material properties are covered in some detail in many undergraduate chemistry programs. However, there are limited examples of laboratory experiments with in…

  16. Advances in High-Fidelity Multi-Physics Simulation Techniques

    DTIC Science & Technology

    2008-01-01

    fluid dynamics with other disciplines also yield a large and typically stiff equation set whose numerical solution mandates the development and...and Electromagnetics . . . . . 3 2.1 Governing Equations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 2.2 Numerical Technique...discrete equivalent of the governing equations . Thus, the values of the solution vector are localized in a pointwise sense at each node of the mesh. This

  17. Single Molecule Techniques for Advanced in situ Hybridization

    SciTech Connect

    Hollars, C W; Stubbs, L; Carlson, K; Lu, X; Wehri, E

    2003-02-03

    One of the most significant achievements of modern science is completion of the human genome sequence, completed in the year 2000. Despite this monumental accomplishment, researchers have only begun to understand the relationships between this three-billion-nucleotide genetic code and the regulation and control of gene and protein expression within each of the millions of different types of highly specialized cells. Several methodologies have been developed for the analysis of gene and protein expression in situ, yet despite these advancements, the pace of such analyses is extremely limited. Because information regarding the precise timing and location of gene expression is a crucial component in the discovery of new pharmacological agents for the treatment of disease, there is an enormous incentive to develop technologies that accelerate the analytical process. Here we report on the use of plasmon resonant particles as advanced probes for in situ hybridization. These probes are used for the detection of low levels of gene-probe response and demonstrate a detection method that enables precise, simultaneous localization within a cell of the points of expression of multiple genes or proteins in a single sample.

  18. Repositioning template for mandibular reconstruction with fibular free flaps: an alternative technique to pre-plating and virtual surgical planning.

    PubMed

    Berrone, M; Crosetti, E; Succo, G

    2014-08-01

    Oral malignancies involving the mandibular bone require a complex reconstructive plan. Mandibular reconstruction with a fibular free flap is currently considered the best choice for functional and aesthetic rehabilitation after oncological surgery. This flap can be modelled with multiple osteotomies and can provide bone, muscle and skin for composite reconstruction. One of the most delicate aspects of mandibular reconstruction is the technique of bone modelling; the risk of prolonging the period of ischaemia and not restoring the correct maxillomandibular and occlusal relationships can ultimately lead to a higher rate of complications as well as poor aesthetic and functional results. Recently, there has been rising interest in virtual surgical planning and computer-assisted mandibular reconstruction in pre-operative planning; however, this is not always possible because of the costs involved and the set-up time for the entire procedure. In this paper, we present a simple and inexpensive technique for fibular free flap modelling and repositioning after segmental resection of the mandible; the technique entails the pre-operative preparation of a resin repositioning template on a stereolithographic model. This technique has been successfully applied in four cases: two cases underwent resection involving only the mandibular body, one case involving the mandibular body and symphysis and one case in which a ramus to ramus resection was performed. In this preliminary report, we show that the resin repositioning template is an easy, safe and useful tool for mandibular reconstruction with a fibular free flap.

  19. Surgical technique: establishing a pre-clinical large animal model to test aortic valve leaflet substitute

    PubMed Central

    Knirsch, Walter; Cesarovic, Niko; Krüger, Bernard; Schmiady, Martin; Frauenfelder, Thomas; Frese, Laura; Dave, Hitendu; Hoerstrup, Simon Philipp; Hübler, Michael

    2016-01-01

    To overcome current limitations of valve substitutes and tissue substitutes the technology of tissue engineering (TE) continues to offer new perspectives in congenital cardiac surgery. We report our experiences and results implanting a decellularized TE patch in nine sheep in orthotropic position as aortic valve leaflet substitute. Establishing the animal model, feasibility, cardiopulmonary bypass issues and operative technique are highlighted. PMID:28149571

  20. Impaction bone grafting and cemented stem revision in periprosthetic hip fractures: a novel surgical technique.

    PubMed

    Dearden, Paul M; Bobak, Peter P; Giannoudis, Peter V

    2014-01-01

    With an ageing population, and increasing longevity of hip arthroplasty prostheses, the incidence of periprosthetic femoral fractures is rising. We present a simple and easily reproducible technique for reduction of any periprosthetic fracture that requires bone graft augmentation. This method facilitates impaction bone grafting to reconstitute lost bone stock and revision using a cemented implant.

  1. Hallux valgus: comparative study between two surgical techniques of proximal addition osteotomy

    PubMed Central

    Lara, Luiz Carlos Ribeiro; de Araujo, Bruno Vierno; Franco, Nelson; Hita, Roberto Minoru

    2012-01-01

    OBJECTIVE: To clinically and radiographically compare the results of treatment of hallux valgus, by two addition osteotomy techniques: one using resected exostosis, and the other using a plate fixation for addition wedge. METHODS: We evaluated 24 feet of 19 patients, mean age 51.3 years, affected by hallux valgus, with a mean follow-up of 50.1 months. 13 feet underwent addition osteotomy with resected exostosis (AORE) and 11 patients (11 feet) underwent addition osteotomy with plate (AOP). The AOFAS score, intermetatarsal 1 and 2 angles, and hallux valgus angle were evaluated before and after surgery. RESULTS: In the AORE technique, the mean preoperative AOFAS was 46.6, with IMA 14o and HVA 32o, while in the postoperative AOFAS it was 81.3, with IMA 9o and HVA 25o, and 92.3% satisfactory results. In the AOP technique, the mean preoperative AOFAS was 42.1, with IMA 15o and HVA 29o while in the postoperative AOFAS it was 77.4, with IMA 11o and HVA 23o and 81.8% of satisfactory results. CONCLUSIONS: Both techniques proved to be effective in the treatment of hallux valgus, both clinically and radiografically, with no statistical difference between them. Level of evidence III, Retrospective comparative study. PMID:24453631

  2. Advanced optical techniques for monitoring dosimetric parameters in photodynamic therapy

    NASA Astrophysics Data System (ADS)

    Li, Buhong; Qiu, Zhihai; Huang, Zheng

    2012-12-01

    Photodynamic therapy (PDT) is based on the generation of highly reactive singlet oxygen through interactions of photosensitizer, light and molecular oxygen. PDT has become a clinically approved, minimally invasive therapeutic modality for a wide variety of malignant and nonmalignant diseases. The main dosimetric parameters for predicting the PDT efficacy include the delivered light dose, the quantification and photobleaching of the administrated photosensitizer, the tissue oxygen concentration, the amount of singlet oxygen generation and the resulting biological responses. This review article presents the emerging optical techniques that in use or under development for monitoring dosimetric parameters during PDT treatment. Moreover, the main challenges in developing real-time and noninvasive optical techniques for monitoring dosimetric parameters in PDT will be described.

  3. Characterization of PTFE Using Advanced Thermal Analysis Techniques

    NASA Astrophysics Data System (ADS)

    Blumm, J.; Lindemann, A.; Meyer, M.; Strasser, C.

    2010-10-01

    Polytetrafluoroethylene (PTFE) is a synthetic fluoropolymer used in numerous industrial applications. It is often referred to by its trademark name, Teflon. Thermal characterization of a PTFE material was carried out using various thermal analysis and thermophysical properties test techniques. The transformation energetics and specific heat were measured employing differential scanning calorimetry. The thermal expansion and the density changes were determined employing pushrod dilatometry. The viscoelastic properties (storage and loss modulus) were analyzed using dynamic mechanical analysis. The thermal diffusivity was measured using the laser flash technique. Combining thermal diffusivity data with specific heat and density allows calculation of the thermal conductivity of the polymer. Measurements were carried out from - 125 °C up to 150 °C. Additionally, measurements of the mechanical properties were carried out down to - 170 °C. The specific heat tests were conducted into the fully molten regions up to 370 °C.

  4. Advance techniques for monitoring human tolerance to +Gz accelerations.

    NASA Technical Reports Server (NTRS)

    Pelligra, R.; Sandler, H.; Rositano, S.; Skrettingland, K.; Mancini, R.

    1972-01-01

    Standard techniques for monitoring the acceleration-stressed human subject have been augmented by measuring (1) temporal, brachial and/or radial arterial blood flow, and (2) indirect systolic and diastolic blood pressure at 60-sec intervals. Results show that the response of blood pressure to positive accelerations is complex and dependent on an interplay of hydrostatic forces, diminishing venous return, redistribution of blood, and other poorly defined compensatory reflexes.

  5. Precise control of caval and hepatic vessels: Surgical technique to treat level III caval thrombus concomitant to renal cell carcinoma

    PubMed Central

    Chen, Ming; Xu, Bin; Liu, Ning; Jiang, Hua; Wang, Yiduo; Yang, Yu; Zhang, Xiaowen; Sun, Chao; Liu, Jing; Zhu, Weidong; Chen, Shuqiu

    2015-01-01

    Introduction: We investigated the surgical techniques, safety, and prevention of complications of nephrectomy and removal of tumour thrombus for treating level III inferior vena cava (IVC) concomitant to renal cell carcinoma (RCC). We did this by precise controlling IVC and hepatic vessels without a vascular bypass. Methods: In this series, we included 5 patients with level III IVC tumour thrombus below the hepatic vein concomitant to RCC. After precisely controlling the IVC and hepatic vessels, we then removed the thrombus en bloc with the renal vein. Blood loss volume, IVC clamping time, hypotension time, resuscitation, cardiocerebrovascular complications, and postoperative organ dysfunction were observed. Results: Surgery was successfully performed without perioperative death. Blood loss volume was 900 to 1500 mL, operation time was 165 to 250 minutes, vascular clamping time was 8 to 12 minutes, and intraoperative hypotension time was 9 to 12 minutes. Serious perioperative complications were not observed. Local recurrence was not observed during the 9 to 24 months of follow-up. One patient exhibited disease-free survival, 3 developed lung or liver metastasis, and 1 died 11 months after surgery. Conclusion: Precise control of IVC and hepatic pedicle vessels, without vascular bypass, is a safe and effective surgical treatment for level III tumor thrombus below the hepatic vein concomitant to RCC. The procedure was conducted without increased risks of intraoperative hypotensive shock, difficult resuscitation, pulmonary embolism, and multiple organ dysfunctions. PMID:26600890

  6. Advanced techniques for characterization of ion beam modified materials

    DOE PAGES

    Zhang, Yanwen; Debelle, Aurélien; Boulle, Alexandre; ...

    2014-10-30

    Understanding the mechanisms of damage formation in materials irradiated with energetic ions is essential for the field of ion-beam materials modification and engineering. Utilizing incident ions, electrons, photons, and positrons, various analysis techniques, including Rutherford backscattering spectrometry (RBS), electron RBS, Raman spectroscopy, high-resolution X-ray diffraction, small-angle X-ray scattering, and positron annihilation spectroscopy, are routinely used or gaining increasing attention in characterizing ion beam modified materials. The distinctive information, recent developments, and some perspectives in these techniques are reviewed in this paper. Applications of these techniques are discussed to demonstrate their unique ability for studying ion-solid interactions and the corresponding radiationmore » effects in modified depths ranging from a few nm to a few tens of μm, and to provide information on electronic and atomic structure of the materials, defect configuration and concentration, as well as phase stability, amorphization and recrystallization processes. Finally, such knowledge contributes to our fundamental understanding over a wide range of extreme conditions essential for enhancing material performance and also for design and synthesis of new materials to address a broad variety of future energy applications.« less

  7. Advanced techniques for characterization of ion beam modified materials

    SciTech Connect

    Zhang, Yanwen; Debelle, Aurélien; Boulle, Alexandre; Kluth, Patrick; Tuomisto, Filip

    2014-10-30

    Understanding the mechanisms of damage formation in materials irradiated with energetic ions is essential for the field of ion-beam materials modification and engineering. Utilizing incident ions, electrons, photons, and positrons, various analysis techniques, including Rutherford backscattering spectrometry (RBS), electron RBS, Raman spectroscopy, high-resolution X-ray diffraction, small-angle X-ray scattering, and positron annihilation spectroscopy, are routinely used or gaining increasing attention in characterizing ion beam modified materials. The distinctive information, recent developments, and some perspectives in these techniques are reviewed in this paper. Applications of these techniques are discussed to demonstrate their unique ability for studying ion-solid interactions and the corresponding radiation effects in modified depths ranging from a few nm to a few tens of μm, and to provide information on electronic and atomic structure of the materials, defect configuration and concentration, as well as phase stability, amorphization and recrystallization processes. Finally, such knowledge contributes to our fundamental understanding over a wide range of extreme conditions essential for enhancing material performance and also for design and synthesis of new materials to address a broad variety of future energy applications.

  8. Development of processing techniques for advanced thermal protection materials

    NASA Technical Reports Server (NTRS)

    Selvaduray, Guna S.

    1994-01-01

    The effort, which was focused on the research and development of advanced materials for use in Thermal Protection Systems (TPS), has involved chemical and physical testing of refractory ceramic tiles, fabrics, threads and fibers. This testing has included determination of the optical properties, thermal shock resistance, high temperature dimensional stability, and tolerance to environmental stresses. Materials have also been tested in the Arc Jet 2 x 9 Turbulent Duct Facility (TDF), the 1 atmosphere Radiant Heat Cycler, and the Mini-Wind Tunnel Facility (MWTF). A significant part of the effort hitherto has gone towards modifying and upgrading the test facilities so that meaningful tests can be carried out. Another important effort during this period has been the creation of a materials database. Computer systems administration and support have also been provided. These are described in greater detail below.

  9. Recent advances in bioprinting techniques: approaches, applications and future prospects.

    PubMed

    Li, Jipeng; Chen, Mingjiao; Fan, Xianqun; Zhou, Huifang

    2016-09-20

    Bioprinting technology shows potential in tissue engineering for the fabrication of scaffolds, cells, tissues and organs reproducibly and with high accuracy. Bioprinting technologies are mainly divided into three categories, inkjet-based bioprinting, pressure-assisted bioprinting and laser-assisted bioprinting, based on their underlying printing principles. These various printing technologies have their advantages and limitations. Bioprinting utilizes biomaterials, cells or cell factors as a "bioink" to fabricate prospective tissue structures. Biomaterial parameters such as biocompatibility, cell viability and the cellular microenvironment strongly influence the printed product. Various printing technologies have been investigated, and great progress has been made in printing various types of tissue, including vasculature, heart, bone, cartilage, skin and liver. This review introduces basic principles and key aspects of some frequently used printing technologies. We focus on recent advances in three-dimensional printing applications, current challenges and future directions.

  10. Advanced materials and techniques for fibre-optic sensing

    NASA Astrophysics Data System (ADS)

    Henderson, Philip J.

    2014-06-01

    Fibre-optic monitoring systems came of age in about 1999 upon the emergence of the world's first significant commercialising company - a spin-out from the UK's collaborative MAST project. By using embedded fibre-optic technology, the MAST project successfully measured transient strain within high-performance composite yacht masts. Since then, applications have extended from smart composites into civil engineering, energy, military, aerospace, medicine and other sectors. Fibre-optic sensors come in various forms, and may be subject to embedment, retrofitting, and remote interrogation. The unique challenges presented by each implementation require careful scrutiny before widespread adoption can take place. Accordingly, various aspects of design and reliability are discussed spanning a range of representative technologies that include resonant microsilicon structures, MEMS, Bragg gratings, advanced forms of spectroscopy, and modern trends in nanotechnology. Keywords: Fibre-optic sensors, fibre Bragg gratings, MEMS, MOEMS, nanotechnology, plasmon.

  11. Training of breast surgical oncologists.

    PubMed

    Teshome, Mediget; Kuerer, Henry M

    2016-06-01

    Breast surgical oncology is a defined sub-specialty of general surgery with focus on the surgical management of breast disease and malignancy within a multidisciplinary context. Much of the training of breast surgical oncologists in the United States exists within a fellowship training structure with oversight and approval by the Society of Surgical Oncology (SSO). Rapid continuous changes in breast oncology practice have further substantiated dedicated expertise in breast surgical oncology. Training programs are structured to develop proficiency in fellows for advanced surgical techniques and clinical decision-making as well as exposure to the multidisciplinary aspects of breast cancer management. Components of a successful program include an intense multidisciplinary curriculum, engagement in clinical research and attention to strong mentorship. National curriculum and training requirements as well as supplemental resources assist in standardizing the fellowship experience. As surgical training and the field of breast oncology continues to evolve, so do fellowship training programs to ensure high quality breast surgical oncologists equipped to deliver high quality evidence based patient care while continuing to drive future research and trainee education.

  12. Advanced Techniques for Constrained Internal Coordinate Molecular Dynamics

    PubMed Central

    Wagner, Jeffrey R.; Balaraman, Gouthaman S.; Niesen, Michiel J. M.; Larsen, Adrien B.; Jain, Abhinandan; Vaidehi, Nagarajan

    2013-01-01

    Internal coordinate molecular dynamics (ICMD) methods provide a more natural description of a protein by using bond, angle and torsional coordinates instead of a Cartesian coordinate representation. Freezing high frequency bonds and angles in the ICMD model gives rise to constrained ICMD (CICMD) models. There are several theoretical aspects that need to be developed in order to make the CICMD method robust and widely usable. In this paper we have designed a new framework for 1) initializing velocities for non-independent CICMD coordinates, 2) efficient computation of center of mass velocity during CICMD simulations, 3) using advanced integrators such as Runge-Kutta, Lobatto and adaptive CVODE for CICMD simulations, and 4) cancelling out the “flying ice cube effect” that sometimes arises in Nosé-Hoover dynamics. The Generalized Newton-Euler Inverse Mass Operator (GNEIMO) method is an implementation of a CICMD method that we have developed to study protein dynamics. GNEIMO allows for a hierarchy of coarse-grained simulation models based on the ability to rigidly constrain any group of atoms. In this paper, we perform tests on the Lobatto and Runge-Kutta integrators to determine optimal simulation parameters. We also implement an adaptive coarse graining tool using the GNEIMO Python interface. This tool enables the secondary structure-guided “freezing and thawing” of degrees of freedom in the molecule on the fly during MD simulations, and is shown to fold four proteins to their native topologies. With these advancements we envision the use of the GNEIMO method in protein structure prediction, structure refinement, and in studying domain motion. PMID:23345138

  13. Advanced techniques for constrained internal coordinate molecular dynamics.

    PubMed

    Wagner, Jeffrey R; Balaraman, Gouthaman S; Niesen, Michiel J M; Larsen, Adrien B; Jain, Abhinandan; Vaidehi, Nagarajan

    2013-04-30

    Internal coordinate molecular dynamics (ICMD) methods provide a more natural description of a protein by using bond, angle, and torsional coordinates instead of a Cartesian coordinate representation. Freezing high-frequency bonds and angles in the ICMD model gives rise to constrained ICMD (CICMD) models. There are several theoretical aspects that need to be developed to make the CICMD method robust and widely usable. In this article, we have designed a new framework for (1) initializing velocities for nonindependent CICMD coordinates, (2) efficient computation of center of mass velocity during CICMD simulations, (3) using advanced integrators such as Runge-Kutta, Lobatto, and adaptive CVODE for CICMD simulations, and (4) cancelling out the "flying ice cube effect" that sometimes arises in Nosé-Hoover dynamics. The Generalized Newton-Euler Inverse Mass Operator (GNEIMO) method is an implementation of a CICMD method that we have developed to study protein dynamics. GNEIMO allows for a hierarchy of coarse-grained simulation models based on the ability to rigidly constrain any group of atoms. In this article, we perform tests on the Lobatto and Runge-Kutta integrators to determine optimal simulation parameters. We also implement an adaptive coarse-graining tool using the GNEIMO Python interface. This tool enables the secondary structure-guided "freezing and thawing" of degrees of freedom in the molecule on the fly during molecular dynamics simulations and is shown to fold four proteins to their native topologies. With these advancements, we envision the use of the GNEIMO method in protein structure prediction, structure refinement, and in studying domain motion.

  14. Laparoscopic loop colostomy using an esophageal retractor and a penrose drain: surgical technique.

    PubMed

    Sabbagh, Raja; Rafiq, Amil; Familua, Oluwamayowa; Donaldson, Brian

    2013-10-01

    Laparoscopic Loop colostomy has been described in the literature as a safe and useful minimally invasive technique. It is indicated in patients with large perineal wounds requiring fecal diversion, obstructing lesions of the distal colon or rectum. The purpose of this article is to describe a modified version of this procedure which was used by 1 surgeon in our institution on a series of 5 patients. In this method, an esophageal retractor and Penrose drain are used to tent up and exteriorize the desired segment of colon to be used for the colostomy site. Results were that all 5 were completed laparoscopically and there were no complications. In conclusion, this variation in the technique has been useful in our institution and others may find it worthwhile to consider.

  15. A new surgical technique for medial collateral ligament balancing: multiple needle puncturing.

    PubMed

    Bellemans, Johan; Vandenneucker, Hilde; Van Lauwe, Johan; Victor, Jan

    2010-10-01

    In this article, we present our experience with a new technique for medial soft tissue balancing, where we make multiple punctures in the medial collateral ligament (MCL) using a 19-gauge needle, to progressively stretch the MCL until a correct ligament balance is achieved. Ligament status was evaluated both before and after the procedure using computer navigation and mediolateral stress testing. The procedure was considered successful when 2 to 4-mm mediolateral joint line opening was obtained in extension and 2 to 6 mm in flexion. In 34 of 35 cases, a progressive correction of medial tightness was achieved according to the above described criteria. One case was considered overreleased in extension. Needle puncturing is a new, effective, and safe technique for progressive correction of MCL tightness in the varus knee.

  16. Degenerative mitral valve disease-contemporary surgical approaches and repair techniques.

    PubMed

    Koprivanac, Marijan; Kelava, Marta; Alansari, Shehab; Javadikasgari, Hoda; Tappuni, Bassman; Mick, Stephanie; Marc, Gillinov A; Suri, Rakesh; Mihaljevic, Tomislav

    2017-01-01

    Given the increasing age of the US population and the accompanying rise in cardiovascular disease, we expect to see an increasing number of patients affected by degenerative mitral valve disease in a more complex patient population. Therefore, increasing the overall rate of mitral valve repair will become even more important than it is today, and the capability to provide a universally and uniformly accepted quality of repair will have important medical, economic, and societal implications. This article will describe preoperative and intraoperative considerations and the currently practiced mitral valve repair approaches and techniques. The aim of the article is to present our contemporary approach to mitral valve repair in the hope that it can be adopted at other institutions that may have low repair rates. Adoption of simple and reproducible mitral valve repair techniques is of paramount importance if we as a profession are to accomplish overall higher rates of mitral valve repair with optimal outcomes.

  17. Avulsion of the anterior medial meniscus root: case report and surgical technique.

    PubMed

    Feucht, Matthias J; Minzlaff, Philipp; Saier, Tim; Lenich, Andreas; Imhoff, Andreas B; Hinterwimmer, Stefan

    2015-01-01

    Injuries of the meniscus roots have become increasingly recognised as a serious pathology of the knee joint. However, the current available literature focuses primarily on posterior meniscus root tears. In this article, a case with an isolated avulsion of the anterior medial meniscus root is presented, and a new arthroscopic technique to treat this type of injury is described. The anterior horn of the medial meniscus was sutured with a double-looped nonabsorbable suture and reattached to the tibial plateau using a knotless suture anchor. This technique may also be useful to treat avulsion injuries of the anterolateral or posteromedial meniscus root, and symptomatic subluxation of the medial meniscus in case of a variant insertion anatomy with an absent attachment of the anterior horn of the medial meniscus to the tibial plateau. Level of evidence V.

  18. Degenerative mitral valve disease-contemporary surgical approaches and repair techniques

    PubMed Central

    Kelava, Marta; Alansari, Shehab; Javadikasgari, Hoda; Tappuni, Bassman; Mick, Stephanie; Marc, Gillinov A.; Suri, Rakesh; Mihaljevic, Tomislav

    2017-01-01

    Given the increasing age of the US population and the accompanying rise in cardiovascular disease, we expect to see an increasing number of patients affected by degenerative mitral valve disease in a more complex patient population. Therefore, increasing the overall rate of mitral valve repair will become even more important than it is today, and the capability to provide a universally and uniformly accepted quality of repair will have important medical, economic, and societal implications. This article will describe preoperative and intraoperative considerations and the currently practiced mitral valve repair approaches and techniques. The aim of the article is to present our contemporary approach to mitral valve repair in the hope that it can be adopted at other institutions that may have low repair rates. Adoption of simple and reproducible mitral valve repair techniques is of paramount importance if we as a profession are to accomplish overall higher rates of mitral valve repair with optimal outcomes. PMID:28203540

  19. Arrow shaft injury of the wrist and hand: case report, management, and surgical technique.

    PubMed

    Launikitis, Robert A; Viegas, Steven F

    2009-01-01

    A case of accidental, self-inflicted injury to the hand from a hollow carbon shaft arrow which broke in its midshaft while attempting to shoot the arrow from a compound bow is presented. Basic knowledge of low velocity gunshot wounds and arrow injuries was applied in the treatment of this injury along with a unique management technique. The outcome, including hand function was good without any functional loss.

  20. Shoulder arthroplasty in osteoarthritis: current concepts in biomechanics and surgical technique

    PubMed Central

    Merolla, G; Nastrucci, G; Porcellini, G

    Shoulder arthroplasty is a technically demanding procedure to restore shoulder function in patients with severe osteoarthritis of the glenohumeral joint. The modern prosthetic system exploit the benefits of modularity and the availibility of additional sizes of the prosthetic components. In this paper we describe the biomechanics of shoulder arthroplasty and the technique for shoulder replacement including total shoulder arthroplasty (TSA) with all-polyethylene and metal-backed glenoid component, humeral head resurfacing and stemless humeral replacement. PMID:24251240

  1. Shoulder arthroplasty in osteoarthritis: current concepts in biomechanics and surgical technique.

    PubMed

    Merolla, G; Nastrucci, G; Porcellini, G

    2013-01-01

    Shoulder arthroplasty is a technically demanding procedure to restore shoulder function in patients with severe osteoarthritis of the glenohumeral joint. The modern prosthetic system exploit the benefits of modularity and the availibility of additional sizes of the prosthetic components. In this paper we describe the biomechanics of shoulder arthroplasty and the technique for shoulder replacement including total shoulder arthroplasty (TSA) with all-polyethylene and metal-backed glenoid component, humeral head resurfacing and stemless humeral replacement.

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

    PubMed

    Khanfour, Ashraf A

    2013-05-01

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

  3. Surgical Technique for the Implantation of Tissue Engineered Vascular Grafts and Subsequent In Vivo Monitoring

    PubMed Central

    Koobatian, Maxwell T.; Koenigsknecht, Carmon; Row, Sindhu; Andreadis, Stelios; Swartz, Daniel

    2015-01-01

    The development of Tissue Engineered Vessels (TEVs) is advanced by the ability to routinely and effectively implant TEVs (4-5 mm in diameter) into a large animal model. A step by-step protocol for inter-positional placement of the TEV and real-time digital assessment of the TEV and native carotid arteries is described here. In vivo monitoring is made possible by the implantation of flow probes, catheters and ultrasonic crystals (capable of recording dynamic diameter changes of implanted TEVs and native carotid arteries) at the time of surgery. Once implanted, researchers can calculate arterial blood flow patterns, invasive blood pressure and artery diameter yielding parameters such as pulse wave velocity, augmentation index, pulse pressures and compliance. Data acquisition is accomplished using a single computer program for analysis throughout the duration of the experiment. Such invaluable data provides insight into TEV matrix remodeling, its resemblance to native/sham controls and overall TEV performance in vivo. PMID:25867203

  4. Results of surgical techniques for re-innervation of the triceps as additional procedures for patients with upper root injuries.

    PubMed

    Flores, L Pretto

    2013-03-01

    Patients with injuries restricted to the upper and middle trunks of the brachial plexus may obtain recovery of elbow extension via the lower trunk, which makes it difficult to assess the real effect of interventions to restore the triceps function in such cases. This study aimed to determine the impact of surgical strategies for re-innervation of the triceps in individuals with partial injuries of the brachial plexus. Patients were divided into two groups. Group 1 consisted of 21 participants in whom the surgery included one technique for re-innervation of elbow extension. In this group, six different extra- or intra-plexal donors were targeted to one of the motor branches of the triceps muscle. Group 2 was composed of 24 controls in which the reconstruction did not include any intervention for recovering triceps function. The individuals who underwent intervention for re-innervation of the triceps obtained significantly better outcomes for elbow extension than the controls.

  5. A new surgical technique using steel suture for trans-scleral fixation of posterior chamber intraocular lenses

    PubMed Central

    Ram, Jagat; Gupta, Nishant; Chaudhary, Manish; Verma, Neelam

    2013-01-01

    Background: A new emerging complication of trans-scleral fixation of posterior chamber (PC) intraocular lens (IOL) with polypropylene suture is high rates of spontaneous dislocation of the IOL due to disintegration or breakage of suture. Materials: We report a new surgical technique of trans-scleral fixation of posterior chamber intraocular lens (SF PCIOL) with steel suture to eliminate the complication of dislocation of IOL fixed with polypropylene suture in one adult and a child. Results: We successfully achieved stable fixation and good centration of IOL after SF PCIOL with steel suture in these patient having inadequate posterior capsular support. Both eyes achieved best corrected visual acuity 20/40 at 18 months follow-up. Conclusions: Steel suture is a viable option for trans-scleral fixation of posterior chamber intraocular lens. PMID:23619504

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

    SciTech Connect

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

    1988-09-01

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

  7. Vascular Surgery Trainees Still Need to Learn How to Sew: Importance of Learning Surgical Techniques in the Era of Endovascular Surgery

    PubMed Central

    Aziz, Faisal

    2015-01-01

    Vascular surgery represents one of the most rapidly evolving specialties in the field of surgery. It was merely 100 years ago when Dr. Alexis Carrel described vascular anastomosis. Over the course of next several decades, vascular surgeons distinguished themselves from general surgeons by horning the techniques of vascular surgery operations. In the era of minimally invasive interventions, the number of endovascular interventions performed by vascular surgeons has increased exponentially. Vascular surgery trainees in the current times spend considerable time in mastering the techniques of endovascular operations. Unfortunately, the reduction in number of open surgical operations has lead to concerns in regards to adequacy of learning open surgical techniques. In future, majority of vascular interventions will be done with minimally invasive techniques. Combination of poor training in open operations and increasing complexity of open surgical operations may lead to poor surgical outcomes. It is the need of the hour for vascular surgery trainees to realize the importance of learning and mastering open surgical techniques. One of the most distinguishing features of contemporary vascular surgeons is their ability to perform both endovascular and open vascular surgery operations, and we should strive to maintain our excellence in both of these arenas. PMID:26029698

  8. Effect of surgical mandibular advancement on pharyngeal airway dimensions: a three-dimensional computed tomography study.

    PubMed

    Kochar, G D; Chakranarayan, A; Kohli, S; Kohli, V S; Khanna, V; Jayan, B; Chopra, S S; Verma, M

    2016-05-01

    The aim of this study was to quantify the changes in pharyngeal airway space (PAS) in patients with a skeletal class II malocclusion managed by bilateral sagittal split ramus osteotomy for mandibular advancement, using three-dimensional (3D) registration. The sample comprised 16 patients (mean age 21.69±2.80 years). Preoperative (T0) and postoperative (T1) computed tomography scans were recorded. Linear, cross-sectional area (CSA), and volumetric parameters of the velopharynx, oropharynx, and hypopharynx were evaluated. Parameters were compared with paired samples t-tests. Highly significant changes in dimension were measured in both sagittal and transverse planes (P<0.001). CSA measurements increased significantly between T0 and T1 (P<0.001). A significant increase in PAS volume was found at T1 compared with T0 (P<0.001). The changes in PAS were quantified using 3D reconstruction. Along the sagittal and transverse planes, the greatest increase was seen in the oropharynx (12.16% and 11.50%, respectively), followed by hypopharynx (11.00% and 9.07%) and velopharynx (8.97% and 6.73%). CSA increased by 41.69%, 34.56%, and 28.81% in the oropharynx, hypopharynx, and velopharynx, respectively. The volumetric increase was greatest in the oropharynx (49.79%) and least in the velopharynx (38.92%). These established quantifications may act as a useful guide for clinicians in the field of dental sleep medicine.

  9. Current advances in diagnosis and surgical treatment of lymph node metastasis in head and neck cancer

    PubMed Central

    Teymoortash, A.; Werner, J. A.

    2012-01-01

    Still today, the status of the cervical lymph nodes is the most important prognostic factor for head and neck cancer. So the individual treatment concept of the lymphatic drainage depends on the treatment of the primary tumor as well as on the presence or absence of suspect lymph nodes in the imaging diagnosis. Neck dissection may have either a therapeutic objective or a diagnostic one. The selective neck dissection is currently the method of choice for the treatment of patients with advanced head and neck cancers and clinical N0 neck. For oncologic reasons, this procedure is generally recommended with acceptable functional and aesthetic results, especially under the aspect of the mentioned staging procedure. In this review article, current aspects on pre- and posttherapeutic staging of the cervical lymph nodes are described and the indication and the necessary extent of neck dissection for head and neck cancer is discussed. Additionally the critical question is discussed if the lymph node metastasis bears an intrinsic risk of metastatic development and thus its removal in a most possible early stage plays an important role. PMID:23320056

  10. Advances in parameter estimation techniques applied to flexible structures

    NASA Technical Reports Server (NTRS)

    Maben, Egbert; Zimmerman, David C.

    1994-01-01

    In this work, various parameter estimation techniques are investigated in the context of structural system identification utilizing distributed parameter models and 'measured' time-domain data. Distributed parameter models are formulated using the PDEMOD software developed by Taylor. Enhancements made to PDEMOD for this work include the following: (1) a Wittrick-Williams based root solving algorithm; (2) a time simulation capability; and (3) various parameter estimation algorithms. The parameter estimations schemes will be contrasted using the NASA Mini-Mast as the focus structure.

  11. Advances in dental veneers: materials, applications, and techniques

    PubMed Central

    Pini, Núbia Pavesi; Aguiar, Flávio Henrique Baggio; Lima, Débora Alves Nunes Leite; Lovadino, José Roberto; Terada, Raquel Sano Suga; Pascotto, Renata Corrêa

    2012-01-01

    Laminate veneers are a conservative treatment of unaesthetic anterior teeth. The continued development of dental ceramics offers clinicians many options for creating highly aesthetic and functional porcelain veneers. This evolution of materials, ceramics, and adhesive systems permits improvement of the aesthetic of the smile and the self-esteem of the patient. Clinicians should understand the latest ceramic materials in order to be able to recommend them and their applications and techniques, and to ensure the success of the clinical case. The current literature was reviewed to search for the most important parameters determining the long-term success, correct application, and clinical limitations of porcelain veneers. PMID:23674920

  12. [Widened forwarding total laryngectomy ("squared laryngectomy"). Hints of surgical techniques and personal experience].

    PubMed

    Croce, A; Moretti, A; Bianchedi, M; Neri, G; Falcone, G

    1995-10-01

    Primitive T4 laryngeal neoplasms with anterior invasion and neoplasm recurring after partial and subtotal intervention often invade the soft prelaryngeal tissues and in these cases the neoplastic illness can be no longer be controlled be "organ surgery". The widened forwarding total laryngectomy, "squared" or "carrè" laryngectomy according to some Authors of French School, is a surgical procedure not "on an organ" but "in an area" or "region" which proposes to delete, in one step, the larynx, the bone hyoid, the fasciae and the prelaryngeal muscles, the thyroid gland and, if necessary, a more or less large quantity of anterior cervical skin. If the removal involves a vast cutaneous area, it is necessary to mend the loss of substance by wrapping around a miocutaneous flap of pectoralis mayor muscle. In the last five years, 4 male patients, between 48 and 73 years, were treated with widened forwarding total laryngectomy. They were all carriers of epidermoid laryngeal carcinomas with various degrees of differentation: primitive in one patients, recidivist after performance of partial (cordectomy) and subtotal (two Labayle) surgery in the other three patients. In the only case of T4 primitive laryngeal neoplasm it was necessary to carry out a functional neck dissection bilaterally. Loss of substance always required the use of a miocutaneous flap of pectoralis mayor muscle except in one patient in which the removal of the prelaryngeal tissues was limited and therefore it was possible to make a direct seam. We always completely removed the thyroid gland, the prelaryngeal muscular system and skin of the preceding stomy (in the Labayle) sparing, on the other hand, the hyoid bone. Only one patient, who died due to recurrence a year after surgery, underwent complemental percutaneous radiotherapy. At present, three patients are alive and NED: one after 5 years, the others are in excellent conditions although the follow-up is still brief. According to our experience, we can

  13. Advanced terahertz techniques for quality control and counterfeit detection

    NASA Astrophysics Data System (ADS)

    Ahi, Kiarash; Anwar, Mehdi

    2016-04-01

    This paper reports our invented methods for detection of counterfeit electronic. These versatile techniques are also handy in quality control applications. Terahertz pulsed laser systems are capable of giving the material characteristics and thus make it possible to distinguish between the materials used in authentic components and their counterfeit clones. Components with material defects can also be distinguished in section in this manner. In this work different refractive indices and absorption coefficients were observed for counterfeit components compared to their authentic counterparts. Existence of unexpected ingredient materials was detected in counterfeit components by Fourier Transform analysis of the transmitted terahertz pulse. Thicknesses of different layers are obtainable by analyzing the reflected terahertz pulse. Existence of unexpected layers is also detectable in this manner. Recycled, sanded and blacktopped counterfeit electronic components were detected as a result of these analyses. Counterfeit ICs with die dislocations were detected by depicting the terahertz raster scanning data in a coordinate plane which gives terahertz images. In the same manner, raster scanning of the reflected pulse gives terahertz images of the surfaces of the components which were used to investigate contaminant materials and sanded points on the surfaces. The results of the later technique, reveals the recycled counterfeit components.

  14. Advanced techniques in reliability model representation and solution

    NASA Technical Reports Server (NTRS)

    Palumbo, Daniel L.; Nicol, David M.

    1992-01-01

    The current tendency of flight control system designs is towards increased integration of applications and increased distribution of computational elements. The reliability analysis of such systems is difficult because subsystem interactions are increasingly interdependent. Researchers at NASA Langley Research Center have been working for several years to extend the capability of Markov modeling techniques to address these problems. This effort has been focused in the areas of increased model abstraction and increased computational capability. The reliability model generator (RMG) is a software tool that uses as input a graphical object-oriented block diagram of the system. RMG uses a failure-effects algorithm to produce the reliability model from the graphical description. The ASSURE software tool is a parallel processing program that uses the semi-Markov unreliability range evaluator (SURE) solution technique and the abstract semi-Markov specification interface to the SURE tool (ASSIST) modeling language. A failure modes-effects simulation is used by ASSURE. These tools were used to analyze a significant portion of a complex flight control system. The successful combination of the power of graphical representation, automated model generation, and parallel computation leads to the conclusion that distributed fault-tolerant system architectures can now be analyzed.

  15. Comparison of three advanced chromatographic techniques for cannabis identification.

    PubMed

    Debruyne, D; Albessard, F; Bigot, M C; Moulin, M

    1994-01-01

    The development of chromatography technology, with the increasing availability of easier-to-use mass spectrometers combined with gas chromatography (GC), the use of diode-array or programmable variable-wavelength ultraviolet absorption detectors in conjunction with high-performance liquid chromatography (HPLC), and the availability of scanners capable of reading thin-layer chromatography (TLC) plates in the ultraviolet and visible regions, has made for easier, quicker and more positive identification of cannabis samples that standard analytical laboratories are occasionally required to undertake in the effort to combat drug addiction. At laboratories that do not possess the technique of GC combined with mass spectrometry, which provides an irrefutable identification, the following procedure involving HPLC or TLC techniques may be used: identification of the chromatographic peaks corresponding to each of the three main cannabis constituents-cannabidiol (CBD), delta-9-tetrahydrocannabinol (delta-9-THC) and cannabinol (CBN)-by comparison with published data in conjunction with a specific absorption spectrum for each of those constituents obtained between 200 and 300 nm. The collection of the fractions corresponding to the three major cannabinoids at the HPLC system outlet and the cross-checking of their identity in the GC process with flame ionization detection can further corroborate the identification and minimize possible errors due to interference.

  16. XII Advanced Computing and Analysis Techniques in Physics Research

    NASA Astrophysics Data System (ADS)

    Speer, Thomas; Carminati, Federico; Werlen, Monique

    November 2008 will be a few months after the official start of LHC when the highest quantum energy ever produced by mankind will be observed by the most complex piece of scientific equipment ever built. LHC will open a new era in physics research and push further the frontier of Knowledge This achievement has been made possible by new technological developments in many fields, but computing is certainly the technology that has made possible this whole enterprise. Accelerator and detector design, construction management, data acquisition, detectors monitoring, data analysis, event simulation and theoretical interpretation are all computing based HEP activities but also occurring many other research fields. Computing is everywhere and forms the common link between all involved scientists and engineers. The ACAT workshop series, created back in 1990 as AIHENP (Artificial Intelligence in High Energy and Nuclear Research) has been covering the tremendous evolution of computing in its most advanced topics, trying to setup bridges between computer science, experimental and theoretical physics. Conference web-site: http://acat2008.cern.ch/ Programme and presentations: http://indico.cern.ch/conferenceDisplay.py?confId=34666

  17. Coal and Coal Constituent Studies by Advanced EMR Techniques

    SciTech Connect

    Alex I. Smirnov; Mark J. Nilges; R. Linn Belford; Robert B. Clarkson

    1998-03-31

    Advanced electronic magnetic resonance (EMR) methods are used to examine properties of coals, chars, and molecular species related to constituents of coal. We have achieved substantial progress on upgrading the high field (HF) EMR (W-band, 95 GHz) spectrometers that are especially advantageous for such studies. Particularly, we have built a new second W-band instrument (Mark II) in addition to our Mark I. Briefly, Mark II features: (i) an Oxford custom-built 7 T superconducting magnet which is scannable from 0 to 7 T at up to 0.5 T/min; (ii) water-cooled coaxial solenoid with up to ±550 G scan under digital (15 bits resolution) computer control; (iii) custom-engineered precision feed-back circuit, which is used to drive this solenoid, is based on an Ultrastab 860R sensor that has linearity better than 5 ppm and resolution of 0.05 ppm; (iv) an Oxford CF 1200 cryostat for variable temperature studies from 1.8 to 340 K. During this grant period we have completed several key upgrades of both Mark I and II, particularly microwave bridge, W-band probehead, and computer interfaces. We utilize these improved instruments for HF EMR studies of spin-spin interaction and existence of different paramagnetic species in carbonaceous solids.

  18. Upper eyelid retraction in Graves' ophthalmopathy: a new surgical technique and a study of the abnormal levator muscle.

    PubMed Central

    Small, R G

    1988-01-01

    A new surgical procedure, the proximal levator technique, achieves recession of the retracted upper eyelid in Graves' ophthalmopathy by sectioning the levator muscle proximal to Whitnall's ligament and fixing eyelid position with sutures that permit postoperative adjustment. This technique deserves further study. Enlargement of the proximal levator muscle in Graves' eye disease is shown on orbital CT scans and is found at surgery when the proximal levator technique is employed. Histologic and morphometric studies demonstrate increased levator muscle fiber size as well as increased extracellular volume. These findings suggest that levator muscle hypertrophy is important in the pathogenesis of upper eyelid retraction in Graves' ophthalmopathy. Images FIGURE 2 A FIGURE 3 A FIGURE 3 B FIGURE 3 C FIGURE 3 D FIGURE 4 A,B FIGURE 4 C,D,E FIGURE 4 F,G FIGURE 6 A FIGURE 6 B FIGURE 7 A FIGURE 7 B FIGURE 8 A FIGURE 8 B FIGURE 9 A FIGURE 9 B FIGURE 10 A FIGURE 10 B FIGURE 11 A FIGURE 11 B FIGURE 12 A FIGURE 12 B FIGURE 13 A FIGURE 13 B FIGURE 14 A FIGURE 14 B FIGURE 15 A FIGURE 15 B FIGURE 16 A FIGURE 16 B FIGURE 17 A FIGURE 17 B FIGURE 18 A FIGURE 18 B FIGURE 19 A FIGURE 19 B FIGURE 20 FIGURE 21 FIGURE 22 FIGURE 23 FIGURE 24 FIGURE 25 FIGURE 26 FIGURE 27 FIGURE 28 FIGURE 29 FIGURE 30 FIGURE 31 FIGURE 32 PMID:2979032

  19. [Surgical technique of saphenous vein harvesting using a Cusco vaginal speculum].

    PubMed

    Kikuchi, Keita; Suzuki, Kotaro; Endo, Yoshiki; Matsuyama, Takayoshi; Osaka, Shin-ichi; Kurata, Atsushi

    2014-11-01

    We used Cusco vaginal speculum in harvesting saphenous vein graft (SVG) as an assist device for making a skin tunnel. After making 2 incisions of 3 to 4 cm, the SVG was dissected in a usual procedure. Then Cusco vaginal speculum was inserted into the skin tunnel between the 2 incisions. The SVG was dissected in a usual fashion under direct vision with the speculum. This procedure requires only small incisions, short learning curve and low cost. The new technique using Cusco vaginal speculum can be a reliable option for harvesting SVG.

  20. The effects of surgical preparation techniques and implant macro-geometry on primary stability: An in vitro study

    PubMed Central

    Severino, Marco; Rastelli, Claudio; Bernardi, Sara; Caruso, Silvia; Galli, Massimo; Lamazza, Luca; Di Paolo, Carlo

    2017-01-01

    Background The attainment of a good primary stability is a necessary condition to ensure the success of osseointegration in implantology. In type IV cancellous bone, however, it is possible that a reduced primary stability can lead to an increased rate of failure. The aim of this study was therefore to determine, with the help of the resonance frequency (Osstell mentor), which technique of implant site preparation (piezo surgery, conventional, under-preparation, bone compaction, osteodistraction) and macro-geometry is able to improve implant stability in type IV cancellous bone. Material and Methods 10 pig ribs were prepared with a surgical pre-drilled guide, calibrated for a correct implant positioning. On each rib, 5 implant sites (one for each technique) were prepared. Successively, 50 conical implants (Tekka Global D) were inserted and measured with the resonance frequency to evaluate the primary stability. Data collected were analyzed by analysis of variance (ANOVA) to test whether the Implant Stability Quotient (ISQ) values of the five techniques were significantly different. Results The results showed that no significant differences among the ISQ values of the five techniques used were found. Also, no significant differences in the macro-geometry of the two types of compared implants were observed. However, the macro-geometry of Tekka implants, characterized by a double condensing thread, seems to provide greater ISQ values than those of single thread implants when using the same technique. Conclusions In light of these preliminary data, it is conceivable that in cases of reduced stability, such as those occurring with a type IV bone, all means ameliorating the primary stability and accelerating the osseointegration can be utilized. Key words:Implant primary stability, resonance frequency analysis, implant site preparation. PMID:28160577

  1. The Role of Robotic Surgery for Rectal Cancer: Overcoming Technical Challenges in Laparoscopic Surgery by Advanced Techniques.

    PubMed

    Park, Seungwan; Kim, Nam Kyu

    2015-07-01

    The conventional laparoscopic approach to rectal surgery has several limitations, and therefore many colorectal surgeons have great expectations for the robotic surgical system as an alternative modality in overcoming challenges of laparoscopic surgery and thus enhancing oncologic and functional outcomes. This review explores the possibility of robotic surgery as an alternative approach in laparoscopic surgery for rectal cancer. The da Vinci® Surgical System was developed specifically to compensate for the technical limitations of laparoscopic instruments in rectal surgery. The robotic rectal surgery is associated with comparable or better oncologic and pathologic outcomes, as well as low morbidity and mortality. The robotic surgery is generally easier to learn than laparoscopic surgery, improving the probability of autonomic nerve preservation and genitourinary function recovery. Furthermore, in very complex procedures such as intersphincteric dissections and transabdominal transections of the levator muscle, the robotic approach is associated with increased performance and safety compared to laparoscopic surgery. The robotic surgery for rectal cancer is an advanced technique that may resolve the issues associated with laparoscopic surgery. However, high cost of robotic surgery must be addressed before it can become the new standard treatment.

  2. Bioactive glass thin films synthesized by advanced pulsed laser techniques

    NASA Astrophysics Data System (ADS)

    Mihailescu, N.; Stan, George E.; Ristoscu, C.; Sopronyi, M.; Mihailescu, Ion N.

    2016-10-01

    Bioactive materials play an increasingly important role in the biomaterials industry, and are extensively used in a range of applications, including biodegradable metallic implants. We report on Bioactive Glasses (BG) films deposition by pulsed laser techniques onto biodegradable substrates. The BG coatings were obtained using a KrF* excimer laser source (λ= 248 nm, τFWHM ≤ 25 ns).Their thickness has been determined by Profilometry measurements, whilst their morphology has been analysed by Scanning Electron Microscopy (SEM). The obtained coatings fairly preserved the targets composition and structure, as revealed by Energy Dispersive X-Ray Spectroscopy, Grazing Incidence X-Ray Diffraction, and Fourier Transform Infra-Red Spectroscopy analyses.

  3. Advanced Techniques in Musculoskeletal Oncology: Perfusion, Diffusion, and Spectroscopy.

    PubMed

    Teixeira, Pedro A Gondim; Beaumont, Marine; Gabriela, Hossu; Bailiang, Chen; Verhaeghe, Jean-luc; Sirveaux, François; Blum, Alain

    2015-12-01

    The imaging characterization of musculoskeletal tumors can be challenging, and a significant number of lesions remain indeterminate when conventional imaging protocols are used. In recent years, clinical availability of functional imaging methods has increased. Functional imaging has the potential to improve tumor detection, characterization, and follow-up. The most frequently used functional methods are perfusion imaging, diffusion-weighted imaging (DWI), and MR proton spectroscopy (MRS). Each of these techniques has specific protocol requirements and diagnostic pitfalls that need to be acknowledged to avoid misdiagnoses. Additionally, the application of functional methods in the MSK system has various technical issues that need to be addressed to ensure data quality and comparability. In this article, the application of contrast-enhanced perfusion imaging, DWI, and MRS for the evaluation of bone and soft tissue tumors is discussed, with emphasis on acquisition protocols, technical difficulties, and current clinical indications.

  4. Advanced fabrication techniques for hydrogen-cooled engine structures

    NASA Technical Reports Server (NTRS)

    Buchmann, O. A.; Arefian, V. V.; Warren, H. A.; Vuigner, A. A.; Pohlman, M. J.

    1985-01-01

    Described is a program for development of coolant passage geometries, material systems, and joining processes that will produce long-life hydrogen-cooled structures for scramjet applications. Tests were performed to establish basic material properties, and samples constructed and evaluated to substantiate fabrication processes and inspection techniques. Results of the study show that the basic goal of increasing the life of hydrogen-cooled structures two orders of magnitude relative to that of the Hypersonic Research Engine can be reached with available means. Estimated life is 19000 cycles for the channels and 16000 cycles for pin-fin coolant passage configurations using Nickel 201. Additional research is required to establish the fatigue characteristics of dissimilar-metal coolant passages (Nickel 201/Inconel 718) and to investigate the embrittling effects of the hydrogen coolant.

  5. Advances in techniques for assessment of microalgal lipids.

    PubMed

    Challagulla, Vineela; Nayar, Sasi; Walsh, Kerry; Fabbro, Larelle

    2016-07-15

    Microalgae are a varied group of organisms with considerable commercial potential as sources of various biochemicals, storage molecules and metabolites such as lipids, sugars, amino acids, pigments and toxins. Algal lipids can be processed to bio-oils and biodiesel. The conventional method to estimate algal lipids is based on extraction using solvents and quantification by gravimetry or chromatography. Such methods are time consuming, use hazardous chemicals and are labor intensive. For rapid screening of prospective algae or for management decisions (e.g. decision on timing of harvest), a rapid, high throughput, reliable, accurate, cost effective and preferably nondestructive analytical technique is desirable. This manuscript reviews the application of fluorescent lipid soluble dyes (Nile Red and BODIPY 505/515), nuclear magnetic resonance (NMR), Raman, Fourier transform infrared (FTIR) and near infrared (NIR) spectroscopy for the assessment of lipids in microalgae.

  6. Repair or Reconstruction in Acute Posterolateral Instability of the Knee: Decision Making and Surgical Technique Introduction.

    PubMed

    Stannard, James P; Stannard, James T; Cook, James L

    2015-12-01

    Complex knee injury surgeons must frequently decide whether to repair or reconstruct an acute posterolateral corner (PLC) injury. If repair is not feasible or fails, reconstruction is often necessary. Several studies have found that reconstruction has better outcomes and lower failure rates. Careful studies of the anatomy of the corner have led to the development of "two-tailed" reconstruction techniques which are becoming widely used in the field. Repair should not be completely disregarded as there are times when it is necessary, especially when no donor allograft tissue is readily available or when aggressive postoperative rehabilitation will not be performed. Optimally, if the patient has high quality tissue available for repair, it is best to combine reconstruction with repair. The authors have developed a new PLC reconstruction technique which applies the functional anatomy that has been increasingly defined. We detail these methods here, which include the use of cortical button suspensory fixation and interference screw fixation of allografts in sockets. This allows for individual and sequential intraoperative tensioning of the grafts to obtain optimal knee stability and motion.

  7. Thoracoscopic sympathicotomy for hyperhidrosis--surgical technique, complications and side effects.

    PubMed

    Göthberg, G; Drott, C; Claes, G

    1994-01-01

    Thoracic sympathectomy is a very effective treatment of palmar hyperhidrosis. The described endoscopic technique has given good primary results in 99% of patients. After another session with this type of "minimal invasive surgery" 100% of the hands were satisfactorily dry. The hospital stay is just one post-operative day and the sick-leave is about a week. The drawbacks are minimal. Pain is tolerable and only eight patients needed a post-operative Bülau-drainage because of pneumothorax or bleeding. About 50% of patients experience a compensatory increased sweating of the trunk, but this is related to a warm environment and regulation of body temperature and seems to decrease with time. This technique makes it possible to treat all those suffering from palmar hyperhidrosis which can be a substantial, but underestimated handicap. To meet this kind of patient after a successful operation is extremely satisfying even for the surgeon. The post-operative wet and cold hand has immediately post-operatively become warm and dry.

  8. Dynamic medial patellofemoral ligament reconstruction in recurrent patellar instability: A surgical technique

    PubMed Central

    Kiran, Kopuri Ravi; Srikanth, I Muni; Chinnusamy, Lenin; Deepti, K

    2015-01-01

    The medial patellofemoral ligament (MPFL) is the primary stabilizer of the patellofemoral joint; its reconstruction has been recommended in adults over the past decade after recurrent patellar instability. However, there has been no standardized technique for reconstruction, therefore, ideal graft and technique for reconstruction are yet undetermined. However, dynamic MPFL reconstruction studies claim to be superior to other procedures as it is more anatomical. This preliminary study aims at assessing the outcomes of MPFL reconstruction in a dynamic pattern using hamstring graft. We performed this procedure in four consecutive patients with chronic patellar instability following trauma. MPFL reconstruction was done with hamstring tendons detached distally and secured to patellar periosteum after being passed through a bony tunnel in the patella without an implant and using the medial collateral ligament as a pulley. In all 4 knees, the MPFL reconstruction was isolated and was not associated with any other realignment procedures. No recurrent episodes of dislocation or subluxation were reported at 24 months followup. PMID:26806970

  9. [Kirschner wire transfixation of unstable ankle fractures: indication, surgical technique and outcomes].

    PubMed

    Marvan, J; Džupa, V; Bartoška, R; Kachlík, D; Krbec, M; Báča, V

    2015-01-01

    , in the group with temporary transfixation, no radiographic evidence of ankle osteoarthritis was recorded in 25 (42%) patients. While tibiofibular synostosis was recorded in only few patients (9%) of the group with one-stage osteosynthesis, it showed a high occurrence in the group with temporary transfixation (35%). The patients with one-stage osteosynthesis (188/68%) had a higher proportion of excellent outcomes measured on the Olerund-Molander ankle scoring scale than the other two groups (temporary transfixation, 47%; definitive transfixation,10%); in both cases the difference was significant (p < 0.001 and p = 0.003, respectively). DISCUSSION In this study the morphological and clinical aspects of surgically treated ankle fractures were assessed. The patients with one-stage osteosynthesis were compared with those treated by temporary or definitive transfixation. The majority of patients undergoing temporary transfixation had a fractured posterior margin of the tibia and major ankle joint dislocation, which suggested serious injuries to bone and ligament structures. Generally, the use of only two K-wires inserted through the calcaneus and talus into the distal tibia is recommended. Patients with K-wire transfixation usually require a longer hospital stay because of the serious nature of their injuries. CONCLUSIONS The therapy of choice for unstable ankle fractures is one-stage osteosynthesis. Temporary transfixation is an effective method of primary management when an unstable fracture cannot be treated by definitive osteosynthesis at the early stage due to local or general health conditions of the patient. The temporary transfixation provides good alignment of the ankle joint necessary for successful healing of soft tissues. A higher occurrence of post-traumatic ankle osteoarthritis, ossification and distal tibiotalar synostosis found in the patients treated by temporary transfixation is more related to serious types of ankle fractures the patient had suffered

  10. Surgical approach for ulcerated locally advanced breast cancer. A single Center experience: a retrospective study.

    PubMed

    Laforgia, Rita; Punzo, Clelia; Panebianco, Annunziata; Volpi, Annalisa; Minafra, Marina; Sederino, Maria Grazia

    2017-01-12

    L’obiettivo del nostro studio è la valutazione della strategia chirurgica più idonea nei casi di LABC (Locally Advanced Breast Cancer) in condizioni di ulcerazione e sanguinamento. La diagnosi clinica del LABC prevede nella maggior parte dei casi una massa mammaria estesa associata ad edema, eritema, retrazione e sanguinamento, dolore, superficie cutanea irregolare e coinvolgimento linfonodale. L’intervento chirurgico di scelta per le forme T3-T4 è la mastectomia radicale che rappresenta un trattamento adeguato per il controllo locale della patologia. In caso di forme localmente avanzate e ulcerate, pur essendo forme inoperabili, l’exeresi chirurgica si rende necessaria per una bonifica locale. La presenza di fenomeni di ulcerazione e sanguinamento non rende possibile avviare un trattamento chemioterapico neoadiuvante ed è necessario eseguire interventi chirurgici palliativi. Il trattamento chirurgico stesso richiede mutilazioni ampie ed associate procedure di chirurgia plastica. Spesso per l’estensione della malattia ed il sovvertimento del corpus mammae durante l’exeresi chirurgica della mammella, la sezione su zone esenti da neoplasia non consente la chiusura immediata dei lembi. Abbiamo considerato, su un campione di 288 pazienti affette da carcinoma mammario, 11 donne con forme avanzate fra T4a e T4c (3.8%). E’ stata posta indicazione a trattamento chirurgico perché pazienti provenienti dal Pronto Soccorso con anemizzazione per neoplasie avanzate ulcerate e sanguinanti, non candidabili in prima istanza a chemioterapia neoadiuvante citoriduttiva. Le procedure adoperate per la ricostruzione della mammella sono state in 2 pazienti la rotazione di un lembo muscolo cutaneo, in 4 casi un innesto cutaneo prelevato dalla coscia, in 4 casi è stata utilizzata una matrice dermica biologica - sostituto cutaneo (INTEGRA) che è stata poi sostituita con un successivo innesto cutaneo a distanza di circa 20-30 giorni. Sono state osservate recidive in 2 casi

  11. Advances in the surgical treatment of fragility fractures of the upper femur

    PubMed Central

    Muncibì, Francesco; Petrai, Veronica; Nistri, Lorenzo; Civinini, Roberto; Innocenti, Massimo

    2009-01-01

    Fragility fractures typically occur in elderly patients. They are related to osteoporosis, because of the weakening of the bone structure, and are the result of low-energy injuries and often involve the metaphyseal segments of bone. The fracture of the upper extremity of the femur are one of the most typical of the elderly patients. They may be intracapsular (femoral neck fractures) or extracapsular (intertrochanteric fractures). Each kind of fracture can be treated in several ways: the intracapsular fracture can be treated with screws, unipolar or bipolar hemiarthroplasty or even with total arthroplasty. The extracapsular fractures instead can be treated with sliding hip screw, intramedullary nail, femoral neck screws, helical blade or primary arthroplasty. What must be remembered is that osteoporotic bone has distinct morphologic characteristics that influence its biomechanical properties and therefore the choices and techniques for internal fixation. Therefore only a complete understanding of the biology of the osteoporotic bone will lead to a good quality of the treatment of the fragility fractures. PMID:22461246

  12. Laparoscopic surgical technique to facilitate management of high anorectal malformations – report of seven cases

    PubMed Central

    Murawski, Maciej; Łosin, Marcin; Królak, Marek; Czauderna, Piotr

    2011-01-01

    Anorectal malformations (ARMs) occur in approximately 1 per 5000 live births. The most commonly used procedure for repair of high ARMs is posterior sagittal anorectoplasty (PSARP). This operation is performed entirely through a perineal approach. The first report of laparoscopically assisted anorectal pull-through (LAARP) for repair of ARMs was presented by Georgeson in 2000. The aim is presenting early experience with laparoscopically assisted anorectal pull-through technique in boys with high anorectal malformations. In the last 5 years 7 boys (9 months to 2 years old) with high ARMs were operated on using the LAARP technique. Laparoscopically the rectal pouch was exposed down to the urethral fistula, which was clipped and divided. Externally, the centre of the muscle complex was identified using an electrical stimulator. In the first 4 patients after a midline incision of 2 cm at the planned anoplasty site, a tunnel to the pelvis was created bluntly and dilated with Hegar probes under laparoscopic control. In the last 3 boys a minimal PSARP was done creating a channel into the pelvis. The separated rectum was pulled down and sutured to the perineum. Laparoscopic mobilization of the rectal pouch and fistula division was possible in all cases. There were no intraoperative complications except one ureteral injury. Patients were discharged home on post-operative day 5 to 7. The early results prove that LAARP, an alternative option to PSARP for treatment of imperforate anus, offers many advantages, including excellent visualization of the pelvic anatomical structures, accurate placement of the bowel into the muscle complex and a minimally invasive abdominal and perineal incision. It allows for shorter hospital stay and faster recovery. However, to compare the functional results against the standard procedure (PSARP), longer follow-up of all patients is necessary. PMID:23255974

  13. Percutaneous Cannulated Compression Screw Osteosynthesis in Phalanx Fractures: The Surgical Technique, the Indications, and the Results

    PubMed Central

    Kisch, Tobias; Wenzel, Eike; Mailänder, Peter; Stang, Felix

    2017-01-01

    Objective: Fractures of metacarpals and phalanges are very common fractures, and there are a lot of treatment modalities. The purpose of the study was to describe the technique of percutaneous fixation of phalangeal fractures using a cannulated compression screw fixation system and its results. Methods: We conducted a prospective clinical study on 43 patients with different types of phalangeal fractures undergoing a percutaneous cannulated compression screw osteosynthesis. Parameters such as average operation time and clinical outcome were evaluated postoperatively. Results: Forty-three patients were treated using a percutaneous cannulated compression screw fixation system for phalanx fractures of the proximal (n = 26), middle phalanx (n = 16), or distal phalanx (n = 1). All fractures healed after 6 to 8 weeks except in 1 patient with secondary loss of reduction occurring 2.5 weeks after surgery. No infections were observed. The mean total active motion values were 247.56° ±16.16° and 244.35° ± 11.61° for the intra-articular fracture and 251.25° ± 19.86° for the shaft fractures; the mean Disabilities of the Arm, Shoulder, and Hand (DASH) score 3 months after the surgery was 1.67 ± 2.74. Conclusions: The advantages of this technique are the avoidance of an open procedure requiring extensive soft-tissue dissection with the risks of tendon adhesions and the achievement of interfragmentary compression. Because of the interfragmentary compression, it is superior to simple K-wires. With regard to indications, our primary focus was on unicondylar proximal interphalangeal joint fractures, shaft fractures, and simple oblique 2-fragment fractures. PMID:28293333

  14. Advanced Infusion Techniques with 3-D Printed Tooling

    SciTech Connect

    Nuttall, David; Elliott, Amy; Post, Brian K.; Love, Lonnie J.

    2016-05-10

    The manufacturing of tooling for large, contoured surfaces for fiber-layup applications requires significant effort to understand the geometry and then to subtractively manufacture the tool. Traditional methods for the auto industry use clay that is hand sculpted. In the marine pleasure craft industry, the exterior of the model is formed from a foam lay-up that is either hand cut or machined to create smooth lines. Engineers and researchers at Oak Ridge National Laboratory s Manufacturing Demonstration Facility (ORNL MDF) collaborated with Magnum Venus Products (MVP) in the development of a process for reproducing legacy whitewater adventure craft via digital scanning and large scale 3-D printed layup molds. The process entailed 3D scanning a legacy canoe form, converting that form to a CAD model, additively manufacturing (3-D Print) the mold tool, and subtractively finishing the mold s transfer surfaces. Future work will include applying a gelcoat to the mold transfer surface and infusing using vacuum assisted resin transfer molding, or VARTM principles, to create a watertight vessel. The outlined steps were performed on a specific canoe geometry found by MVP s principal participant. The intent of utilizing this geometry is to develop an energy efficient and marketable process for replicating complex shapes, specifically focusing on this particular watercraft, and provide a finished product for demonstration to the composites industry. The culminating part produced through this agreement has been slated for public presentation and potential demonstration at the 2016 CAMX (Composites and Advanced Materials eXpo) exposition in Anaheim, CA. Phase I of this collaborative research and development agreement (MDF-15-68) was conducted under CRADA NFE-15-05575 and was initiated on May 7, 2015, with an introduction to the MVP product line, and concluded in March of 2016 with the printing of and processing of a canoe mold. The project partner Magnum Venous Products (MVP) is

  15. Impact of Surgical Evaluation of Additional Cine Magnetic Resonance Imaging for Advanced Thymoma with Infiltration of Adjacent Structures: The Thoracic Surgeon's View.

    PubMed

    Ried, Michael; Hnevkovsky, Stefanie; Neu, Reiner; von Süßkind-Schwendi, Marietta; Götz, Andrea; Hamer, Okka W; Schalke, Berthold; Hofmann, Hans-Stefan

    2017-04-01

    Background Preoperative radiological assessment is important for clarification of surgical operability for advanced thymic tumors. Objective was to determine the feasibility of magnetic resonance imaging (MRI) with cine sequences for evaluation of cardiovascular tumor invasion. Patients and Methods This prospective study included patients with advanced thymoma, who underwent surgical resection. All patients received preoperative computed tomography (CT) scan and cine MRI. Results Tumor infiltration was surgically confirmed in the pericardium (n = 12), myocardium (n = 1), superior caval vein (SCV; n = 3), and aorta (n = 2). A macroscopic complete resection was possible in 10 patients, whereas 2 patients with aortic or myocardial tumor invasion had R2 resection. The positive predictive value (PPV) was 50% for cine MRI compared with 0% for CT scan regarding myocardial tumor infiltration. The PPV for tumor infiltration of the aorta was 50%, with a higher sensitivity for the CT scan (100 vs. 50%). Infiltration of the SCV could be detected slightly better with cine MRI (PPV 75 vs. 66.7%). Conclusion Cine MRI seems to improve the accuracy of preoperative staging of advanced thymoma regarding infiltration of cardiovascular structures and supports the surgical approach.

  16. Recent advances in techniques for tsetse-fly control*

    PubMed Central

    MacLennan, K. J. R.

    1967-01-01

    With the advent of modern persistent insecticides, it has become possible to utilize some of the knowledge that has accumulated on the ecology and bionomics of Glossina and to devise more effective techniques for the control and eventual extermination of these species. The present article, based on experience of the tsetse fly problem in Northern Nigeria, points out that the disadvantages of control techniques—heavy expenditure of money and manpower and undue damage to the biosystem—can now largely be overcome by basing the application of insecticides on knowledge of the habits of the particular species of Glossina in a particular environment. Two factors are essential to the success of a control project: the proper selection of sites for spraying (the concept of restricted application) and the degree of persistence of the insecticide used. Reinfestation from within or outside the project area must also be taken into account. These and other aspects are discussed in relation to experience gained from a successful extermination project carried out in the Sudan vegetation zone and from present control activities in the Northern Guinea vegetation zone. PMID:5301739

  17. Advances in Current Rating Techniques for Flexible Printed Circuits

    NASA Technical Reports Server (NTRS)

    Hayes, Ron

    2014-01-01

    Twist Capsule Assemblies are power transfer devices commonly used in spacecraft mechanisms that require electrical signals to be passed across a rotating interface. Flexible printed circuits (flex tapes, see Figure 2) are used to carry the electrical signals in these devices. Determining the current rating for a given trace (conductor) size can be challenging. Because of the thermal conditions present in this environment the most appropriate approach is to assume that the only means by which heat is removed from the trace is thru the conductor itself, so that when the flex tape is long the temperature rise in the trace can be extreme. While this technique represents a worst-case thermal situation that yields conservative current ratings, this conservatism may lead to overly cautious designs when not all traces are used at their full rated capacity. A better understanding of how individual traces behave when they are not all in use is the goal of this research. In the testing done in support of this paper, a representative flex tape used for a flight Solar Array Drive Assembly (SADA) application was tested by energizing individual traces (conductors in the tape) in a vacuum chamber and the temperatures of the tape measured using both fine-gauge thermocouples and infrared thermographic imaging. We find that traditional derating schemes used for bundles of wires do not apply for the configuration tested. We also determine that single active traces located in the center of a flex tape operate at lower temperatures than those on the outside edges.

  18. Advanced Manufacturing Techniques Demonstrated for Fabricating Developmental Hardware

    NASA Technical Reports Server (NTRS)

    Redding, Chip

    2004-01-01

    NASA Glenn Research Center's Engineering Development Division has been working in support of innovative gas turbine engine systems under development by Glenn's Combustion Branch. These one-of-a-kind components require operation under extreme conditions. High-temperature ceramics were chosen for fabrication was because of the hostile operating environment. During the designing process, it became apparent that traditional machining techniques would not be adequate to produce the small, intricate features for the conceptual design, which was to be produced by stacking over a dozen thin layers with many small features that would then be aligned and bonded together into a one-piece unit. Instead of using traditional machining, we produced computer models in Pro/ENGINEER (Parametric Technology Corporation (PTC), Needham, MA) to the specifications of the research engineer. The computer models were exported in stereolithography standard (STL) format and used to produce full-size rapid prototype polymer models. These semi-opaque plastic models were used for visualization and design verification. The computer models also were exported in International Graphics Exchange Specification (IGES) format and sent to Glenn's Thermal/Fluids Design & Analysis Branch and Applied Structural Mechanics Branch for profiling heat transfer and mechanical strength analysis.

  19. Simulation of an advanced techniques of ion propulsion Rocket system

    NASA Astrophysics Data System (ADS)

    Bakkiyaraj, R.

    2016-07-01

    The ion propulsion rocket system is expected to become popular with the development of Deuterium,Argon gas and Hexagonal shape Magneto hydrodynamic(MHD) techniques because of the stimulation indirectly generated the power from ionization chamber,design of thrust range is 1.2 N with 40 KW of electric power and high efficiency.The proposed work is the study of MHD power generation through ionization level of Deuterium gas and combination of two gaseous ions(Deuterium gas ions + Argon gas ions) at acceleration stage.IPR consists of three parts 1.Hexagonal shape MHD based power generator through ionization chamber 2.ion accelerator 3.Exhaust of Nozzle.Initially the required energy around 1312 KJ/mol is carrying out the purpose of deuterium gas which is changed to ionization level.The ionized Deuterium gas comes out from RF ionization chamber to nozzle through MHD generator with enhanced velocity then after voltage is generated across the two pairs of electrode in MHD.it will produce thrust value with the help of mixing of Deuterium ion and Argon ion at acceleration position.The simulation of the IPR system has been carried out by MATLAB.By comparing the simulation results with the theoretical and previous results,if reaches that the proposed method is achieved of thrust value with 40KW power for simulating the IPR system.

  20. Advances in low energy neutral atom imaging techniques

    SciTech Connect

    Scime, E.E.; Funsten, H.O.; McComas, D.J.; Moore, K.R. ); Gruntman, M. . Space Sciences Center)

    1993-01-01

    Recently proposed low energy neutral atom (LENA) imaging techniques use a collisional process to convert the low energy neutrals into ions before detection. At low energies, collisional processes limit the angular resolution and conversion efficiencies of these devices. However, if the intense ultraviolet light background can be suppressed, direct LENA detection is possible. We present results from a series of experiments designed to develop a novel filtering structure based on free-standing transmission gratings. If the grating period is sufficiently small, free standing transmission gratings can be employed to substantially polarize ultraviolet (UV) light in the wavelength range 300 [Angstrom] to 1500 [Angstrom]. If a second grating is placed behind the first grating with its axis of polarization oriented at a right angle to the first's, a substantial attenuation of UV radiation is achievable. ne neutrals will pass through the remaining open area of two gratings and be detected without UV background complications. We have obtained nominal 2000 [Angstrom] period (1000 [Angstrom] bars with 1000 [Angstrom] slits) free standing, gold transmission gratings and measured their UV and atomic transmission characteristics. The geometric factor of a LENA imager based on this technology is comparable to that of other proposed LENA imagers. In addition, this of imager does not distort the neutral trajectories, allowing for high angular resolution.

  1. Advanced signal processing technique for damage detection in steel tubes

    NASA Astrophysics Data System (ADS)

    Amjad, Umar; Yadav, Susheel Kumar; Dao, Cac Minh; Dao, Kiet; Kundu, Tribikram

    2016-04-01

    In recent years, ultrasonic guided waves gained attention for reliable testing and characterization of metals and composites. Guided wave modes are excited and detected by PZT (Lead Zirconate Titanate) transducers either in transmission or reflection mode. In this study guided waves are excited and detected in the transmission mode and the phase change of the propagating wave modes are recorded. In most of the other studies reported in the literature, the change in the received signal strength (amplitude) is investigated with varying degrees of damage while in this study the change in phase is correlated with the extent of damage. Feature extraction techniques are used for extracting phase and time-frequency information. The main advantage of this approach is that the bonding condition between the transducer and the specimen does not affect the phase while it can affect the strength of recorded signal. Therefore, if the specimen is not damaged but the transducer-specimen bonding is deteriorated then the received signal strength is altered but the phase remains same and thus false positive predictions for damage can be avoided.

  2. Advanced techniques for determining long term compatibility of materials with propellants

    NASA Technical Reports Server (NTRS)

    Green, R. L.; Stebbins, J. P.; Smith, A. W.; Pullen, K. E.

    1973-01-01

    A method for the prediction of propellant-material compatibility for periods of time up to ten years is presented. Advanced sensitive measurement techniques used in the prediction method are described. These include: neutron activation analysis, radioactive tracer technique, and atomic absorption spectroscopy with a graphite tube furnace sampler. The results of laboratory tests performed to verify the prediction method are presented.

  3. Biotechnology Apprenticeship for Secondary-Level Students: Teaching Advanced Cell Culture Techniques for Research

    ERIC Educational Resources Information Center

    Lewis, Jennifer R.; Kotur, Mark S.; Butt, Omar; Kulcarni, Sumant; Riley, Alyssa A.; Ferrell, Nick; Sullivan, Kathryn D.; Ferrari, Mauro

    2002-01-01

    The purpose of this article is to discuss "small-group apprenticeships (SGAs)" as a method to instruct cell culture techniques to high school participants. The study aimed to teach cell culture practices and to introduce advanced imaging techniques to solve various biomedical engineering problems. Participants designed and completed experiments…

  4. Advanced Techniques for Reservoir Simulation and Modeling of Non-Conventional Wells

    SciTech Connect

    Durlofsky, Louis J.

    2000-08-28

    This project targets the development of (1) advanced reservoir simulation techniques for modeling non-conventional wells; (2) improved techniques for computing well productivity (for use in reservoir engineering calculations) and well index (for use in simulation models), including the effects of wellbore flow; and (3) accurate approaches to account for heterogeneity in the near-well region.

  5. Biotechnology Apprenticeship for Secondary-Level Students: Teaching Advanced Cell Culture Techniques for Research.

    ERIC Educational Resources Information Center

    Lewis, Jennifer R.; Kotur, Mark S.; Butt, Omar; Kulcarni, Sumant; Riley, Alyssa A.; Ferrell, Nick; Sullivan, Kathryn D.; Ferrari, Mauro

    2002-01-01

    Discusses small-group apprenticeships (SGAs) as a method for introducing cell culture techniques to high school participants. Teaches cell culture practices and introduces advance imaging techniques to solve various biomedical engineering problems. Clarifies and illuminates the value of small-group laboratory apprenticeships. (Author/KHR)

  6. Recent Surgical and Medical Advances in the Treatment of Dupuytren’s Disease - A Systematic Review of the Literature

    PubMed Central

    R, Mafi; S, Hindocha; W, Khan

    2012-01-01

    Dupuytren’s disease (DD) is a type of fibromatosis which progressively results in the shortening and thickening of the fibrous tissue of the palmar fascia. This condition which predominantly affects white-northern Europeans has been identified since 1614. DD can affect certain activities of daily living such as face washing, combing hair and putting hand in a glove. The origin of Dupuytren’s contracture is still unknown, but there are a number of treatments that doctors have come across throughout the years. Historically surgery has been the mainstay treatment for DD but not the only one. The objective is to make a structured review of the most recent advances in treatment of DD including the surgical and medical interventions. We have looked at the most relevant published articles regarding the various treatment options for DD. This review has taken 55 articles into consideration which have met the inclusion criteria. The most recent treatments used are multi-needle aponeurotomy, extensive percutaneous aponeurotomy and lipografting, injecting collagenase Clostridium histolyticum, INF-gamma and shockwave therapy as well as radiotherapy. Each of these treatments has certain advantages and drawbacks and cannot be used for every patient. In order to prevent this condition, spending more time and money in the topic is required to reach better and more consistent treatments and ultimately to eradicate this disease. PMID:22431952

  7. Recent Surgical and Medical Advances in the Treatment of Dupuytren's Disease - A Systematic Review of the Literature.

    PubMed

    R, Mafi; S, Hindocha; W, Khan

    2012-01-01

    Dupuytren's disease (DD) is a type of fibromatosis which progressively results in the shortening and thickening of the fibrous tissue of the palmar fascia. This condition which predominantly affects white-northern Europeans has been identified since 1614. DD can affect certain activities of daily living such as face washing, combing hair and putting hand in a glove. The origin of Dupuytren's contracture is still unknown, but there are a number of treatments that doctors have come across throughout the years. Historically surgery has been the mainstay treatment for DD but not the only one. The objective is to make a structured review of the most recent advances in treatment of DD including the surgical and medical interventions. We have looked at the most relevant published articles regarding the various treatment options for DD. This review has taken 55 articles into consideration which have met the inclusion criteria. The most recent treatments used are multi-needle aponeurotomy, extensive percutaneous aponeurotomy and lipografting, injecting collagenase Clostridium histolyticum, INF-gamma and shockwave therapy as well as radiotherapy. Each of these treatments has certain advantages and drawbacks and cannot be used for every patient. In order to prevent this condition, spending more time and money in the topic is required to reach better and more consistent treatments and ultimately to eradicate this disease.

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

    PubMed

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

    2012-08-01

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

  9. Anterograde excision of a sublingual gland: new surgical technique for the treatment of ranulas.

    PubMed

    Liu, Zhigang; Wang, Bin

    2016-02-01

    Wharton's duct is dissected in a retrograde direction from the orifice of the duct to the hilum of the submandibular gland when the gland is being excised conventionally. Here we describe an anterograde technique, in which Wharton's duct is dissected in an anterograde direction from the hilum of the submandibular gland to the orifice of the duct. This prospective clinical study included 50 consecutive patients with ranulas who had anterograde excision of the sublingual gland between May 2012 and January 2015. The intraoral incision was similar to that for conventional excision. Wharton's duct and other important anatomical structures located in the space behind the sublingual gland were all identified at the beginning of the procedure, followed by anterograde dissection of Wharton's duct. After the glandular tissue lateral to the duct had been incised completely, the duct was exposed and the gland cut into two parts. Finally, the two parts were removed, and the ranula ruptured. The patients were followed up from 6 months-2 years. There were no complications. Anterograde excision of the sublingual gland is based on the anatomy, and this reduces the risk of complications after removal of a ranula.

  10. In vitro characterization of the technique of portal vein embolization by injection of a surgical glue

    NASA Astrophysics Data System (ADS)

    Salsac, Anne-Virginie; Sandulache, Mihai-Cristinel; Lancon, Oceane; El Kadri Benkara, Khadija

    2012-11-01

    Partial embolization of the portal trunk by glue injection is a minimally invasive technique used in the case of malignant liver tumors. It is conducted few weeks prior to partial liver ablation, when the volume of the remnant liver section is too small to allow hepatectomy. The limitation of glue embolotherapy is that its clinical practice is based on empirical knowledge. The present objective is to study glue injection in a confined blood flow and investigate how the injection dynamics is coupled with glue polymerization. We first characterize polymerization under static conditions for various glue concentrations and then consider the influence of injection. An experimental setup reproduces the co-flow of two immiscible fluids. The glue mixture is injected through a capillary tube into a saline solution with the same ionic concentration, pH and viscosity as blood, flowing steadily in a straight cylindrical tube. The injected phase is visualized with a high-speed imaging system and results are compared with those obtained for non-reacting fluids. These experiments have enabled us to characterize the characteristic times of polymerization of the glue mixtures under static and dynamic conditions and understand how they affect the flow topology of the glue once injected. Biomechanics and Bioengineering Laboratory (UMR CNRS 7338).

  11. Surgical techniques: how I do it? The Reamer/Irrigator/Aspirator (RIA) system.

    PubMed

    Giannoudis, P V; Tzioupis, C; Green, J

    2009-11-01

    Although reamed intramedullary nailing has long been considered a safe procedure, pulmonary complications have been reported in some groups of patients. Concerns over fat embolisation, adult respiratory distress syndrome (ARDS), and sudden intraoperative death have prompted some authors to question whether the benefits of reaming are outweighed by its potential adverse effects to the patient. In response to these complications, recent evaluations have focused on alternative systems that reduce intramedullary pressure during reaming. The Reamer/Irrigator/Aspirator (RIA) system (Synthes, Inc., West Chester, PA) was developed as a simultaneous reaming and aspiration system to reduce the intramedullary pressure, heat generation, operating time, and systemic effects of reaming. It was designed with an aggressive one-pass reamer head which is connected to a hand-held reamer via a drive shaft, simultaneously irrigating and aspirating femoral canal contents during reaming, thus preventing thermal necrosis and fat embolisation. After its early use, investigators examined the "aspirate" captured by the RIA which appeared to be loaded with osteogenic substrates. This discovery revealed a second potential use for the RIA-a bone graft harvester. The different design characteristics and technicalities of the RIA system necessitate a deep and clear understanding of its technique, a meticulous preoperative planning and a strict adherence to its principles intraoperatively. We present our current approach to the use of the RIA system, including the preoperative planning, the details of the operative procedure, the pitfalls and the potential complications that could be encountered.

  12. Lumbar extracavitary corpectomy with a single stage circumferential arthrodesis: surgical technique and clinical series.

    PubMed

    Singh, Kern; Park, Daniel K

    2012-07-01

    Circumferential arthrodesis and reconstruction is necessary after a lumbar corpectomy in the setting of malignancy and infection. The advent of expandable cage technology now allows for safe anterior column reconstruction via a posterior approach with no transection and minimal retraction of the lumbar spinal nerve roots. Fifteen patients underwent a single-stage, circumferential corpectomy and anterior spinal reconstruction with an expandable cage via a midline, posterior, lateral lumbar extracavitary approach. Posterior segmental pedicle screw fixation and iliac crest bone graft was used in all cases. Fifteen lumbar extracavitary corpectomy nerve root-sparing procedures have been performed to date, with at least 1-year follow-up (12 tumors/3 infections). No patient suffered any neurological complications. One patient suffered from a postoperative myocardial infarction 10 days after the procedure. Two patients had medical complications that were treated without sequelae. We present a technical description and case series of patients undergoing a single-stage, circumferential corpectomy and anterior spinal reconstruction with an expandable cage via a midline, posterior, lateral lumbar extracavitary approach with at least 1-year follow-up. The technique is safe, technically feasible, and obviates an anterior approach in this oftentimes critically ill patient population.

  13. Novel Techniques with the Aid of a Staged CBCT Guided Surgical Protocol

    PubMed Central

    Drew, Howard

    2015-01-01

    The case report will present some novel techniques for using a “staged” protocol utilizing strategic periodontally involved teeth as transitional abutments in combination with CBCT guided implant surgery. Staging the case prevented premature loading of the grafted sites during the healing phase. A CBCT following a tenting screw guided bone regeneration procedure ensured adequate bone to place an implant fixture. Proper assessment of the CBCT allowed the surgeon to do an osteotome internal sinus lift in an optimum location. The depth of the bone needed for the osteotome sinus floor elevation was planned. The staged appliance allowed these sinus-augmented sites to heal for an extended period of time compared to implants, which were uncovered and loaded at an earlier time frame. The staged protocol and CBCT analysis enabled the immediate implants to be placed in proper alignment to the adjacent fixture. After teeth were extracted, the osseointegrated implants were converted to abutments for the transitional appliance. Finally, the staged protocol allowed for soft tissue enhancement in the implant and pontic areas prior to final insertion of the prosthesis. PMID:25632356

  14. The Use of MMF Screws: Surgical Technique, Indications, Contraindications, and Common Problems in Review of the Literature

    PubMed Central

    Cornelius, Carl-Peter; Ehrenfeld, Michael

    2010-01-01

    Mandibulo-maxillary fixation (MMF) screws are inserted into the bony base of both jaws in the process of fracture realignment and immobilisation. The screw heads act as anchor points to fasten wire loops or rubber bands connecting the mandible to the maxilla. Traditional interdental chain-linked wiring or arch bar techniques provide the anchorage by attached cleats, hooks, or eyelets. In comparison to these tooth-borne appliances MMF screws facilitate and shorten the way to achieve intermaxillary fixation considerably. In addition, MMF screws help to reduce the hazards of glove perforation and wire stick injuries. On the downside, MMF screws are attributed with the risk of tooth root damage and a lack of versatility beyond the pure maintenance of occlusion such as stabilizing loose teeth or splinting fragments of the alveolar process. The surgical technique of MMF screws as well as the pros and cons of the clinical application are reviewed. The adequate screw placement to prevent serious tooth root injuries is still an issue to rethink and modify conceptual guidelines. PMID:22110819

  15. Clinical Outcome of a Wide-diameter Bone-anchored Hearing Implant and a Surgical Technique With Tissue Preservation

    PubMed Central

    Mowinckel, Marius S.; Møller, Martin N.; Wielandt, Kirsten N.; Foghsgaard, Søren

    2016-01-01

    Objective: To investigate the clinical outcome of a surgical technique with tissue preservation for a wide bone-anchored hearing implant concerning postoperative complications, skin reactions, implant loss, and implant stability. Study Design: Consecutive, prospective case series. Setting: Tertiary referral center. Patients: Twenty-four adult patients with normal skin quality were enrolled. Intervention(s): Implantation of bone-anchored implant was performed using a one-stage linear-incision technique with tissue preservation surgery. Main Outcome Measures(s): Skin and soft tissue reactions according to Holgers grading system. Pain and numbness measured according to visual analogue scale. Implant stability quotient values were recorded using resonance frequency analysis. Follow-up at 10 days, 6 weeks, 6 months, and 1 year after surgery. Results: Primary implant stability was good and a significant increase in implant stability quotient occurred during the first 10 days and continued to be stable throughout the 1-year observation period. No implants were lost. Skin and soft tissue reactions were few, no reaction (Holger grade 0) was observed in 88% of the follow-up examinations and no grade 4 reactions occurred. Pain and numbness were minimal. Conclusion: The wide implant showed good stability initially and throughout the observation period. Skin and soft tissue reactions were rare and minor. No implants were lost. PMID:26954348

  16. The Use of MMF Screws: Surgical Technique, Indications, Contraindications, and Common Problems in Review of the Literature.

    PubMed

    Cornelius, Carl-Peter; Ehrenfeld, Michael

    2010-06-01

    Mandibulo-maxillary fixation (MMF) screws are inserted into the bony base of both jaws in the process of fracture realignment and immobilisation. The screw heads act as anchor points to fasten wire loops or rubber bands connecting the mandible to the maxilla. Traditional interdental chain-linked wiring or arch bar techniques provide the anchorage by attached cleats, hooks, or eyelets. In comparison to these tooth-borne appliances MMF screws facilitate and shorten the way to achieve intermaxillary fixation considerably. In addition, MMF screws help to reduce the hazards of glove perforation and wire stick injuries. On the downside, MMF screws are attributed with the risk of tooth root damage and a lack of versatility beyond the pure maintenance of occlusion such as stabilizing loose teeth or splinting fragments of the alveolar process. The surgical technique of MMF screws as well as the pros and cons of the clinical application are reviewed. The adequate screw placement to prevent serious tooth root injuries is still an issue to rethink and modify conceptual guidelines.

  17. Semitendinosus and gracilis free muscle-tendon graft for repair of massive rotator cuff tears: surgical technique

    PubMed Central

    GIGANTE, ANTONIO; BOTTEGONI, CARLO; MILANO, GIUSEPPE; RICCIO, MICHELE; DEI GIUDICI, LUCA

    2016-01-01

    Massive rotator cuff tears are difficult to treat surgically due to retraction, degeneration and fraying of the ends of torn tendons, severe fatty infiltration and atrophy of the respective muscles. Procedures developed to close the gap between the rotator cuff and the greater tuberosity of the humerus, such as soft tissue release may be inadequate for large tears. Human or porcine dermal allografts still have uncertain benefits, and tendon transfers seem to be associated with poor outcomes, donor site morbidity and altered mechanics. Reverse total shoulder arthroplasty has limited durability and is not indicated in young patients with high functional demands. We developed a new technique for repairing massive rotator cuff tears by semitendinosus and gracilis myotendinous grafting. This novel therapeutic option allows massive rotator cuff tears to be repaired using autologous material that is adequate and adaptable, making it possible to cover any width of defect. The technique is low-invasive and not technically demanding, with minimal donor site morbidity. PMID:27900313

  18. The "Hoop" Plate for Posterior Bicondylar Shear Tibial Plateau Fractures: Description of a New Surgical Technique.

    PubMed

    Giordano, Vincenzo; Schatzker, Joseph; Kfuri, Mauricio

    2016-09-29

    High-energy fractures of the proximal tibia with extensive fragmentation of the posterior rim of the tibial plateau are challenging. This technique aims to describe a method on how to embrace the posterior rim of the tibial plateau by placing a horizontal precontoured one-third tubular plate wrapped around its corners. This method, which we named "hoop plating," is mainly indicated for cases of crushed juxta-articular rim fractures, aiming to restore cortical containment of the tibial plateau. Through a lateral approach with a fibular head osteotomy (Lobenhoffer approach), both anterolateral and posterolateral fragments are directly reduced and supported by a one-third tubular plate of adequate length. The plate is inserted from lateral to medial deep to all soft tissues, and its position is checked with fluoroscopy. The implant sits exactly on the posterior cortex of the tibial plateau and provides containment for the reduced juxta-articular posterior cortex and rim. We begin with immediate range of motion. Toe-touch weight-bearing with crutches is allowed with the operated knee in full extension. Weight-bearing is gradually increased only after 6 weeks as bone healing is taking place. Clinical follow-up is performed at 1, 3, 6, and 12 weeks. If the radiological exam confirms that the fracture is healed, the patient is allowed to proceed to muscle strengthening and bear weight entirely. The "hoop plating" may be a good option for the management in cases of extensive posterior tibial plateau articular surface fracture and impaction with rim and posterior cortical wall fragmentation.

  19. Dome osteotomy for posttraumatic cubitus varus: a surgical technique to avoid lateral condylar prominence.

    PubMed

    Pankaj, Amite; Dua, Aman; Malhotra, Rajesh; Bhan, Surya

    2006-01-01

    The indication for surgery in most children with posttraumatic cubitus varus is the presence of an unsightly deformity. The function of the limb is generally not impaired. Lateral closing-wedge supracondylar osteotomy, although a widely used corrective procedure, tends to produce lateral condylar prominence, thus jeopardizing the cosmetic outcome. The authors used the dome supracondylar osteotomy, as described by Tien et al, as the corrective procedure for cubitus varus in 12 consecutive children. The average follow-up was 2.3 (range 1-4) years. The objective evaluation was done by one of the authors by measuring the pre- and postoperative lateral condylar prominence index, carrying angle, and the range of movement at the elbow. The patients and parents were also asked to self-assess the cosmetic outcome. There were seven excellent and five good results. None of the children showed a prominent lateral humeral condyle. Hypertrophic scar formation and ulnar neurapraxia were seen in one patient each. These results were comparable to the published results of lateral closing-wedge osteotomy in terms of correction of carrying angle and preservation of elbow motion and were superior to those of the lateral closing-wedge osteotomy in terms of the prominence of lateral humeral condyle, acceptability of the scar, and cosmesis. The authors offer independent verification of the observation that the technique of dome osteotomy as described by Tien et al for the correction of the posttraumatic cubitus varus is a simple, safe, and technically sound procedure that prevents the lateral condyle from becoming prominent and yields an excellent cosmetic outcome.

  20. Prospective Study of the Surgical Techniques Used in Primary Rhinoplasty on the Caucasian Nose and Comparison of the Preoperative and Postoperative Anthropometric Nose Measurements

    PubMed Central

    Berger, Cezar Augusto Sarraf; Freitas, Renato da Silva; Malafaia, Osvaldo; Pinto, José Simão de Paula; Macedo Filho, Evaldo Dacheux; Mocellin, Marcos; Fagundes, Marina Serrato Coelho

    2014-01-01

    Introduction The knowledge and study of surgical techniques and anthropometric measurements of the nose make possible a qualitative and quantitative analysis of surgical results. Objective Study the main technique used in rhinoplasty on Caucasian noses and compare preoperative and postoperative anthropometric measurements of the nose. Methods A prospective study with 170 patients was performed at a private hospital. Data were collected using the Electronic System Integrated of Protocols software (Sistema Integrado de Protocolos Eletrônicos, SINPE©). The surgical techniques used in the nasal dorsum and tip were evaluated. Preoperative and 12-month follow-up photos as well as the measurements compared with the ideal aesthetic standard of a Caucasian nose were analyzed objectively. Student t test and standard deviation test were applied. Results There was a predominance of endonasal access (94.4%). The most common dorsum technique was hump removal (33.33%), and the predominance of sutures (24.76%) was observed on the nasal tip, with the lateral intercrural the most frequent (32.39%). Comparison between preoperative and postoperative photos found statistically significant alterations on the anthropometric measurements of the noses. Conclusion The main surgical techniques on Caucasian noses were evaluated, and a great variety was found. The evaluation of anthropometric measurements of the nose proved the efficiency of the performed procedures. PMID:25992149

  1. A Novel Microcharacterization Technique in the Measurement of Strain and Orientation Gradient in Advanced Materials

    NASA Technical Reports Server (NTRS)

    Garmestai, H.; Harris, K.; Lourenco, L.

    1997-01-01

    Representation of morphology and evolution of the microstructure during processing and their relation to properties requires proper experimental techniques. Residual strains, lattice distortion, and texture (micro-texture) at the interface and the matrix of a layered structure or a functionally gradient material and their variation are among parameters important in materials characterization but hard to measure with present experimental techniques. Current techniques available to measure changes in interred material parameters (residual stress, micro-texture, microplasticity) produce results which are either qualitative or unreliable. This problem becomes even more complicated in the case of a temperature variation. These parameters affect many of the mechanical properties of advanced materials including stress-strain relation, ductility, creep, and fatigue. A review of some novel experimental techniques using recent advances in electron microscopy is presented here to measure internal stress, (micro)texture, interracial strength and (sub)grain formation and realignment. Two of these techniques are combined in the chamber of an Environmental Scanning Electron Microscope to measure strain and orientation gradients in advanced materials. These techniques which include Backscattered Kikuchi Diffractometry (BKD) and Microscopic Strain Field Analysis are used to characterize metallic and intermetallic matrix composites and superplastic materials. These techniques are compared with the more conventional x-ray diffraction and indentation techniques.

  2. Surgical Techniques to Increase the Apicocoronal Dimension of the Attached Gingiva: A 1-Year Comparison Between the Free Gingival Graft and the Modified Apically Repositioned Flap.

    PubMed

    Carnio, João; Camargo, Paulo M; Pirih, Paulo Q

    2015-01-01

    The attached gingiva is a desirable anatomical element for the maintenance of gingival health. The free gingival graft (FGG) and the modified apically repositioned flap (MARF) are predictable surgical techniques often employed to increase the zone of attached gingiva. This randomized study compared the FGG and the MARF in increasing the zone of attached gingiva in contralateral sides of 15 patients 1 year posttreatment. There was an increase in keratinized tissue and attached gingiva in both groups. Gingival recession did not significantly change between pre- and posttreatment levels in either group. The MARF surgical time was approximately half as long as that of the FGG. The authors conclude that both techniques are viable; however, the main advantages of the MARF were decreased surgical time and less postoperative discomfort.

  3. [Operating rooms during the second half of the 20th century and its change with surgical advances].

    PubMed

    Steimle, Raoul H

    2011-01-01

    With the rise of new specialities after the World War, the number of OP rooms increases. They became gathered on the basement of buildings near the central sterilisation. To enter the OP room, everyone passes through the dressing "sas". "Slippers", uniforms, gloves and many supplies are now for single-use. Electrified operating tables with their own accessories became very useful. Air conditioning is appreciated too in our countries. The operating microscope for ORL, ophthalmology and neurosurgery is used by every one. In cardiology the coronary revascularisation being common stuff, cardiac transplantation (1967) and open-heart surgery received special attention. Vascular surgeons are dedicated to arteritiden, implants, and aortic aneurysms. Urology is focused on renal transplants (since 1959), and more recently on lithotrity and coelioscopic prostatectomy. The coeliosurgery conquered the abdominal pathology and the endoscopic techniques became current. In neurosurgery, stereotaxy to treat parkinson's disease is not used so often since Levodopa exists. But it is still useful to implant brain-stimulating electrodes for refractory parkinson's cases, some other dyskinesias, mental troubles or epilepsies. The neuronavigation brought new possibilities. At century's end, ambulatory surgery reduces surgical costs. Bigger and multidisciplinary theatres are now preferred. The open-heart surgery assisted by computer and robotics is evolving. Finally, we recall OP room accidents, which are not directly dealing with the operation.

  4. 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

  5. Modulation/demodulation techniques for satellite communications. Part 2: Advanced techniques. The linear channel

    NASA Technical Reports Server (NTRS)

    Omura, J. K.; Simon, M. K.

    1982-01-01

    A theory is presented for deducing and predicting the performance of transmitter/receivers for bandwidth efficient modulations suitable for use on the linear satellite channel. The underlying principle used is the development of receiver structures based on the maximum-likelihood decision rule. The application of the performance prediction tools, e.g., channel cutoff rate and bit error probability transfer function bounds to these modulation/demodulation techniques.

  6. Advanced combustion techniques for controlling NO sub x emissions of high altitude cruise aircraft

    NASA Technical Reports Server (NTRS)

    Rudey, R. A.; Reck, G. M.

    1976-01-01

    An array of experiments designed to explore the potential of advanced combustion techniques for controlling the emissions of aircraft into the upper atmosphere was discussed. Of particular concern are the oxides of nitrogen (NOx) emissions into the stratosphere. The experiments utilize a wide variety of approaches varying from advanced combustor concepts to fundamental flame tube experiments. Results are presented which indicate that substantial reductions in cruise NOx emissions should be achievable in future aircraft engines. A major NASA program is described which focuses the many fundamental experiments into a planned evolution and demonstration of the prevaporized-premixed combustion technique in a full-scale engine.

  7. POC-Scale Testing of an Advanced Fine Coal Dewatering Equipment/Technique

    SciTech Connect

    Karekh, B K; Tao, D; Groppo, J G

    1998-08-28

    Froth flotation technique is an effective and efficient process for recovering of ultra-fine (minus 74 mm) clean coal. Economical dewatering of an ultra-fine clean coal product to a 20% level moisture will be an important step in successful implementation of the advanced cleaning processes. This project is a step in the Department of Energy's program to show that ultra-clean coal could be effectively dewatered to 20% or lower moisture using either conventional or advanced dewatering techniques. The cost-sharing contract effort is for 45 months beginning September 30, 1994. This report discusses technical progress made during the quarter from January 1 - March 31, 1998.

  8. Intermediate-Term Outcomes of Dual Adult versus Single-Kidney Transplantation: Evolution of a Surgical Technique

    PubMed Central

    Islam, Ana K.; Mayer, Wesley A.; Hollander, Adam B.; Patel, Samir; Teeter, Larry D.; Graviss, Edward A.; Saharia, Ashish; Podder, Hemangshu; Asham, Emad H.; Gaber, A. Osama

    2016-01-01

    Background. Acceptance of dual kidney transplantation (DKT) has proven difficult, due to surgical complexity and concerns regarding long-term outcomes. We herein present a standard technique for ipsilateral DKT and compare outcomes to single-kidney transplant (SKT) recipients. Methods. A retrospective single-center comparison of DKT and SKT performed between February 2007 and July 2013. Results. Of 516 deceased donor kidney transplants, 29 were DKT and 487 were SKT. Mean follow-up was 43 ± 67 months. DKT recipients were older and more likely than SKT recipients to receive an extended criteria graft (p < 0.001). For DKT versus SKT, the rates of delayed graft function (10.3 versus 9.2%) and acute rejection (20.7 versus 22.4%) were equivalent (p = ns). A higher than expected urologic complication rate in the DKT cohort (14 versus 2%, p < 0.01) was reduced through modification of the ureteral anastomosis. Graft survival was equivalent between DKT and SKT groups (p = ns) with actuarial 3-year DKT patient and graft survivals of 100% and 93%. At 3 years, the groups had similar renal function (p = ns). Conclusions. By utilizing extended criteria donor organs as DKT, the donor pool was enlarged while providing excellent patient and graft survival. The DKT urologic complication rate was reduced by modification of the ureteral anastomosis. PMID:27478630

  9. First Robotic-Assisted Dual Kidney Transplant: Surgical Technique and Report of a Case With 24-month Follow-up

    PubMed Central

    Frongia, Mauro; Cadoni, Rossano; Solinas, Andrea

    2015-01-01

    Background Open surgery is the gold standard procedure for kidney transplantation. There is a strong rationale for using minimally invasive surgery in patients with end-stage renal disease. A robotic-assisted dual kidney transplant was performed for the first time at our institution. Methods In August 2013, a 63-year-old man with end-stage renal disease and diabetes mellitus under pharmacological control received both kidneys from a 70-year-old marginal donor. Pretransplant donor biopsy demonstrated a bilateral Karpinski score greater than 5. The organs did not exhibit malformations and each had an artery and a vein. The procedure was carried out by a 7-port intraperitoneal approach using the da Vinci surgical system. The procedure was identical for the 2 kidneys except that mobilization of the sigmoid colon was required to introduce the left graft. The renal vessels were anastomosed to the left external iliac vessels. The novel aspect of the technique was the introduction of both grafts through a single, 7-cm upper midline incision. Results Total operative time was 400 minutes and blood loss was 120 mL. Both grafts immediately began functioning. There were no intraoperative or postoperative complications. The patient was discharged on the seventh postoperative day with normal renal function. At 24 months, he is well and does not require hemodialysis. Conclusions Minimally invasive robotic-assisted technology is a promising technique that provides exceptional patient outcomes by reducing operative morbidity, immobilization, and time to recovery, while affording better esthetic results. Selected patients with multiple comorbidities benefit most. Grafts from marginal donors are an extremely valuable resource. PMID:27500234

  10. Surgical treatment of necrotic scleral calcification using combined conjunctival autografting and an amniotic membrane inlay filling technique

    PubMed Central

    Kim, B-H

    2011-01-01

    Purpose To introduce a novel technique to treat necrotic scleral calcification caused by previous regional conjunctivectomy using conjunctival autografting and amniotic membrane inlay filling, and to evaluate the clinical outcome. Methods Ten patients (11 eyes, 12 regions) who had undergone regional conjunctivectomy with postoperative mitomycin C (MMC) for pterygia or pingueculae were included. Scleral calcification was removed using a bevel-down crescent knife. After the conjunctival donor tissue was harvested from the upper bulbar conjunctiva, the tissue was grafted to the scleral defect and secured with sutures. Amniotic membrane was inserted randomly into spaces between the conjunctival graft and the scleral bed. Protective amniotic membrane was transplanted over the graft, with stromal side up. Results Scleral calcification developed in ischaemic areas in 11 of the 12 regions; 50% of cases had a surface defect seen with a fluorescent dye. The grafted conjunctiva epithelialized successfully in all cases. In 10 regions, the epithelialization occurred in 1 or 2 weeks. In the remaining two regions, one region required another surgery because of graft failure, and epithelialization occurred in the last region in 9 weeks. Vascular growth into the graft from the surrounding tissue occurred in all cases in 1 to 10 weeks. The surgical wound stabilized 3 weeks postoperatively. Conclusion The combined technique had high success rates of graft survival and good revitalization of the necrotic area of scleral calcification, eliminated the need for invasive and time-consuming scleral autografting or allografting, and provided good cosmesis. Scleral ischaemia, which was caused by MMC, may induce scleral calcification. PMID:21869832

  11. Surgical Management of Oro-Antral Communications Using Resorbable GTR Membrane and FDMB Sandwich Technique: A Clinical Study.

    PubMed

    Sandhya, G; Reddy, P Bal; Kumar, K A Jeevan; Sridhar Reddy, B; Prasad, N; Kiran, G

    2013-09-01

    The paper describes a new technique for closure of the oro-antral communication, in which both hard (bone) and soft tissue closure was achieved. The technique uses a Guided Tissue Regeeration (GTR) membrane and Freez Dried Mineralized Bone (FDMB) allograft for closure of the defect. Aim of the study was to assess the advantages of the surgical management of oro-antral communications using resorbable GTR membrane and FDMB sandwich technique. A total 10 patients were selected in whom dental extractions were complicated by formation of oro-antral communication (OAC). The resorbable guided tissue regeneration membrane (PERIOCOL-GTR) and freeze dried mineralized bone allograft material was used. Some cancellous granules of freeze dried bone allograft was sandwiched between sheaths of appropriately trimmed collagen membrane which was previously sutured together on three sides using 3/0 resorbable polyglycolic acid suture (vicryl). The fourth side was then adequately closed using the same suture after the bone graft had been inserted, thus creating a closed sandwich. The prepared sandwich was then tucked into the OAC in such a way that it formed a convexity towards the sinus and a concavity towards the alveolar bone. The rough surface of the sandwich is faced to the alveolar bone and additional bone graft is filled into this concavity. Suturing done without tension. Post-operative orthopantomogram was taken to radiologically quantify the amount of bone grafting/augmentation and closure of oro-antral fistula. There was an average of 11.84 mm bone formation after 6 months, the average width preserved and obtained was 6.9 mm. By the end of 4 months there was evidence of bone formation in 7 subjects and in three subjects bony trabeculae formed was almost similar to the adjacent bone. By the end of 6 months follow-up of 7 subjects showed trabeculae indistinguishable from the adjacent bone. The study was done in 10 patients with a follow-up period of 6 months and found to

  12. The clinical application of the sliding loop technique for renorrhaphy during robot-assisted laparoscopic partial nephrectomy: Surgical technique and outcomes

    PubMed Central

    Kim, Hyung Suk; Lee, Young Ju; Ku, Ja Hyeon; Kwak, Cheol; Kim, Hyeon Hoe

    2015-01-01

    Purpose To report the initial clinical outcomes of the newly devised sliding loop technique (SLT) used for renorrhaphy in patients who underwent robot-assisted laparoscopic partial nephrectomy (RALPN) for small renal mass. Materials and Methods We reviewed the surgical videos and medical charts of 31 patients who had undergone RALPN with the SLT renorrhaphy performed by two surgeons (CWJ and CK) between January 2014 and October 2014. SLT renorrhaphy was performed after tumor excision and renal parenchymal defect repair. Assessed outcomes included renorrhaphy time (RT), warm ischemic time, perioperative complications, and perioperative renal function change. RT was defined as interval from the end of bed suture to the renal artery declamping. Results In all patients, sliding loop renorrhaphy was successfully conducted without conversions to radical nephrectomy or open approaches. Mean renorrhaphy and warm ischemic time were 9.0 and 22.6 minutes, respectively. After completing renorrhaphy, there were no adverse events such as dehiscence of approximated renal parenchyma, renal parenchymal tearing, or significant bleeding. Furthermore, no postoperative complications or significant renal function decline were observed as of the last follow-up for all patients. The limitations of this study include the small volume case series, the retrospective nature of the study, and the heterogeneity of surgeons. Conclusions From our initial clinical experience, SLT may be an efficient and safe renorrhaphy method in real clinical practice. Further large scale, prospective, long-term follow-up, and direct comparative studies with other techniques are required to confirm the clinical applicability of SLT. PMID:26568794

  13. Modulation/demodulation techniques for satellite communications. Part 3: Advanced techniques. The nonlinear channel

    NASA Technical Reports Server (NTRS)

    Omura, J. K.; Simon, M. K.

    1982-01-01

    A theory for deducing and predicting the performance of transmitter/receivers for bandwidth efficient modulations suitable for use on the nonlinear satellite channel is presented. The underlying principle used throughout is the development of receiver structures based on the maximum likelihood decision rule and aproximations to it. The bit error probability transfer function bounds developed in great detail in Part 4 is applied to these modulation/demodulation techniques. The effects of the various degrees of receiver mismatch are considered both theoretically and by numerous illustrative examples.

  14. Advances in fetal surgery

    PubMed Central

    Pedreira, Denise Araujo Lapa

    2016-01-01

    ABSTRACT This paper discusses the main advances in fetal surgical therapy aiming to inform health care professionals about the state-of-the-art techniques and future challenges in this field. We discuss the necessary steps of technical evolution from the initial open fetal surgery approach until the development of minimally invasive techniques of fetal endoscopic surgery (fetoscopy). PMID:27074241

  15. Application of Advanced Magnetic Resonance Imaging Techniques in Evaluation of the Lower Extremity

    PubMed Central

    Braun, Hillary J.; Dragoo, Jason L.; Hargreaves, Brian A.; Levenston, Marc E.; Gold, Garry E.

    2012-01-01

    Synopsis This article reviews current magnetic resonance imaging techniques for imaging the lower extremity, focusing on imaging of the knee, ankle, and hip joints. Recent advancements in MRI include imaging at 7 Tesla, using multiple receiver channels, T2* imaging, and metal suppression techniques, allowing more detailed visualization of complex anatomy, evaluation of morphological changes within articular cartilage, and imaging around orthopedic hardware. PMID:23622097

  16. Advances in neutron radiographic techniques and applications: a method for nondestructive testing.

    PubMed

    Berger, Harold

    2004-10-01

    A brief history of neutron radiography is presented to set the stage for a discussion of significant neutron radiographic developments and an assessment of future directions for neutron radiography. Specific advances are seen in the use of modern, high dynamic range imaging methods (image plates and flat panels) and for high contrast techniques such as phase contrast, and phase-sensitive imaging. Competition for neutron radiographic inspection may develop as these techniques offer application prospects for X-ray methods.

  17. Advanced techniques for high resolution spectroscopic observations of cosmic gamma-ray sources

    NASA Technical Reports Server (NTRS)

    Matteson, J. L.; Pelling, M. R.; Peterson, L. E.; Lin, R. P.; Anderson, K. A.; Pehl, R. H.; Hurley, K. C.; Vedrenne, G.; Sniel, M.; Durouchoux, P.

    1985-01-01

    An advanced gamma-ray spectrometer that is currently in development is described. It will obtain a sensitivity of 0.0001 ph/sq cm./sec in a 6 hour balloon observation and uses innovative techniques for background reduction and source imaging.

  18. Recognizing and Managing Complexity: Teaching Advanced Programming Concepts and Techniques Using the Zebra Puzzle

    ERIC Educational Resources Information Center

    Crabtree, John; Zhang, Xihui

    2015-01-01

    Teaching advanced programming can be a challenge, especially when the students are pursuing different majors with diverse analytical and problem-solving capabilities. The purpose of this paper is to explore the efficacy of using a particular problem as a vehicle for imparting a broad set of programming concepts and problem-solving techniques. We…

  19. Real-time application of advanced three-dimensional graphic techniques for research aircraft simulation

    NASA Technical Reports Server (NTRS)

    Davis, Steven B.

    1990-01-01

    Visual aids are valuable assets to engineers for design, demonstration, and evaluation. Discussed here are a variety of advanced three-dimensional graphic techniques used to enhance the displays of test aircraft dynamics. The new software's capabilities are examined and possible future uses are considered.

  20. Fabrication of advanced electrochemical energy materials using sol-gel processing techniques

    NASA Technical Reports Server (NTRS)

    Chu, C. T.; Chu, Jay; Zheng, Haixing

    1995-01-01

    Advanced materials play an important role in electrochemical energy devices such as batteries, fuel cells, and electrochemical capacitors. They are being used as both electrodes and electrolytes. Sol-gel processing is a versatile solution technique used in fabrication of ceramic materials with tailored stoichiometry, microstructure, and properties. The application of sol-gel processing in the fabrication of advanced electrochemical energy materials will be presented. The potentials of sol-gel derived materials for electrochemical energy applications will be discussed along with some examples of successful applications. Sol-gel derived metal oxide electrode materials such as V2O5 cathodes have been demonstrated in solid-slate thin film batteries; solid electrolytes materials such as beta-alumina for advanced secondary batteries had been prepared by the sol-gel technique long time ago; and high surface area transition metal compounds for capacitive energy storage applications can also be synthesized with this method.