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Sample records for intraoperative transesophageal echocardiography-guided

  1. Transesophageal echocardiography-guided thrombectomy of intracardiac renal cell carcinoma without cardiopulmonary bypass

    PubMed Central

    Souki, Fouad Ghazi; Demos, Michael; Fermin, Lilibeth; Ciancio, Gaetano

    2016-01-01

    Advanced renal cell carcinoma (RCC) resection has important anesthetic management implications, particularly when tumor extends, suprahepatic, into the right atrium. Use of transesophageal echocardiogram (TEE) is essential in identifying tumor extension and guiding resection. Latest surgical approach avoids venovenous and cardiopulmonary bypass yet requires special precautions and interventions on the anesthesiologist's part. We present a case of Level IV RCC resected without cardiopulmonary bypass and salvaged by TEE guidance and detection of residual intracardiac tumor. PMID:27716710

  2. Hemodynamic Transesophageal Echocardiography-Guided Venous-Arterial Extracorporeal Membrane Oxygenation Support in a Case of Giant Cell Myocarditis

    PubMed Central

    Ratzlaff, Robert A.; Menke, David M.; Olave, Maria C.; Maleszewski, Joseph J.

    2016-01-01

    Giant cell myocarditis (GCM) is a rare and commonly fatal form of fulminant myocarditis. During the acute phase, while immunosuppressive therapy is initiated, venoarterial extracorporeal membrane oxygenation (VA-ECMO) support is commonly used as a bridge to heart transplantation or recovery. Until recently, conventional transesophageal echocardiography and transthoracic echocardiography were the tools available for hemodynamic assessment of patients on this form of mechanical circulatory support. Nevertheless, both techniques have their limitations. We present a case of a 54-year-old man diagnosed with GCM requiring VA-ECMO support that was monitored under a novel miniaturized transesophageal echocardiography (hTEE) probe recently approved for 72 hours of continuous hemodynamic monitoring. Our case highlights the value of this novel, flexible, and disposable device for hemodynamic monitoring, accurate therapy guidance, and potential VA-ECMO weaning process of patients with this form of severe myocarditis.

  3. Hemodynamic Transesophageal Echocardiography-Guided Venous-Arterial Extracorporeal Membrane Oxygenation Support in a Case of Giant Cell Myocarditis

    PubMed Central

    Ratzlaff, Robert A.; Menke, David M.; Olave, Maria C.; Maleszewski, Joseph J.

    2016-01-01

    Giant cell myocarditis (GCM) is a rare and commonly fatal form of fulminant myocarditis. During the acute phase, while immunosuppressive therapy is initiated, venoarterial extracorporeal membrane oxygenation (VA-ECMO) support is commonly used as a bridge to heart transplantation or recovery. Until recently, conventional transesophageal echocardiography and transthoracic echocardiography were the tools available for hemodynamic assessment of patients on this form of mechanical circulatory support. Nevertheless, both techniques have their limitations. We present a case of a 54-year-old man diagnosed with GCM requiring VA-ECMO support that was monitored under a novel miniaturized transesophageal echocardiography (hTEE) probe recently approved for 72 hours of continuous hemodynamic monitoring. Our case highlights the value of this novel, flexible, and disposable device for hemodynamic monitoring, accurate therapy guidance, and potential VA-ECMO weaning process of patients with this form of severe myocarditis. PMID:27648312

  4. Hemodynamic Transesophageal Echocardiography-Guided Venous-Arterial Extracorporeal Membrane Oxygenation Support in a Case of Giant Cell Myocarditis.

    PubMed

    Ripoll, Juan G; Ratzlaff, Robert A; Menke, David M; Olave, Maria C; Maleszewski, Joseph J; Díaz-Gómez, José L

    2016-01-01

    Giant cell myocarditis (GCM) is a rare and commonly fatal form of fulminant myocarditis. During the acute phase, while immunosuppressive therapy is initiated, venoarterial extracorporeal membrane oxygenation (VA-ECMO) support is commonly used as a bridge to heart transplantation or recovery. Until recently, conventional transesophageal echocardiography and transthoracic echocardiography were the tools available for hemodynamic assessment of patients on this form of mechanical circulatory support. Nevertheless, both techniques have their limitations. We present a case of a 54-year-old man diagnosed with GCM requiring VA-ECMO support that was monitored under a novel miniaturized transesophageal echocardiography (hTEE) probe recently approved for 72 hours of continuous hemodynamic monitoring. Our case highlights the value of this novel, flexible, and disposable device for hemodynamic monitoring, accurate therapy guidance, and potential VA-ECMO weaning process of patients with this form of severe myocarditis. PMID:27648312

  5. Role of intraoperative transesophageal echocardiography in pediatric cardiac surgery

    PubMed Central

    Jijeh, Abdulraouf M.Z.; Omran, Ahmad S.; Najm, Hani K.; Abu-Sulaiman, Riyadh M.

    2015-01-01

    Background Intraoperative transesophageal echocardiography (TEE) has a major role in detecting residual lesions during and/or after pediatric cardiac surgery. Methods All pediatric patients who underwent cardiac surgery between July 2001 and December 2008 were reviewed. The records of surgical procedure, intraoperative TEE, and predischarge transthoracic echocardiograms were reviewed to determine minor and major residual cardiac lesions after surgical repair. Results During the study period, a total of 2268 pediatric cardiac patients were operated in our center. Mean age was 21 months (from 1 day to 14 years). Of these patients, 1016 (48%) had preoperative TEE and 1036 (46%) were evaluated by intraoperative echocardiography (TEE or epicardial study). We identified variations between TEE and preoperative transthoracic echocardiography in 14 patients (1.3%). Only one surgical procedure was cancelled after atrial septal defect exclusion. The other 13 patients had minor variation from their surgical plan. Major residual lesions requiring surgical revision were detected in 41 patients (3.9%), with the following primary diagnoses: tetralogy of Fallot in 12 patients (29%), atrioventricular septal defect in seven patients (17%), ventricular septal defect in seven patients (17%), double outlet right ventricle in two patients (5%), Shone complex in two patients (5%), subaortic stenosis in two patients (5%), mitral regurgitation in two patients (5%), pulmonary atresia in two patients (5%), and five patients (12%) with other diagnoses. Conclusion Intraoperative TEE has a major impact in pediatric cardiac surgery to detect significant residual lesions. Preoperative TEE has a limited role in case of a high quality preoperative transthoracic echocardiography. We recommend routine use of intraoperative TEE during and/or after intracardiac repair in children. PMID:27053898

  6. Intraoperative Transesophageal Echocardiographic Diagnosis of Acute Budd-Chiari Syndrome After Extended Right Hepatectomy.

    PubMed

    Alcaraz, Gabriela; Meineri, Massimiliano; Dattilo, Kathleen; Wąsowicz, Marcin

    2016-07-01

    Budd-Chiari syndrome (BCS) is a congestive hepatopathy caused by hepatic venous outflow obstruction. Torsion of the remnant liver after extended right hepatectomy is a potential cause of acute BCS, and it can lead to acute liver failure or death. We present a case of intraoperative transesophageal echocardiographic (TEE) diagnosis of acute BCS after extended right hepatectomy. TEE allowed timely detection of acute BCS and consequent inferior vena cava obstruction and decreased right atrial filling as the cause of sudden life-threatening hemodynamic collapse unresponsive to intravascular volume therapy and inotropic support. TEE constituted a stepped-up level of monitoring, prompting an immediate surgical reexploration, and resolution of hemodynamic instability. PMID:27166743

  7. Intraoperative Monitoring of Pulmonary Artery Physiology With Transesophageal Echocardiography in a Patient With an Extensive Pulmonary Aneurysm Undergoing Partial Nephrectomy.

    PubMed

    Plakke, Michael J; Maxwell, Cory D; Bottiger, Brandi A

    2016-09-01

    Surgical patients with pulmonary hypertension present a significant challenge to the anesthesiologist. Continuous perioperative monitoring of pulmonary artery (PA) pressure is recommended and most often accomplished with a PA catheter. Placement of a PA catheter may be difficult or contraindicated, and in these cases, transesophageal echocardiography is a useful alternative to monitor dynamic PA physiology. In this case, we used intraoperative transesophageal echocardiography to detect changes in peak PA pressure and guide clinical treatment in a patient with pulmonary hypertension and an extensive PA aneurysm undergoing partial nephrectomy. PMID:27580409

  8. Accurate localization and echocardiographic-pathologic correlation of tricuspid valve angiolipoma by intraoperative transesophageal echocardiography.

    PubMed

    Misra, Satyajeet; Sinha, Prabhat K; Koshy, Thomas; Sandhyamani, Samavedam; Parija, Chandrabhanu; Gopal, Kirun

    2009-11-01

    Angiolipoma (angiolipohamartoma) of the tricuspid valve (TV) is a rare tumor which may be occasionally misdiagnosed as right atrial (RA) myxoma. Transesophageal echocardiography (TEE) provides accurate information regarding the size, shape, mobility as well as site of attachment of RA tumors and is a superior modality as compared to transthoracic echocardiography (TTE). Correct diagnosis of RA tumors has therapeutic significance and guides management of patients, as myxomas are generally more aggressively managed than lipomas. We describe a rare case of a pedunculated angiolipoma of the TV which was misdiagnosed as RA myxoma on TTE and discuss the echocardiographic-pathologic correlates of the tumor as well as its accurate localization by TEE.

  9. Intraoperative multiplane transesophageal echocardiography for guiding direct myocardial gene transfer of vascular endothelial growth factor in patients with refractory angina pectoris.

    PubMed

    Esakof, D D; Maysky, M; Losordo, D W; Vale, P R; Lathi, K; Pastore, J O; Symes, J F; Isner, J M

    1999-09-20

    Gene transfer for therapeutic angiogenesis represents a novel treatment for patients with chronic angina refractory to standard medical therapy and not amenable to conventional revascularization. We sought to assess the role of intraoperative multiplane transesophageal echocardiography (MPTEE) in guiding injection of naked DNA encoding vascular endothelial growth factor (VEGF) into the left ventricular (LV) myocardium of patients with refractory angina. After exposing the LV myocardium via a limited lateral thoracotomy, each of 17 patients in this series received 4 separate injections of VEGF DNA into different myocardial sites. Initial injections in the first patient produced intracavitary microbubbles, indicating injection of DNA into the LV chamber. Subsequently, each injection was preceded by a test injection of agitated saline. The absence of microbubbles while visualizing the LV cavity during the test injection verified that the ensuing injection of DNA would not be inadvertently squandered in the LV chamber itself. Intracavitary LV microbubbles were observed by MPTEE in 13 of 64 (20.3%) saline test injections and in 8 of 16 (50.0%) patients in which saline test injection was used, leading to adjustments in needle position. MPTEE imaging detected a previously unknown large, apical left ventricular thrombus in one patient, thereby preventing inadvertent injection of VEGF DNA through the myocardium into the thrombus. Imaging during and after injection verified no deleterious impact on LV function. We conclude that MPTEE is a useful tool for ensuring that myocardial gene therapy performed by direct needle injection results in gene transfer to the LV myocardium.

  10. Emerging Concepts in Transesophageal Echocardiography

    PubMed Central

    Maxwell, Cory; Konoske, Ryan; Mark, Jonathan

    2016-01-01

    Introduced in 1977, transesophageal echocardiography (TEE) offered imaging through a new acoustic window sitting directly behind the heart, allowing improved evaluation of many cardiac conditions. Shortly thereafter, TEE was applied to the intraoperative environment, as investigators quickly recognized that continuous cardiac evaluation and monitoring during surgery, particularly cardiac operations, were now possible. Among the many applications for perioperative TEE, this review will focus on four recent advances: three-dimensional TEE imaging, continuous TEE monitoring in the intensive care unit, strain imaging, and assessment of diastolic ventricular function. PMID:26998250

  11. Effect of intraoperative magnesium intravenous infusion on the hemodynamic changes associated with right lobe living donor hepatotomy under transesophageal Doppler monitoring-randomized controlled trial

    PubMed Central

    Mahmoud, G; Sayed, E; Eskander, A; ElSheikh, M; Lotfy, M; Yassen, K

    2016-01-01

    Background: Liver donors are subjected to specific postresection hemodynamic changes. The aim was to monitor these changes and to evaluate the effect of magnesium sulfate infusion (MgSO4) on these changes together with total anesthetic agents consumption. Patients and Methods: A total of 50 donors scheduled for right hepatotomy were divided into two equal groups. Controls (C) received saline and magnesium group (Mg) received MgSO4 10% (30 mg/kg over 20 min) administered immediately after induction of anesthesia, followed by infusion (10 mg/kg/h) till the end of surgery. Hemodynamics, transesophageal Doppler (TED) data and anesthetic depth guided by Entropy were recorded. Results: Postresection both groups demonstrated an increase in heart rate (HR) and cardiac output (COP) in association with lowering of systemic vascular resistance (SVR). The increase in HR with Mg was lower when compared with C, P = 0.00. Increase in COP was lower with Mg compared to (C) (6.1 ± 1.3 vs. 7.5 ± 1.6 L/min, P = 0.00) and with less reduction in SVR compared to C (1145 ± 251 vs. 849.2 ± 215 dynes.s/cm5, P < 0.01), respectively. Sevoflurane consumption was lower with Mg compared to C (157.1 ± 35.1 vs. 187.6 ± 25.6 ml, respectively, P = 0.001). Reduced fentanyl and rocuronium consumption in Mg group are compared to C (P = 0.00). Extubation time, postoperative patient-controlled fentanyl were lower in Mg than C (P = 0.001). Conclusion: TED was able to detect significant hemodynamic changes associated with major hepatotomy. Prophylactic magnesium helped to reduce these changes with lower anesthetic and analgesics consumption and an improvement in postoperative pain relief. PMID:27051361

  12. Multiplane transesophageal echocardiography: a basic oblique plane patient imaging sequence.

    PubMed

    Griffin, M; Rafferty, T

    1998-01-01

    We have previously reported a standardized 10-step sequence of monoplane (transverse plane) transesophageal two-dimensional echocardiographic views and a standardized 7-step vertical plane examination, both suitable for expeditious intraoperative use by the beginning practitioner. A multiplane transesophageal examination involves transverse plane views, vertical plane views and the remaining "in-between" oblique plane views. This report describes a sequence of specific oblique views to be used as a framework for the completion of a multiplane transesophageal examination. Each of these steps is illustrated with a two-dimensional echocardiographic image, a matching diagram and a schematic representation of the corresponding axis of interrogation. This description of oblique plane imaging, therefore, completes the components of a multiplane transesophageal examination.

  13. Intraoperative aortic dissection

    PubMed Central

    Singh, Ajmer; Mehta, Yatin

    2015-01-01

    Intraoperative aortic dissection is a rare but fatal complication of open heart surgery. By recognizing the population at risk and by using a gentle operative technique in such patients, the surgeon can usually avoid iatrogenic injury to the aorta. Intraoperative transesophageal echocardiography and epiaortic scanning are invaluable for prompt diagnosis and determination of the extent of the injury. Prevention lies in the strict control of blood pressure during cannulation/decannulation, construction of proximal anastomosis, or in avoiding manipulation of the aorta in high-risk patients. Immediate repair using interposition graft or Dacron patch graft is warranted to reduce the high mortality associated with this complication. PMID:26440240

  14. Congenital sinus of Valsalva aneurysm: a multiplane transesophageal echocardiographic experience.

    PubMed

    Wang, K Y; St John Sutton, M; Ho, H Y; Ting, C T

    1997-01-01

    Sinus of Valsalva aneurysm is a rare congenital anomaly which, if overlooked, may be associated with increased mortality and morbidity. Multiplane transesophageal echocardiography proved useful in identifying a variety of associated structural heart disease. This study sought to assess the accuracy of the surgical result on the basis of the multiplane transesophageal echocardiography findings and to describe patient demographics and clinical outcome in an Oriental patient cohort. From July 1984 to December 1995, clinical, catheterization, echocardiographic, and surgical results were retrospectively studied in 23 patients with documented sinus of Valsalva aneurysm. Compared with previous reports of Oriental patients, our patient cohort was older (p < 0.025), had more associated aortic, mitral, and tricuspid regurgitation (p < 0.01), but had fewer coexistent ventricular septal defects (p < 0.01), and had more associated coronary artery disease (9%). Multiplane transesophageal echocardiography precisely showed three undiagnosed and/or ambiguous transthoracic echocardiographic studies, and the preoperative transesophageal echocardiography TEE findings were confirmed intraoperatively in the last eight consecutive patients. We concluded that multiplane transesophageal echocardiography provides conclusive information and is the current technique of choice for diagnosis and clinical management of patients with sinus of Valsalva aneurysm; although the natural history of sinus of Valsalva aneurysm remains uncertain, it is likely that the incidence of unruptured sinus of Valsalva aneurysm is considerably higher in the elderly than has been previously reported.

  15. Combined transesophageal echocardiography and transesophageal cardioversion probe: technical aspects.

    PubMed

    Kronzon, Itzhak; Tunick, Paul A; Scholten, Marcoen F; Kerber, Richard E; Roelandt, J R T C

    2005-03-01

    A probe assembly for simultaneous transesophageal echocardiography and transesophageal cardioversion has been developed. This probe allows cardioversion with the delivery of much lower energy than the standard external approach. Details of the probe construction and its use are described, as is the prospect for future practice. The use of a combined probe may be the technique of choice for patients who require both cardioversion and transesophageal echocardiography. PMID:15746708

  16. Intraoperative aortic dissection in pediatric heart surgery.

    PubMed

    Hibino, Narutoshi; Harada, Yorikazu; Hiramatsu, Takeshi; Yasukochi, Satoshi; Satomi, Gengi

    2006-06-01

    Intraoperative aortic dissection occurred in a 3-year-old-boy undergoing repair of an atrial septal defect. Transesophageal echocardiography was useful for the diagnosis, and conservative medical treatment under close observation was feasible in this case which involved a limited intimal tear. PMID:16714685

  17. Role of transesophageal echocardiography: A rare case of acute left atrial free wall dissection

    PubMed Central

    Kumar, G. Anil; Nandakumar, N. M.; Sudhir, B. V.; Pasarad, Ashwini Kumar

    2015-01-01

    Transesophageal echocardiography (TEE) has been used routinely in the diagnosis and follow-up of cardiac cases. Left atrial dissection (LAd), an exceedingly rare complication of cardiac surgery, is most commonly associated with mitral valve surgery. A case of LAd is presented, and the pathology was accurately defined and immediately diagnosed using intraoperative TEE. This case highlights the importance of prompt diagnosis of LAd using intraoperative TEE, and a second cardiac surgery was avoided. PMID:26440252

  18. Methemoglobinemia and transesophageal echo.

    PubMed

    Jiminez, Marcelo A; Polena, Sotir; Coplan, Neil L; Patel, Kashyapkumar; Gintautas, Jonas

    2007-01-01

    Methemoglobin (MHb) is the oxidized form of Hemoglobin (Hb) containing iron in its ferric (Fe3+) rather than ferrous (Fe2+) state. Under physiologic conditions, diaphorase II accounts for only a small percentage of the red blood cell reducing capacity but can be pharmacologically activated by exogenous cofactors. Methemoglobinemia is an abnormal elevation of MHb levels resulting in impaired oxygen delivery to tissues as well as a left shift of the oxygen-Hb dissociation curve. We present the case of a 56-year-old female patient who underwent transesophageal echocardiography (TEE) prior to elective cardioversion. Prep for TEE included use of Hurricane spray. Twenty min after receipt, the patient's O2 saturation by pulse oximetry dropped from 100% to 86%; heart rate and blood pressure were unchanged. Physical exam revealed pallor, perioralcyanosis and acrocyanosis without tachypnea, respiratory distress, or jugular venous distension. A 100% non-rebreather mask provided no improvement. MHb was suspected and arterial blood gasses were drawn which was dark chocolate in appearance. Methylene Blue at 1 mg/kg over 5 minutes was administered empirically. ABG results were: pH 7.44/ CO2 40/ O2 315/ HCO2 26/ O2 sat 69%; MHb levels were 30.1% confirming the diagnosis of methemoglobinemia. This condition resolved within minutes. Though uncommon, MHb is the most Sported adverse event associated with topical benzocaine use. Untreated, it can lead to significant cardiopulmonary compromise, neurologic sequelae, and even death. Prompt recognition of this potentially life-threatening side-effect is essential in order to provide opportune treatment.

  19. Diagnosis of cardiac tamponade with transesophageal echocardiography following the induction of anesthesia for suspected testicular torsion

    PubMed Central

    McHugh, Stephen M.; Wang, Xiao; Sullivan, Erin A.

    2015-01-01

    Transesophageal echocardiography (TEE) is a valuable tool for evaluating hemodynamic instability in patients under general anesthesia. We present the case of a 28-year-old man who presented with complaints of testicular pain concerning for testicular torsion. After induction of general anesthesia for scrotal exploration and possible orchiopexy, the patient developed severe and persistent hypotension. Using intraoperative TEE, the diagnosis of pericardial tamponade was made, and an emergent pericardial window was performed. PMID:26139762

  20. Annular sizing using real-time three-dimensional intracardiac echocardiography-guided trans-catheter aortic valve replacement

    PubMed Central

    Rendon, Alejandro; Hamid, Tahir; Kanaganayagam, Gajen; Karunaratne, Devinda; Mahadevan, Vaikom S

    2016-01-01

    Objective Transcatheter aortic valve replacement (TAVR) has been established as an alternative therapy for patients with severe aortic stenosis who are unfit for the surgical aortic valve replacements. Pre and periprocedural imaging for the TAVR procedure is the key to procedural success. Currently transesophageal echocardiography (TOE), including real-time three-dimensional (RT-3D) imaging TOE, has been used for peri-interventional monitoring and guidance for TAVR. We describe our initial experience with real-time three-dimensional intracardiac echocardiography (RT-3DICE), imaging technology for the use in the TAVR procedure. Methods We used RT-3DICE using an ACUSON SC2000 2.0v (Siemens Medical Solution), and a 10F AcuNav V catheter (Siemens-Acuson, Inc, Mountain View, California, USA) in addition to preoperative multislice CT (MSCT) in total of five patients undergoing TAVR procedure. Results Aortic annulus and sinus of valsalva diameters were measured using RT-3DICE. Aortic valve measurements obtained using RT-3DICE are comparable to those obtained using MSCT with no significant difference in our patients. Conclusions This small study of five patients shows the safe use of RT-3DICE in TAVR Procedure and may help the procedures performed under local anaesthesia without the need for TOE. PMID:27158522

  1. SPY Imaging Assessment Correlates With Transesophageal Echocardiogram Assessment of Ventricular Function During Off-Pump Coronary Artery Bypass Grafting.

    PubMed

    Anderson, Curtis A; Kypson, Alan P; Hudson, Wes; Ferguson, Bruce; Rodriguez, Evelio

    2008-05-01

    Intraoperative assessment of graft anastomoses is commonly performed after off-pump coronary artery bypass grafting (OPCAB). The SPY imaging system allows intraoperative graft assessment. We document correlation between intraoperative SPY images and wall motion abnormality by transesophageal echocardiogram (TEE) during OPCAB. A 79-year-old female underwent OPCAB. Intraoperative graft patency assessment was performed with the SPY and left ventricular wall motion was assessed by TEE. SPY imaging demonstrated poor flow trough the distal vein graft anastomosis to the posterior descending artery, which correlated with a new posterior wall motion hypokinesis. After graft revision, SPY imaging demonstrated good distal flow and the TEE demonstrated normalization of the left ventricular posterior wall motion. SPY technology allows the surgeon to accurately assess graft patency intraoperatively and allows immediate correction of a technical problem.

  2. Accuracy assessment of fluoroscopy-transesophageal echocardiography registration

    NASA Astrophysics Data System (ADS)

    Lang, Pencilla; Seslija, Petar; Bainbridge, Daniel; Guiraudon, Gerard M.; Jones, Doug L.; Chu, Michael W.; Holdsworth, David W.; Peters, Terry M.

    2011-03-01

    This study assesses the accuracy of a new transesophageal (TEE) ultrasound (US) fluoroscopy registration technique designed to guide percutaneous aortic valve replacement. In this minimally invasive procedure, a valve is inserted into the aortic annulus via a catheter. Navigation and positioning of the valve is guided primarily by intra-operative fluoroscopy. Poor anatomical visualization of the aortic root region can result in incorrect positioning, leading to heart valve embolization, obstruction of the coronary ostia and acute kidney injury. The use of TEE US images to augment intra-operative fluoroscopy provides significant improvements to image-guidance. Registration is achieved using an image-based TEE probe tracking technique and US calibration. TEE probe tracking is accomplished using a single-perspective pose estimation algorithm. Pose estimation from a single image allows registration to be achieved using only images collected in standard OR workflow. Accuracy of this registration technique is assessed using three models: a point target phantom, a cadaveric porcine heart with implanted fiducials, and in-vivo porcine images. Results demonstrate that registration can be achieved with an RMS error of less than 1.5mm, which is within the clinical accuracy requirements of 5mm. US-fluoroscopy registration based on single-perspective pose estimation demonstrates promise as a method for providing guidance to percutaneous aortic valve replacement procedures. Future work will focus on real-time implementation and a visualization system that can be used in the operating room.

  3. Residual Inferior Vena Cava Thrombus Detected by Transesophageal Echocardiography After Resection of a Malignant Adrenal Mass.

    PubMed

    Burbano, Nelson H; Vlah, Claudene; Argalious, Maged

    2015-10-15

    A 43-year-old woman with a history of the Cushing syndrome secondary to adrenocortical carcinoma presented to the operating room for right adrenalectomy, hepatectomy, nephrectomy, and inferior vena cava (IVC) thrombectomy. Initial intraoperative transesophageal echocardiogram (TEE) confirmed the presence of an IVC tumor below the hepatic veins. Total vascular exclusion of the liver was necessary to perform the operation. A repeat TEE showed a residual thrombus within the IVC prompting an additional cavotomy to successfully remove the entire mass. The remainder of the procedure finalized uneventfully. The case highlights the importance of TEE monitoring for noncardiac surgery with thrombotic involvement of the IVC. PMID:26466307

  4. Transesophageal echocardiography in the postoperative child with an open sternum.

    PubMed

    Marcus, B; Wong, P C; Wells, W J; Lindesmith, G G; Starnes, V A

    1994-07-01

    We report the use of transesophageal echocardiography in 3 children whose sternums remained open for several days postoperatively. In these patients transesophageal echocardiography provided critical information when transthoracic echocardiography was ineffective due to limited acoustic windows. This report points out the application of transesophageal echocardiography in children with chest wall distortion. PMID:8037535

  5. Intraoperative echocardiographic detection of regurgitant jets after valve replacement

    NASA Technical Reports Server (NTRS)

    Morehead, A. J.; Firstenberg, M. S.; Shiota, T.; Qin, J.; Armstrong, G.; Cosgrove, D. M. 3rd; Thomas, J. D.

    2000-01-01

    BACKGROUND: Paravalvular jets, documented by intraoperative transesophageal echocardiography, have prompted immediate valve explantation by others, yet the significance of these jets is unknown. METHODS: Twenty-seven patients had intraoperative transesophageal two-dimensional color Doppler echocardiography, performed to assess the number and area of regurgitant jets after valve replacement, before and after protamine. Patients were grouped by first time versus redo operation, valve position and type. RESULTS: Before protamine, 55 jets were identified (2.04+/-1.4 per patient) versus 29 jets after (1.07+/-1.2 per patient, p = 0.0002). Total jet area improved from 2.0+/-2.2 cm2 to 0.86+/-1.7 cm2 with protamine (p<0.0001). In all patients jet area decreased (average decrease, 70.7%+/-27.0%). First time and redo operations had similar improvements in jet number and area (both p>0.6). Furthermore, mitral and mechanical valves each had more jets and overall greater jet area when compared to aortic and tissue valves, respectively. CONCLUSIONS: Following valve replacement, multiple jets are detected by intraoperative transesophageal echocardiography. They are more common and larger in the mitral position and with mechanical valves. Improvement occurs with reversal of anticoagulation.

  6. Transesophageal echocardiography in NeoChord procedure

    PubMed Central

    Demetrio, Pittarello; Andrea, Colli; Gianclaudio, Falasco; Antonio, Marcassa; Gino, Gerosa; Carlo, Ori

    2015-01-01

    Background: Transapical off-pump mitral valve intervention with neochord implantation for degenerative mitral valve disease have been recently introduced in the surgical practice. The procedure is performed under 2D-3D transesophageal echocardiography guidance. Methods: The use of 3D real-time transesophageal echocardiography provides more accurate information than 2D echocardiography only in all the steps of the procedure. In particular 3D echocardiography is mandatory for preoperative assessment of the morphology of the valve, for correct positioning of the neochord on the diseased segment, for the final tensioning of the chordae and for the final evaluation of the surgical result. Result and Conclusion: This article is to outline the technical aspects of the transesophageal echocardiography guidance of the NeoChord procedure showing that the procedure can be performed only with a close and continuous interaction between the anesthesiologist and the cardiac surgeon. PMID:25849688

  7. Transesophageal color Doppler evaluation of obstructive lesions using the new "Quasar" technology.

    PubMed

    Fan, P; Nanda, N C; Gatewood, R P; Cape, E G; Yoganathan, A P

    1995-01-01

    Due to the unavoidable problem of aliasing, color flow signals from high blood flow velocities cannot be measured directly by conventional color Doppler. A new technology termed Quantitative Un-Aliased Speed Algorithm Recognition (Quasar) has been developed to overcome this limitation. Employing this technology, we used transesophageal color Doppler echocardiography to investigate whether the velocities detected by the Quasar would correlate with those obtained by continuous-wave Doppler both in vitro and in vivo. In the in vitro study, a 5.0 MHz transesophageal transducer of a Kontron Sigma 44 color Doppler flow system was used. Fourteen different peak velocities calculated and recorded by color Doppler-guided continuous-wave Doppler were randomly selected. In the clinical study, intraoperative transesophageal echocardiography was performed using the same transducer 18 adults (13 aortic valve stenosis, 2 aortic and 2 mitral stenosis, 2 hypertrophic obstructive cardiomyopathy and 1 mitral valve stenosis). Following each continuous-wave Doppler measurement, the Quasar was activated, and a small Quasar marker was placed in the brightest area of the color flow jet to obtain the maximum mean velocity readout. The maximum mean velocities measured by Quasar closely correlated with maximum peak velocities obtained by color flow guided continuous-wave Doppler in both in vitro (0.53 to 1.65 m/s, r = 0.99) and in vivo studies (1.50 to 6.01 m/s, r = 0.97). We conclude that the new Quasar technology can accurately measure high blood flow velocities during transesophageal color Doppler echocardiography. This technique has the potential of obviating the need for continuous-wave Doppler.

  8. Artifacts in three-dimensional transesophageal echocardiography.

    PubMed

    Faletra, Francesco Fulvio; Ramamurthi, Alamelu; Dequarti, Maria Cristina; Leo, Laura Anna; Moccetti, Tiziano; Pandian, Natesa

    2014-05-01

    Three-dimensional (3D) transesophageal echocardiography (TEE) is subject to the same types of artifacts encountered on two-dimensional TEE. However, when displayed in a 3D format, some of the artifacts appear more "realistic," whereas others are unique to image acquisition and postprocessing. Three-dimensional TEE is increasingly used in the setting of percutaneous catheter-based interventions and ablation procedures, and 3D artifacts caused by the metallic components of catheters and devices are particularly frequent. Knowledge of these artifacts is of paramount relevance to avoid misinterpretation of 3D images. Although artifacts and pitfalls on two-dimensional echocardiography are well described and classified, a systematic description of artifacts in 3D transesophageal echocardiographic images and how they affect 3D imaging is still absent. The aim of this review is to describe the most relevant artifacts on 3D TEE, with particular emphasis on those occurring during percutaneous interventions for structural heart disease and ablation procedures.

  9. Clinical usefulness of multiplane transesophageal echocardiography: comparison to biplanar imaging.

    PubMed

    Tardif, J C; Schwartz, S L; Vannan, M A; Cao, Q L; Pandian, N G

    1994-07-01

    The increased diagnostic usefulness of multiplane over biplane transesophageal echocardiography has not yet been conclusively determined. In this study the diagnostic yield of multiplanar and biplanar imaging was compared blindly by using the information content obtained from multiplane transesophageal echocardiography to that derived from biplanar type of imaging planes available in the multiplane echocardiography recordings in 80 patients with a variety of cardiac disorders. Among these patients 9 new abnormalities were identified by multiplane transesophageal echocardiography in 8 patients. Multiplane imaging yielded better delineation of 40 various lesions in 31 patients. Thus multiplane transesophageal echocardiography has a greater diagnostic yield than biplane imaging by depicting more lesions in 10% of patients and by enhanced delineation of the extent of pathologic characteristics in 39% of patients. This versatility, coupled with the ease of obtaining a vast assembly of imaging planes without undue probe manipulations, makes multiplane transesophageal echocardiography more useful than biplanar imaging.

  10. Prediction of thrombus-related mechanical prosthetic valve dysfunction using transesophageal echocardiography

    NASA Technical Reports Server (NTRS)

    Lin, S. S.; Tiong, I. Y.; Asher, C. R.; Murphy, M. T.; Thomas, J. D.; Griffin, B. P.

    2000-01-01

    Identification of thrombus-related mechanical prosthetic valve dysfunction (MPVD) has important therapeutic implications. We sought to develop an algorithm, combining clinical and echocardiographic parameters, for prediction of thrombus-related MPVD in a series of 53 patients (24 men, age 52 +/- 16 years) who had intraoperative diagnosis of thrombus or pannus from 1992 to 1997. Clinical and echocardiographic parameters were analyzed to identify predictors of thrombus and pannus. Prevalence of thrombus and diagnostic yields relative to the number of predictors were determined. There were 22 patients with thrombus, 19 patients with pannus, and 12 patients with both. Forty-two of 53 masses were visualized using transesophageal echocardiography (TEE), including 29 of 34 thrombi or both thrombi and panni and 13 of 19 isolated panni. Predictors of thrombus or mixed presentation include mobile mass (p = 0.009), attachment to occluder (p = 0.02), elevated gradients (p = 0.04), and an international normalized ratio of < or = 2.5 (p = 0.03). All 34 patients with thrombus or mixed presentation had > or = 1 predictor. The prevalence of thrombus in the presence of < or = 1, 2, and > or = 3 predictors is 14%, 69%, and 91%, respectively. Thus, TEE is sensitive in the identification of abnormal mass in the setting of MPVD. An algorithm based on clinical and transesophageal echocardiographic predictors may be useful to estimate the likelihood of thrombus in the setting of MPVD. In the presence of > or = 3 predictors, the probability of thrombus is high.

  11. Prediction of thrombus-related mechanical prosthetic valve dysfunction using transesophageal echocardiography.

    PubMed

    Lin, S S; Tiong, I Y; Asher, C R; Murphy, M T; Thomas, J D; Griffin, B P

    2000-11-15

    Identification of thrombus-related mechanical prosthetic valve dysfunction (MPVD) has important therapeutic implications. We sought to develop an algorithm, combining clinical and echocardiographic parameters, for prediction of thrombus-related MPVD in a series of 53 patients (24 men, age 52 +/- 16 years) who had intraoperative diagnosis of thrombus or pannus from 1992 to 1997. Clinical and echocardiographic parameters were analyzed to identify predictors of thrombus and pannus. Prevalence of thrombus and diagnostic yields relative to the number of predictors were determined. There were 22 patients with thrombus, 19 patients with pannus, and 12 patients with both. Forty-two of 53 masses were visualized using transesophageal echocardiography (TEE), including 29 of 34 thrombi or both thrombi and panni and 13 of 19 isolated panni. Predictors of thrombus or mixed presentation include mobile mass (p = 0.009), attachment to occluder (p = 0.02), elevated gradients (p = 0.04), and an international normalized ratio of < or = 2.5 (p = 0.03). All 34 patients with thrombus or mixed presentation had > or = 1 predictor. The prevalence of thrombus in the presence of < or = 1, 2, and > or = 3 predictors is 14%, 69%, and 91%, respectively. Thus, TEE is sensitive in the identification of abnormal mass in the setting of MPVD. An algorithm based on clinical and transesophageal echocardiographic predictors may be useful to estimate the likelihood of thrombus in the setting of MPVD. In the presence of > or = 3 predictors, the probability of thrombus is high. PMID:11074206

  12. Initial Experience With a Miniaturized Multiplane Transesophageal Probe in Small Infants Undergoing Cardiac Operations

    PubMed Central

    Zyblewski, Sinai C.; Shirali, Girish S.; Forbus, Geoffrey A.; Hsia, Tain-Yen; Bradley, Scott M.; Atz, Andrew M.; Cohen, Meryl S.; Graham, Eric M.

    2015-01-01

    Purpose There has been reluctance to use intraoperative transesophageal echocardiography (TEE) in small infants. We assessed the utility and safety of a new miniaturized multiplane micro-TEE probe in small infants undergoing cardiac operations. Description Hemodynamic and ventilation variables were prospectively recorded before and after micro-TEE insertion and removal in infants weighing 5 kg or less undergoing cardiac operations. Evaluation The study included 42 patients with a mean weight of 3.6 ± 0.9 kg (range, 1.7 to 5 kg). All probe insertions were successful. There were no complications or clinically significant changes in hemodynamic or ventilation variables. Information provided by TEE resulted in surgical revision in 6 of the 42 patients. Conclusions The micro-TEE provides high quality, useful diagnostic images without hemodynamic or ventilation compromise in small infants undergoing cardiac operations. This advance is important with the growing trend towards complete repair of complex structural heart disease in small infants. PMID:20494062

  13. Principles for Management of Intraoperative Acute Type A Aortic Dissection.

    PubMed

    Gukop, Philemon; Chandrasekaran, Vankatachalam

    2015-12-01

    Intraoperative Type A aortic dissection is a rare pathology with incidence of 0.06-0.32%. It is associated with a high mortality between 30-50%. Some associated risk factors, including hypertension, enlarged aorta, peripheral vascular disease, advanced age, atheroma, and high arterial pressure on cardiopulmonary bypass, have been identified. Modification of these risk factors could reduce the incidence of this event. Prompt diagnosis and management, with the aid of intraoperative trans-esophageal echocardiography and/or epi-aortic ultrasound has been shown to reduce the mortality to 17%. We illustrate the principles of management of this pathology with the case of a 62-year-old female who developed acute Type A aortic dissection while undergoing minimally invasive mitral valve repair.

  14. Assessment of coronary artery aneurysms with multiplane transesophageal echocardiography.

    PubMed

    Kosar, E; Chandraratna, P A

    1997-05-01

    Coronary artery aneurysms are rare and may be difficult to detect clinically. Multiplane transesophageal echocardiography provides numerous imaging planes that may improve the assessment of coronary aneurysms and act as an adjunct to standard angiography. Five patients with angiographically detected coronary aneurysms were studied with multiplane transesophageal echocardiography and Doppler flow imaging. Transesophageal echocardiography was successful in identifying the size and characteristics of the coronary aneurysms. Doppler ultrasound identified markedly increased flow velocity in a patient with a coronary arteriovenous fistula and decreased coronary flow velocity in two patients with aneurysmal coronary arteries and intracoronary thrombus. Multiplane transesophageal echocardiography is a useful, noninvasive method of assessing coronary artery aneurysms and may act as an adjunct to angiography in identifying fistula anastomosis.

  15. [Intraoperative colonoscopy: current indications].

    PubMed

    Stroppa, I; D'Antini, P; Rossi, L; Farinon, A M

    1993-01-01

    From January 1987 to December 1991, 37 patients underwent intraoperative colonoscopy for several indications; these latter can be summarized in the need to define the site or extension of the lesions treated or detected by endoscopy before surgery. This procedure is therefore necessary in those cases in whom intraoperative endoscopy is likely to be useful in planning the surgical treatment. The use of intraoperative colonoscopy should be however considered complementary, but not substitutive, of the preoperative colonoscopy.

  16. Natural orifice transesophageal endoscopic surgery: state of the art.

    PubMed

    Moreira-Pinto, João; Ferreira, Aníbal; Rolanda, Carla; Correia-Pinto, Jorge

    2012-01-01

    The main goal of Natural Orifice Transluminal Endoscopic Surgery (NOTES) is performing surgery avoiding skin incisions. Theoretical advantages of NOTES include decreased postoperative pain, reduction/elimination of general anesthesia, improved cosmetic outcomes, elimination of skin incision-related complications such as wound infections and hernias, and increased overall patient satisfaction. Although various forms of port creation to accomplish thoracic NOTES procedures have been proposed, transesophageal NOTES has been shown to be the most reliable one. The evolution of endoscopic submucosal transesophageal access resulted in the development of per-oral endoscopic myotomy (POEM), which had a fast transition to clinical practice. The authors present a review of the current state of the art concerning transesophageal NOTES, looking at its potential for diagnostic and therapeutic interventions as well as the hurdles yet to be overcome. PMID:22567228

  17. Natural Orifice Transesophageal Endoscopic Surgery: State of the Art

    PubMed Central

    Moreira-Pinto, João; Ferreira, Aníbal; Rolanda, Carla; Correia-Pinto, Jorge

    2012-01-01

    The main goal of Natural Orifice Transluminal Endoscopic Surgery (NOTES) is performing surgery avoiding skin incisions. Theoretical advantages of NOTES include decreased postoperative pain, reduction/elimination of general anesthesia, improved cosmetic outcomes, elimination of skin incision-related complications such as wound infections and hernias, and increased overall patient satisfaction. Although various forms of port creation to accomplish thoracic NOTES procedures have been proposed, transesophageal NOTES has been shown to be the most reliable one. The evolution of endoscopic submucosal transesophageal access resulted in the development of per-oral endoscopic myotomy (POEM), which had a fast transition to clinical practice. The authors present a review of the current state of the art concerning transesophageal NOTES, looking at its potential for diagnostic and therapeutic interventions as well as the hurdles yet to be overcome. PMID:22567228

  18. The role of intraoperative transesophageal echocardiographic monitoring in a patient with hypertrophic cardiomyopathy undergoing laparoscopic surgery.

    PubMed

    Gregory, Stephen H; Fierro, Michael A

    2016-11-01

    Hypertrophic cardiomyopathy (HCM) presents a significant perioperative challenge. Anesthetic drugs, patient positioning, and surgical technique can provoke worsening left ventricular outflow tract obstruction and hemodynamic deterioration. In this case report, we present the perioperative management of a 70-year-old male with a history of HCM who underwent a robotic laparoscopic prostatectomy. Discussion focuses on the utilization of echocardiographic guidance in the care of patients with HCM undergoing noncardiac surgery, as well as the pathophysiology of laparoscopic insufflation and its effects on left ventricular outflow tract obstruction in HCM. PMID:27687358

  19. Transesophageal echocardiography: first-line imaging for aortic diseases

    NASA Technical Reports Server (NTRS)

    Yalcin, F.; Thomas, J. D.; Homa, D.; Flachskampf, F. A.

    2000-01-01

    Transesophageal echocardiography (TEE) is now commonly used to evaluate the thoracic aorta, because it is widely available and provides high-resolution images and flow information by Doppler. This article reviews the essential features on TEE of acute and chronic aortic diseases, such as aortic dissection, aneurysm, and atherosclerosis, and discusses its strengths, weaknesses, and indications.

  20. Transesophageal echocardiography assessment of severe ostial left main coronary stenosis

    NASA Technical Reports Server (NTRS)

    Firstenberg, M. S.; Greenberg, N. L.; Lin, S. S.; Garcia, M. J.; Alexander, L. A.; Thomas, J. D.

    2000-01-01

    Doppler echocardiography is commonly used in the assessment of stenotic valvular orifices. We describe the application of transesophageal echocardiography for the detection of a critical ostial left main coronary stenosis. Because preoperative coronary angiography often is not routinely performed in young patients undergoing valve surgery, application of Doppler echocardiography can potentially prevent catastrophic complications, particularly in atypical cases.

  1. Warden repair for superior sinus venosus atrial septal defect and anomalous pulmonary venous drainage in children: Anesthesia and transesophageal echocardiography perspectives

    PubMed Central

    Aggarwal, Neelam; Gadhinglajkar, Shrinivas; Sreedhar, Rupa; Dharan, Baiju S.; Chigurupati, Keerthi; Babu, Saravana

    2016-01-01

    Objective: Review of intraoperative anesthetic challenges and the role of transesophageal echocardiography in children with sinus venosus atrial septal defect and partial anomalous pulmonary venous drainage undergoing Warden repair. Design: A retrospective observational case series. Methodolgy: Pediatric patients who underwent Warden repair between October 2011-September 2015 were recruited. Their preoperative clinical details, anesthetic techniques, intraoperative TEE findings and postoperative events were recorded from the medical records. The categorical variables and the continuous variables were expressed as number (percentages) and mean ± SD respectively. Results: A total of 35 patients were operated for Warden repair during the study period. Anesthesia was induced with the aim to prevent any fall in pulmonary vascular resistance. The right internal jugular vein was cannulated under ultrasound guidance using a short length cannula to monitor right superior vena cava pressure. Intraoperative TEE revealed the drainage of PAPVC high into RSVC in 22 patients. Persistent LSVC was found in 9 patients. After repair, TEE imaging detected a high gradient at Warden anastomotic site in 5 patients and 3 of them required revision of surgery. Rerouted pulmonary veins required surgical correction in 2 patients in view of obstruction. None of them had pulmonary venous and SVC obstruction in the postoperative period. Conclusion: The primary aim of anesthesia is to avoid any fall in PVR. Right IJV cannulation can be beneficial. The intraoperative TEE can help in delineating the anatomy of lesion and detecting anastomotic site obstruction. PMID:27052072

  2. Intraoperative Stem Cell Therapy

    PubMed Central

    Coelho, Mónica Beato; Cabral, Joaquim M.S.; Karp, Jeffrey M.

    2013-01-01

    Stem cells hold significant promise for regeneration of tissue defects and disease-modifying therapies. Although numerous promising stem cell approaches are advancing in clinical trials, intraoperative stem cell therapies offer more immediate hope by integrating an autologous cell source with a well-established surgical intervention in a single procedure. Herein, the major developments in intraoperative stem cell approaches, from in vivo models to clinical studies, are reviewed, and the potential regenerative mechanisms and the roles of different cell populations in the regeneration process are discussed. Although intraoperative stem cell therapies have been shown to be safe and effective for several indications, there are still critical challenges to be tackled prior to adoption into the standard surgical armamentarium. PMID:22809140

  3. How standard transesophageal echocardiography views change with dextrocardia.

    PubMed

    Raut, Monish S; Maheshwari, Arun; Shad, Sujay; Rachna, G

    2013-01-01

    Dextrocardia with situs inversus is a rare condition. Situs inversus with dextrocardia is also called as "situs inversus totalis". Transesophageal echocardiography (TEE) views in dextrocardia patient are not discussed in the literature. The cardiac position and the cardiac chambers are mirror image of the normal anatomy. Because of this positional change, certain TEE probe and multiplane angle manipulations are required to obtain the recommended views.

  4. Real-time transesophageal echocardiography facilitates antegrade balloon aortic valvuloplasty

    PubMed Central

    Ito, Kazato; Yano, Kentaro; Tanaka, Chiharu; Nakashoji, Tomohiro; Tonomura, Daisuke; Takehara, Kosuke; Kino, Naoto; Yoshida, Masataka; Kurotobi, Toshiya; Tsuchida, Takao; Fukumoto, Hitoshi

    2016-01-01

    We report two cases of severe aortic stenosis (AS) where antegrade balloon aortic valvuloplasty (BAV) was performed under real-time transesophageal echocardiography (TEE) guidance. Real-time TEE can provide useful information for evaluating the aortic valve response to valvuloplasty during the procedure. It was led with the intentional wire-bias technique in order to compress the severely calcified leaflet, and consequently allowed the balloon to reach the largest possible size and achieve full expansion of the aortic annulus. PMID:27054107

  5. Three-dimensional reconstruction of multiplane transesophageal rotational scanning echocardiography

    NASA Astrophysics Data System (ADS)

    He, Aijun; Wang, Tianfu; Zheng, Changqiong; Li, Deyu; Yin, Lixue; Zheng, Yi

    2001-09-01

    The present paper studies the method of 3D reconstruction of multiplane transesophageal rotational scanning echocardiography. According to the characteristic of rotational scanning echocardiography, a direct matching interpolation method is exploited to reconstruct regular volume data from distributed ultrasound scanning points. The whole system is developed and clinical ultrasound data is tested for this method. The volume rendering results show that the proposed method is valid and effective. At last, the possibility of functional reconstruction based on tissue Doppler imaging is explored.

  6. Multiplane transesophageal echocardiography: a roadmap for mitral valve repair.

    PubMed

    Shah, P M; Raney, A A; Duran, C M; Oury, J H

    1999-11-01

    Multiplane transesophageal echocardiography (TEE) is useful in providing a detailed anatomic map for successful mitral valve repair. This report describes an approach, developed over the past two to three years, which helps to delineate valve anatomy in specific detail. Mid-esophageal views are selected to view different segments of the valve leaflets. When correlated with surgical anatomy, this approach is found to be both practical and useful.

  7. A Case of Kommerell's Diverticulum Initially Detected by Transesophageal Echocardiography.

    PubMed

    Lee, Seung-Jun; Lee, Seung-Hyun; Kim, Jin Ho; Lee, Hancheol; Lee, Dong-Jun; Kim, Jeong Hun; Son, Jung-Woo; Son, Jang-Won; Hong, Geu-Ru

    2013-03-01

    Kommerell's diverticulum is a rare congenital disorder characterized by typical right sided aortic arch and aberrant left subclavian artery which are usually detected by accident in asymptomatic patients. However, some of patients complain of severe symptoms caused by compression of the adjacent organs or complicated aortic dissection by the diverticulum. Early detection of the disease can lead to elective surgical correction. In this article, we report a Kommerell's diverticulum case initially detected by transesophageal echocardiography.

  8. A Case of Kommerell's Diverticulum Initially Detected by Transesophageal Echocardiography

    PubMed Central

    Lee, Seung-Jun; Lee, Seung-Hyun; Kim, Jin Ho; Lee, Hancheol; Lee, Dong-Jun; Kim, Jeong Hun; Son, Jung-Woo; Son, Jang-Won

    2013-01-01

    Kommerell's diverticulum is a rare congenital disorder characterized by typical right sided aortic arch and aberrant left subclavian artery which are usually detected by accident in asymptomatic patients. However, some of patients complain of severe symptoms caused by compression of the adjacent organs or complicated aortic dissection by the diverticulum. Early detection of the disease can lead to elective surgical correction. In this article, we report a Kommerell's diverticulum case initially detected by transesophageal echocardiography. PMID:23560141

  9. Acute Intraoperative Pulmonary Aspiration

    PubMed Central

    Nason, Katie S.

    2015-01-01

    Synopsis Acute intraoperative aspiration is a potentially fatal complication with significant associated morbidity. Patients undergoing thoracic surgery are at increased risk for anesthesia-related aspiration, largely due to the predisposing conditions associated with this complication. Awareness of the risk factors, predisposing conditions, maneuvers to decrease risk and immediate management options by both the thoracic surgeon and the anesthesia team is imperative to reducing risk and optimizing patient outcomes associated with acute intraoperative pulmonary aspiration. Based on the root-cause analyses that many of the aspiration events can be traced back to provider factors, having an experienced anesthesiologist present for high-risk cases is also critical. PMID:26210926

  10. The advantages of live/real time three-dimensional transesophageal echocardiography in the assessment of tricuspid valve infective endocarditis.

    PubMed

    Sungur, Aylin; Hsiung, Ming C; Meggo Quiroz, Luis D; Oz, Tuğba Kemaloğlu; Haj Asaad, Ayman; Joshi, Deepak; Dönmez, Cevdet; Güvenç, Tolga S; Nanda, Navin C

    2014-11-01

    Currently, tricuspid valve infective endocarditis (TVIE) is encountered in daily clinical practice more frequently due to the increasing prevalence of illicit intravenous drug use and the implantation of intracardiac devices. In this study, we compared findings from intra-operative live/real time three-dimensional transesophageal echocardiograms (3DTEE) and two-dimensional transesophageal echocardiograms (2DTEE) of 10 patients who underwent surgery for native tricuspid valve (TV) endocarditis. Unlike 2DTEE, 3DTEE allowed en face visualization of the 3 TV leaflets from both, atrial and ventricular aspects, in 9 of the 10 cases. In the remaining patient, in whom 3DTEE could not identify all 3 leaflets en face, the TV was found essentially destroyed at surgery. Using 3DTEE, the number of vegetations was accurately reported when compared with the surgical record. Furthermore, the orientation of each vegetation was the same as noted in the surgical findings. 2DTEE missed the identification of vegetations in 5 patients. The attachment site of vegetations to the TV were also not characterized by 2DTEE in 5 patients. In all 10 cases, 3DTEE characterized the vegetations more accurately with larger dimensions, including those in the azimuthal axis, and volumes. In addition, a perivalvular abscess that lead to surgical intervention was identified by 3DTEE, however, missed by 2DTEE. In conclusion, 3DTEE allows en face visualization of the TV apparatus permitting accurate description of the number and dimensions of vegetations identified by our surgical standard, which ultimately informs patients' prognosis and dictates the timing and planning for surgical intervention. Its use should be in conjunction with 2DTEE when evaluating TVIE.

  11. Isolated noncompaction of the myocardium: multiplane transesophageal echocardiography diagnosis in an adult.

    PubMed

    Maltagliati, A; Pepi, M

    2000-11-01

    We describe a case of isolated noncompaction of the myocardium in a 66-year-old patient. Peculiar anatomic features of this disease were clearly suspected on transthoracic echocardiography and precisely recognized through transesophageal echocardiography. The role of transthoracic and transesophageal echocardiography in the detection of this rare disease is described in this report.

  12. Intraoperative endovascular ultrasonography

    NASA Astrophysics Data System (ADS)

    Eton, Darwin; Ahn, Samuel S.; Baker, J. D.; Pensabene, Joseph; Yeatman, Lawrence S.; Moore, Wesley S.

    1991-05-01

    The early experience using intra-operative endovascular ultrasonography (EU) is reported in eight patients undergoing lower extremity revasularization. In four patients, intra-operative EU successfully characterized inflow stenoses that were inadequately imaged with pre- operative arteriography. Two patients were found to have hemodynamically significant inflow stenoses, and were treated with intra-operative balloon angioplasty followed by repeat EU. The other two patients were found to have non-hemodynamically significant inflow stenoses requiring no treatment. Additional outflow procedures were required in all four patients. In the remaining four patients, EU was used to evaluate the completeness of TEC rotary atherectomy, of Hall oscillatory endarterectomy, of thrombectomy of the superficial femoral and popliteal arteries, and of valve lysis during in situ saphenous vein grafting, respectively. In the latter case, the valve leaflets were not clearly seen. In the other cases, EU assisted the surgeon. Angioscopy and angiography were available for comparison. In one case, angioscopy failed because of inability to clear the field while inspecting retrograde the limb of an aorto-bi-femoral graft. EU however was possible. No complications of EU occurred. EU is a safe procedure indicated when characterization of a lesion is needed prior to an intervention or when evaluation of the intervention's success is desired. We did not find it useful in valve lysis for in-site grafting.

  13. Variations of transesophageal echocardiography practices in India: A survey by Indian College of Cardiac Anaesthesia

    PubMed Central

    Borde, Deepak Prakash; George, Antony; Joshi, Shreedhar; Nair, Suresh; Koshy, Thomas; Gandhe, Uday; Chakravarthy, Murali

    2016-01-01

    Context: Use of perioperative transesophageal echocardiography (TEE) has expanded in India. Despite attempts to standardize the practice of TEE in cardiac surgical procedures, variation in practice and application exists. This is the first online survey by Indian College of Cardiac Anaesthesia, research and academic wing of the Indian Association of Cardiovascular Thoracic Anaesthesiologists (IACTA). Aims: We hypothesized that variations in practice of intraoperative TEE exist among centers and this survey aimed at analyzing them. Settings and Design: This is an online survey conducted among members of the IACTA. Subjects and Methods: All members of IACTA were contacted using online questionnaire fielded using SurveyMonkey™ software. There were 21 questions over four pages evaluating infrastructure, documentation of TEE, experience and accreditation of anesthesiologist performing TEE, and finally impact of TEE on clinical practice. Questions were also asked about national TEE workshop conducted by the IACTA, and suggestions were invited by members on overseas training. Results: Response rate was 29.7% (382/1222). 53.9% were from high-volume centers (>500 cases annually). TEE machine/probe was available to 75.9% of the respondents and those in high-volume centers had easier (86.9%) access. There was poor documentation of preoperative consent (23.3%) as well as TEE findings (66%). Only 18.2% of responders were board qualified. Almost 90% of the responders felt surgeons respected their TEE diagnosis. Around half of the responders felt that new intraoperative findings by TEE were considered in decision-making in most of the cases and 70% of the responders reported that surgical plan was altered based on TEE finding more than 10 times in the last year. Despite this, only 5% of the responders in this survey were monetarily awarded for performing impactful skill of TEE. Majority (57%) felt that there is no need for overseas training for Indian cardiac anesthesiologists

  14. [Transesophageal electrophysiologic study: utility in the diagnosis of syncope].

    PubMed

    Hidalgo Ottolenghi, F

    2001-01-01

    Neurocardiogenic and arrhythmic syncope are very common and may be found in many patients in Emergency Departments or admitted to hospitals. Technologic advances now allow etiologic diagnosis to be determined but the importance of a detailed clinical history and physical examination can not be overemphasized in the evaluation of syncope, thereby to avoid some costly or invasive procedures. The recent introduction of the head-up tilt test alone or in combination with electrophysiologic studies, has significantly improved our ability to diagnose the etiology of syncope in many cases. Suspicion of an arrhythmic cause of syncope does not always require an invasive electrophysiologic study since the transesophageal electrophysiologic study is useful and provides a high diagnostic yield in the evaluation of non ventricular arrhythmic syncope, such as in the sick sinus syndrome, atrio-ventricular block or in supraventricular tachycardia and for the study of atrial stability. The transesophageal electrophysiologic study is an inexpensive non invasive procedure which does not require complex hospitalary installations. PMID:11535186

  15. Transesophageal Echocardiographic Study of Decompression-Induced Venous Gas Emboli

    NASA Technical Reports Server (NTRS)

    Butler, B. D.; Morris, W. P.

    1995-01-01

    Transesophageal echo-cardiography was used to evaluate venous bubbles produced in nine anesthetized dogs following decompression from 2.84 bar after 120 min at pressure. In five dogs a pulsed Doppler cuff probe was placed around the inferior vena cava for bubble grade determination. The transesophageal echo images demonstrated several novel or less defined events. In each case where the pulmonary artery was clearly visualized, the venous bubbles were seen to oscillate back and forth several times, bringing into question the effect of coincidental counting in routine bubble grade analysis using precordial Doppler. A second finding was that in all cases, extensive bubbling occurred in the portal veins with complete extraction by the liver sinusoids, with one exception where a portal-to-hepatic venous anastomosis was observed. Compression of the bowel released copious numbers of bubbles into the portal veins, sometimes more than were released into the inferior vena cava. Finally, large masses of foam were routinely observed in the non-dependent regions of the inferior vena cava that not only delayed the appearance of bubbles in the pulmonary artery but also allowed additional opportunity for further reaction with blood products and for coalescence to occur before reaching the pulmonary microcirculation. These novel observations are discussed in relation to the decompression process.

  16. Intraoperative virtual brain counseling

    NASA Astrophysics Data System (ADS)

    Jiang, Zhaowei; Grosky, William I.; Zamorano, Lucia J.; Muzik, Otto; Diaz, Fernando

    1997-06-01

    Our objective is to offer online real-tim e intelligent guidance to the neurosurgeon. Different from traditional image-guidance technologies that offer intra-operative visualization of medical images or atlas images, virtual brain counseling goes one step further. It can distinguish related brain structures and provide information about them intra-operatively. Virtual brain counseling is the foundation for surgical planing optimization and on-line surgical reference. It can provide a warning system that alerts the neurosurgeon if the chosen trajectory will pass through eloquent brain areas. In order to fulfill this objective, tracking techniques are involved for intra- operativity. Most importantly, a 3D virtual brian environment, different from traditional 3D digitized atlases, is an object-oriented model of the brain that stores information about different brain structures together with their elated information. An object-oriented hierarchical hyper-voxel space (HHVS) is introduced to integrate anatomical and functional structures. Spatial queries based on position of interest, line segment of interest, and volume of interest are introduced in this paper. The virtual brain environment is integrated with existing surgical pre-planning and intra-operative tracking systems to provide information for planning optimization and on-line surgical guidance. The neurosurgeon is alerted automatically if the planned treatment affects any critical structures. Architectures such as HHVS and algorithms, such as spatial querying, normalizing, and warping are presented in the paper. A prototype has shown that the virtual brain is intuitive in its hierarchical 3D appearance. It also showed that HHVS, as the key structure for virtual brain counseling, efficiently integrates multi-scale brain structures based on their spatial relationships.This is a promising development for optimization of treatment plans and online surgical intelligent guidance.

  17. Intraoperative anesthetic complications.

    PubMed

    Milam, S B

    1987-01-01

    Intraoperative anesthetic complications can be prevented or minimized if the anesthetist is able to anticipate such problems in the preanesthetic period. Therefore, an adequate preanesthetic medical history that includes previous anesthetic experiences and past and current drug therapy is extremely important. Furthermore, the anesthetist must be properly trained to anticipate undesirable reactions to anesthetic agents. The signs of an impending disaster are subtle and nonspecific in the anesthetized patient. Therefore, continuous vigilance of the patient's physiologic status coupled with a high index of suspicion are essential to safe anesthetic management of dental patients. PMID:3468015

  18. The role of transesophageal echocardiography in aortic surgery.

    PubMed

    Nowak-Machen, Martina

    2016-09-01

    Aortic disease, when left untreated, is still associated with major morbidity and mortality. Aortic dissection and aortic aneurysm are the main reasons for performing aortic surgery procedures in the adult. Imaging techniques such as computed tomography and magnetic resonance imaging play a key role in the preoperative evaluation. Transesophageal echocardiography (TEE) has become a safe and invaluable perioperative imaging tool for aortic disease over the past decade with high sensitivity and specificity. TEE can increase patient safety and improve overall patient outcome in aortic surgery. Especially during endovascular aortic repair, TEE is more sensitive than other imaging modalities in diagnosing complications such as graft endoleaks. Newer echocardiographic techniques such as three-dimensional (3D) TEE and contrast-enhanced TEE are emerging and seem to have a valuable role especially in aortic dissection repair and endovascular aortic stent procedures. In the absence of contraindications, TEE should generally be performed during aortic surgery and endovascular aortic procedures. PMID:27650342

  19. Transesophageal echocardiography in the anesthetic management of total hip arthroplasty.

    PubMed

    Johnson, C; Lewis, K D; Steen, S N; Mok, M S; Wu, C C

    2001-09-01

    Total hip arthroplasty is a common procedure in the elderly and thromboembolism continues to be a cause of mortality and morbidity associated with this procedure. When properly diagnosed and treated the mortality rate from pulmonary embolism can be reduced significantly. Transesophageal echocardiograpic (TEE) detection of central pulmonary artery thromboemboli in patients with severe pulmonary embolism has been reported to have a sensitivity of 96.7% and a specificity of 88%. However TEE is not universally available due to its cost and expertise that is required. Taking into consideration its cost/effectiveness we suggest that in patients undergoing the cement type of total hip arthroplasty who are cardiopulmonary compromised, debilitated or elderly the use of TEE is indicated.

  20. Intraoperative magnetic resonance imaging.

    PubMed

    Hall, Walter A; Truwit, Charles L

    2011-01-01

    Neurosurgeons have become reliant on image-guidance to perform safe and successful surgery both time-efficiently and cost-effectively. Neuronavigation typically involves either rigid (frame-based) or skull-mounted (frameless) stereotactic guidance derived from computed tomography (CT) or magnetic resonance imaging (MRI) that is obtained days or immediately before the planned surgical procedure. These systems do not accommodate for brain shift that is unavoidable once the cranium is opened and cerebrospinal fluid is lost. Intraoperative MRI (ioMRI) systems ranging in strength from 0.12 to 3 Tesla (T) have been developed in part because they afford neurosurgeons the opportunity to accommodate for brain shift during surgery. Other distinct advantages of ioMRI include the excellent soft tissue discrimination, the ability to view the surgical site in three dimensions, and the ability to "see" tumor beyond the surface visualization of the surgeon's eye, either with or without a surgical microscope. The enhanced ability to view the tumor being biopsied or resected allows the surgeon to choose a safe surgical corridor that avoids critical structures, maximizes the extent of the tumor resection, and confirms that an intraoperative hemorrhage has not resulted from surgery. Although all ioMRI systems allow for basic T1- and T2-weighted imaging, only high-field (>1.5 T) MRI systems are capable of MR spectroscopy (MRS), MR angiography (MRA), MR venography (MRV), diffusion-weighted imaging (DWI), and brain activation studies. By identifying vascular structures with MRA and MRV, it may be possible to prevent their inadvertent injury during surgery. Biopsying those areas of elevated phosphocholine on MRS may improve the diagnostic yield for brain biopsy. Mapping out eloquent brain function may influence the surgical path to a tumor being resected or biopsied. The optimal field strength for an ioMRI-guided surgical system and the best configuration for that system are as yet

  1. A prospective, randomized, blinded comparison of multiplane and biplane transesophageal echocardiographic techniques.

    PubMed

    Warner, J G; Nomeir, A M; Salim, M; Kitzman, D W

    1996-01-01

    Although multiplane transesophageal echocardiography has become an accepted diagnostic technique, there is a paucity of literature directly comparing the diagnostic yield of multiplane and biplane transesophageal examinations. This study was designed to compare the ability of multiplane and biplane transesophageal echocardiographic techniques to visualize intracardiac structures. Complete multiplane and biplane transesophageal studies were performed on each of 50 patients (100 total studies) referred to the echocardiography laboratory for elective transesophageal echocardiography. The biplane examinations were performed with a multiplane probe with angles only at 0 and 90 degrees. Images of 29 prospectively selected cardiac structures and valvular function parameters were scored as follows: 0 = not visualized, 1 = visualized well enough to identify structure, 2 = diagnostic quality, and 3 = exceptional quality. The scores for the individual structures were combined to identify total structure visualization quality scores for each of the imaging techniques. A separate subjective score was also determined to assess the overall adequacy of each study for addressing the clinical indication. The total structure visualization quality score was significantly higher for multiplane transesophageal echocardiography than for biplane transesophageal echocardiography (49 +/- 7 versus 45 +/- 7; p = 0.0001). Several individual structures were visualized significantly better (p < 0.05) by the multiplane technique, including the left upper pulmonary vein, fossa ovalis, left main coronary artery, and proximal ascending aorta. The subjective score of overall adequacy of the study for addressing the clinical indication showed a strong trend (p < 0.06) in favor of the multiplane technique, with higher scores in 11 of 50 multiplane studies versus three of 50 biplane studies when the two techniques were compared in individual patients. Therefore multiplane transesophageal

  2. The Preoperative Evaluation of Infective Endocarditis via 3-Dimensional Transesophageal Echocardiography.

    PubMed

    Yong, Matthew S; Saxena, Pankaj; Killu, Ammar M; Coffey, Sean; Burkhart, Harold M; Wan, Siu-Hin; Malouf, Joseph F

    2015-08-01

    Transesophageal echocardiography continues to have a central role in the diagnosis of infective endocarditis and its sequelae. Recent technological advances offer the option of 3-dimensional imaging in the evaluation of patients with infective endocarditis. We present an illustrative case and review the literature regarding the potential advantages and limitations of 3-dimensional transesophageal echocardiography in the diagnosis of complicated infective endocarditis. A 51-year-old man, an intravenous drug user who had undergone bioprosthetic aortic valve replacement 5 months earlier, presented with prosthetic valve endocarditis. Preoperative transesophageal echocardiography with 3D rendition revealed a large abscess involving the mitral aortic intervalvular fibrosa, together with a mycotic aneurysm that had ruptured into the left atrium, resulting in a left ventricle-to-left atrium fistula. Three-dimensional transesophageal echocardiography enabled superior preoperative anatomic delineation and surgical planning. We conclude that 3-dimensional transesophageal echocardiography can be a useful adjunct to traditional 2-dimensional transesophageal echocardiography as a tool in the diagnosis of infective endocarditis.

  3. Elevated transaortic valvular gradients after combined aortic valve and mitral valve replacement: an intraoperative dilemma.

    PubMed

    Essandoh, Michael; Portillo, Juan; Zuleta-Alarcon, Alix; Castellon-Larios, Karina; Otey, Andrew; Sai-Sudhakar, Chittoor B

    2015-03-01

    High transaortic valvular gradients, after combined aortic valve and mitral valve replacement, require prompt intraoperative diagnosis and appropriate management. The presence of high transaortic valvular gradients after cardiopulmonary bypass, in this setting, can be secondary to the following conditions: prosthesis dysfunction, left ventricular outflow tract obstruction, supravalvular obstruction, prosthesis-patient mismatch, hyperkinetic left ventricle from administration of inotropes, left ventricular intracavitary gradients, pressure recovery phenomenon, and increased transvalvular blood flow resulting from hyperdynamic circulation or anemia. Transesophageal echocardiography is an extremely useful tool for timely diagnosis and treatment of this complication. We describe a case of a critically ill patient with endocarditis and acute lung injury, who presented for combined aortic valve and mitral valve replacement. Transesophageal echocardiographic assessment, post-cardiopulmonary bypass, revealed high transaortic valvular gradients due to encroachment of the mitral prosthesis strut on the left ventricular outflow tract, which was compounded by a small, hypertrophied, and hyperkinetic left ventricle. Discontinuation of inotropic support, administration of fluids, phenylephrine, and esmolol led to resolution of the high gradients and prevented further surgery. PMID:25549635

  4. Transesophageal NOTES--a critical analysis of relevant problems.

    PubMed

    Grund, Karl E; Lehmann, Thorsten G

    2010-10-01

    The transesophageal access route has not become a principal topic in the discussion about NOTES up to now. Analyzing the problems in this new field of surgery, however, the transesophageal route shows high relevance. Here, all possibilities, limitations, and problems of NOTES become obvious. This paper contains a critical analysis of the literature published to date (nine full papers, five abstracts). Nearly all publications represent experimental studies in living pigs. In most cases a submucosal tunnel technique is performed as access route to mediastinum, pleural cavity, and heart. Interventions and operations include simple mediastinoscopies as well as epicardial operations after exposition of the heart. For access and manipulation, conventional flexible endoscopes and instruments are used. Clips, T-bars, or a combination of both achieve the closure. Some studies rely on spontaneous closure of the incision without any suturing or approximation. In such experimental settings, the following results are presented: Access is achieved in 90% of cases, the aim of the operation is met in 92%, technical success in closure is achieved in 90%, healing of incision assessed as good in two of five studies, satisfactory in three of five studies. Mortality, ranging from 6 to 25%, and complication rates were (surprisingly) high. It has to be stressed that analyzing these papers published to date, no adequate attention is paid to basic facts and problems of general and thoracic surgery (e.g. different forms, prevention, diagnosis and therapy of pneumothorax or differentiated forms of ventilation). Relevant differences in the anatomy and physiology of the esophagus and mediastinum between humans and pigs should additionally be taken into account to choose optimal experimental parameters when transferring results to human settings. Moreover, requirements regarding sterility and hygiene in a structure like the mediastinum, which is at high risk from the point of view of infection

  5. Premature aortic stiffness in systemic lupus erythematosus by transesophageal echocardiography.

    PubMed

    Roldan, C A; Joson, J; Qualls, C R; Sharrar, J; Sibbitt, W L

    2010-12-01

    To assess aortic stiffness by transesophageal echocardiography (TEE) and to determine its clinical predictors and relation to age, blood pressure, renal function, and atherosclerosis, 50 patients with systemic lupus erythematosus (SLE), 94% women, with a mean age of 38 ± 12 years, and 22 age and gender-matched healthy controls underwent clinical and laboratory evaluations and multiplane TEE to assess stiffness, intima-media thickness (IMT), and plaques of the proximal, mid, and distal descending thoracic aorta. Stiffness at each level and overall aortic stiffness by the pressure-strain elastic modulus was higher in patients than in controls after adjusting for age (overall, 8.25 ± 4.13 versus 6.1 ± 2.5 Pascal units, p = 0.01). Patients had higher aortic stiffness than controls after adjusting both groups to the same mean age, blood pressure, creatinine, and aortic IMT (p = 0.005). Neither IMT nor plaques were predictors of aortic stiffness. Moreover, normotensive patients, those without aortic plaques, and non-smokers had higher stiffness than controls (all p < 0.05). Age at SLE diagnosis and non-neurologic damage score were the only SLE-specific independent predictors of aortic stiffness (both p ≤ 0.01). Thus, increased aortic stiffness is an early manifestation of lupus vasculopathy that seems to precede the development of hypertension and atherosclerosis.

  6. Multiplane transesophageal echocardiographic evaluation of mitral valve disease.

    PubMed

    Stewart, W J; Griffin, B; Thomas, J D

    1995-04-01

    With the additional ability to rotate the image around the axis of the centerline of the sector, multiplane transesophageal echocardiography (TEE) improves over single or biplane TEE in ease of use and diagnostic accuracy. This article reviews the anatomic, physiological, and topographic considerations that affect the use of multiplane TEE in evaluation of patients with mitral valve disease. The optimum mitral valve examination includes a true "short-axis" view, obtained by a transverse (zero-degree angle) transgastric image orientation with the probe tip flexed anteriorly, and several "long-axis" views, obtained from various rotations of the basilar multiplane TEE image planes. This provides a useful and accurate means to determine the mechanism of mitral regurgitation, which is useful in planning and timing, determining the likelihood, and predicting the surgical techniques that will be required for mitral valve repair. The postcardiopulmonary bypass (postpump) TEE examination in a patient with mitral regurgitation is a second important component of the process of repair, to determine the presence and severity of residual mitral regurgitation, and identify any complications of surgery. Of 1,550 mitral repair operations studied with postpump echocardiography at our hospital since 1987, a total of 105 (7%) have had second pump runs. Multiplane TEE is also useful to pinpoint the exact site of periprosthetic regurgitation around a mitral prosthesis, enabling direct surgical closure in some cases. Understanding special technical features of multiplane TEE is an important component for optimum utilization of this powerful diagnostic modality.

  7. Transesophageal echocardiography in the management of burn patients.

    PubMed

    Maybauer, Marc O; Asmussen, Sven; Platts, David G; Fraser, John F; Sanfilippo, Filippo; Maybauer, Dirk M

    2014-06-01

    A systematic review was conducted to assess the level of evidence for the use of transesophageal echocardiography (TEE) in the management of burn patients. We searched any article published before and including June 30, 2013. Our search yielded 118 total publications, 11 met the inclusion criteria of burn injury and TEE. Available studies published in any language were rated and included. At the present time, there are no available systematic reviews/meta-analyses published that met our search criteria. Only a small number of clinical trials, all with a limited number of patients were available. Therefore, a meta-analysis on outcome parameters was not performed. However, the major pathologic findings in burn patients were reduced left ventricular (LV) systolic and diastolic function, mitral valve vegetation, pulmonary hypertension, pericardial effusion, fluid overload, and right heart failure. The advantages of TEE include offering direct assessment of cardiac valve competency, myocardial contractility, and most importantly real time assessment of adequacy of hemodynamic resuscitation and preload in the acute phase of resuscitation, with minimal additional risk. TEE serves multiple diagnostic purposes and is being used to better understand the fluid status and cardiac physiology of the critically ill burn patient. Randomized controlled trials especially on fluid resuscitation and cardiac performance in acute burns are warranted to potentially further improve outcome.

  8. Incremental Value of Three-Dimensional Transesophageal Echocardiography over the Two-Dimensional Technique in the Assessment of a Thrombus in Transit through a Patent Foramen Ovale.

    PubMed

    Thind, Munveer; Ahmed, Mustafa I; Gok, Gulay; Joson, Marisa; Elsayed, Mahmoud; Tuck, Benjamin C; Townsley, Matthew M; Klas, Berthold; McGiffin, David C; Nanda, Navin C

    2015-05-01

    We report a case of a right atrial thrombus traversing a patent foramen ovale into the left atrium, where three-dimensional transesophageal echocardiography provided considerable incremental value over two-dimensional transesophageal echocardiography in its assessment. As well as allowing us to better spatially characterize the thrombus, three-dimensional transesophageal echocardiography provided a more quantitative assessment through estimation of total thrombus burden.

  9. Intraoperative monitoring of evoked potentials.

    PubMed

    Raudzens, P A

    1982-01-01

    Sensory EPs were recorded intraoperatively in 173 neurosurgical procedures (71 VEPs, 66 BAEPs, and 31 SSEPs) to evaluate the utility of this technique. EPs could be safely recorded in all cases, but the yield of useful results varied with each sensory modality. BAEPs were recorded reliably in 100% of the cases and intraoperative latency changes accurately predicted postoperative hearing deficits in 10%. Potential hearing deficits were detected in another 15%. BAEP changes were associated with brainstem dysfunction in only one case. VEP changes were difficult to interpret intraoperatively because of contamination by a high degree of variability and both false negative and false positive results. Changes in VEP amplitudes related to surgical manipulation of the optic chiasm were only suggested. SSEP changes were recorded reliably in only 75% of the cases and no correlations between SSEP changes and postoperative sensory function were established. Again, intraoperative amplitude attenuation of the SSEP waveform with surgical manipulation only suggested a potential sensory deficit. Intraoperative EP monitoring is a valuable technique that provides a functional analysis of the sensory nervous system during surgical procedures. Specific sensory stimuli and improved data analysis will increase the utility of this CNS monitor.

  10. Future perspectives in intraoperative imaging.

    PubMed

    Jolesz, F A

    2003-01-01

    Of all the advances in imaging science in the past twenty years, none has had a greater impact than Magnetic Resonance Imaging. Since its introduction as a diagnostic tool in the mid-1980's, MRI has evolved into the premier neuroimaging modality, and with the addition of higher field magnets, we are able to achieve spatial resolution of such superb quality that even the most exquisite details of the brain anatomy can be visualized. With the implementation of intraoperative, neurosurgical MRI, we can not only monitor brain shifts and deformations; we can achieve intraoperative navigation using intraoperative image updates. In the future, intraoperative MRI can be used not only to localize, target, and resect brain tumors and other lesions but also to fully comprehend the surrounding cortical and white matter functional anatomy. In addition to the inclusion of new imaging methods such as diffusion tensor imaging, new therapeutic methods will be applied. Especially encouraging are the promising results in MRI-guided Focused Ultrasound Surgery, in which the non-invasive thermal ablation of tumors is monitored and controlled by MRI. With the clinical introduction of these advances, intraoperative MRI is changing the face of Neurosurgery today. PMID:12570132

  11. Intraoperative MRI and functional mapping.

    PubMed

    Gasser, Thomas; Szelenyi, Andrea; Senft, Christian; Muragaki, Yoshihiro; Sandalcioglu, I Erol; Sure, Ulrich; Nimsky, Christopher; Seifert, Volker

    2011-01-01

    The integration of functional and anatomical data into neuronavigation is an established standard of care in many neurosurgical departments. Yet, this method has limitations as in most cases the data are acquired prior to surgery. Due to brain-shift the accurate presentation of functional as well as anatomical structures declines in the course of surgery. In consequence, the acquisition of information during surgery about the brain's current functional state is of specific interest. The advancement of imaging technologies (e.g. fMRI, MEG, Intraoperative Optical Intrinsic Signal Imaging--IOIS) and neurophysiological techniques and the advent of intraoperative MRI all had a major impact on neurosurgery. The combination of modalities such as neurophysiology and intraoperative MRI (ioMRI), as well as the acquisition of functional MRI during surgery (ifMRI) are in the focus of this work. Especially the technical aspects and safety issues are elucidated.

  12. [Intraoperative OCT in ophthalmic microsurgery].

    PubMed

    Stanzel, B V; Gagalick, A; Brinkmann, C K; Brinken, R; Herwig, M C; Holz, F G

    2016-05-01

    Recent improvements in technology have enabled integration of SD-OCT into the optical path of an operating microscope. Here we present an overview of possible applications of iOCT (intraoperative optical coherence tomography) for retinal, glaucoma and corneal surgery. iOCT-based imaging can not only improve safety and quality of the surgery but also the learning curve of the surgeon. The ability to visualize barely visible or transparent structures with iOCT has achieved a significant added value intraoperatively, particularly in macular surgery, trabeculectomy and lamellar keratoplasty. Further, systematic assessment is warranted to define the usefulness of the iOCT more precisely. PMID:27126797

  13. [Intraoperative OCT in ophthalmic microsurgery].

    PubMed

    Stanzel, B V; Gagalick, A; Brinkmann, C K; Brinken, R; Herwig, M C; Holz, F G

    2016-05-01

    Recent improvements in technology have enabled integration of SD-OCT into the optical path of an operating microscope. Here we present an overview of possible applications of iOCT (intraoperative optical coherence tomography) for retinal, glaucoma and corneal surgery. iOCT-based imaging can not only improve safety and quality of the surgery but also the learning curve of the surgeon. The ability to visualize barely visible or transparent structures with iOCT has achieved a significant added value intraoperatively, particularly in macular surgery, trabeculectomy and lamellar keratoplasty. Further, systematic assessment is warranted to define the usefulness of the iOCT more precisely.

  14. Acute Bilateral Internal Carotid Occlusion from Embolization of Left Atrial Thrombus During Transesophageal Echocardiography: Case Report

    PubMed Central

    Mahmood, Syed Saad; Manjila, Sunil; Singh, Gagandeep; Xavier, Andrew R

    2016-01-01

    Background and purpose: Transesophageal echocardiography (TEE) is a relatively safe imaging modality used to visualize intracardiac thrombus. Summary of case: We report on a unique, fatal complication during TEE of embolization of a pre-existing “smoking” left atrial thrombus causing acute bilateral internal carotid occlusion, confirmed on angiogram. Conclusions: Patients with history of lung pathology, such as COPD, who experience retching and cough during transesophageal echocardiography may be more susceptible to embolization of pre-existing thrombi. A need exists to risk stratify such patients. PMID:27403219

  15. Intraoperative transfusion practices in Europe

    PubMed Central

    Meier, J.; Filipescu, D.; Kozek-Langenecker, S.; Llau Pitarch, J.; Mallett, S.; Martus, P.; Matot, I.

    2016-01-01

    Background. Transfusion of allogeneic blood influences outcome after surgery. Despite widespread availability of transfusion guidelines, transfusion practices might vary among physicians, departments, hospitals and countries. Our aim was to determine the amount of packed red blood cells (pRBC) and blood products transfused intraoperatively, and to describe factors determining transfusion throughout Europe. Methods. We did a prospective observational cohort study enrolling 5803 patients in 126 European centres that received at least one pRBC unit intraoperatively, during a continuous three month period in 2013. Results. The overall intraoperative transfusion rate was 1.8%; 59% of transfusions were at least partially initiated as a result of a physiological transfusion trigger- mostly because of hypotension (55.4%) and/or tachycardia (30.7%). Haemoglobin (Hb)- based transfusion trigger alone initiated only 8.5% of transfusions. The Hb concentration [mean (sd)] just before transfusion was 8.1 (1.7) g dl−1 and increased to 9.8 (1.8) g dl−1 after transfusion. The mean number of intraoperatively transfused pRBC units was 2.5 (2.7) units (median 2). Conclusion. Although European Society of Anaesthesiology transfusion guidelines are moderately implemented in Europe with respect to Hb threshold for transfusion (7–9 g dl−1), there is still an urgent need for further educational efforts that focus on the number of pRBC units to be transfused at this threshold. Clinical trial registration. NCT 01604083. PMID:26787795

  16. Quantitation of aortic valve area in aortic stenosis with multiplane transesophageal echocardiography: comparison with monoplane transesophageal approach.

    PubMed

    Tribouilloy, C; Shen, W F; Peltier, M; Mirode, A; Rey, J L; Lesbre, J P

    1994-09-01

    The accuracy and reliability of two-dimensional monoplane and multiplane transesophageal echocardiography (TEE) in the quantitation of aortic valve area were compared in 54 patients with aortic stenosis. Fifty patients had aortic valve area calculated by the continuity equation and transthoracic Doppler echocardiography (TTE); 25 underwent cardiac catheterization. Two-dimensional echocardiograms adequate for quantitation of aortic valve area were obtained in 21 (39%) patients with monoplane TEE and in 51 (94%) with multiplane TEE. The mean aortic valve area determined by both TEE methods did not differ significantly from that derived from TTE and catheterization. The mean difference of aortic valve area measurements between monoplane TEE and TTE was -0.045 +/- 0.11 cm2; that between multiplane TEE and TTE was 0.001 +/- 0.11 cm2. Multiplane TEE provided a better correlation of aortic valve area measurements with either TTE (y = 0.97 x + 0.03; r = 0.96; SEE = 0.11 cm2) or catheterization (y = 0.84 x + 0.11; r = 0.90; SEE = 0.12 cm2) than the monoplane TEE (y = 0.88 x + 0.13; r = 0.83; SEE = 0.15 cm2 and y = 0.41 x + 0.42; r = 0.81; SEE = 0.15 cm2). Severe aortic stenosis with valve orifice area of < or = 0.75 cm2 during TTE examination was found by multiplane TEE with a sensitivity of 96% and a specificity of 96%. Thus aortic valve area can be directly and reliably measured by two-dimensional multiplane TEE in majority of patients with aortic stenosis.

  17. Benzocaine-induced methemoglobinemia: a potentially fatal complication of transesophageal echocardiography.

    PubMed

    Sachdeva, Rajesh; Pugeda, Jaime G; Casale, Linda R; Meizlish, Jay L; Zarich, Stuart W

    2003-01-01

    We describe the cases of 2 patients who developed benzocaine-induced methemoglobinemia after the administration of benzocaine as premedication for transesophageal echocardiography. The use of intravenous methylene blue resolved the cyanosis in both patients. Physicians who perform procedures involving the application of topical anesthesia need to be aware of this side effect to prevent morbidity and mortality.

  18. Does multiplane transesophageal echocardiography improve the assessment of prosthetic valve regurgitation?

    PubMed

    Flachskampf, F A; Hoffmann, R; Franke, A; Job, F P; Schöndube, F A; Messmer, B J; Hanrath, P

    1995-01-01

    Assessment of prosthetic valve regurgitation by echocardiography remains difficult. To study the value of the newly introduced multiplane transesophageal technology for this purpose, prosthetic valve regurgitation was examined in 63 consecutive patients with 35 mitral and 33 aortic prostheses (23 bioprostheses and 45 mechanical prostheses). Transvalvular, paravalvular and, in mechanical valves, normal or pathologic transvalvular regurgitation were identified first with 0 degrees (transverse) and 90 degrees (longitudinal) planes combined with flexion of the echoscope tip and then additionally with multiple intermediary planes by transducer rotation. In a subgroup of 20 patients interobserver variability was evaluated. Both methods showed regurgitation in 56 of 68 valves; one additional case of regurgitation was seen by multiplane imaging only. However, 19 cases of regurgitation were not clearly classifiable by biplane transesophageal echocardiography compared with only three with multiplane transesophageal echocardiography. Grading of severity was concordant by both modalities in 66 and discordant in only two cases. Observers disagreed on severity in two of 20 cases based on biplane imaging but in none based on multiplane imaging; classification of regurgitation differed in six of 20 (biplane) and one of 20 (multiplane), respectively. Multiplane transesophageal imaging improves classification of prosthetic regurgitation but has little effect on severity grading.

  19. From hand-rotated multiplane transesophageal to fast-rotating parasternal probes for cardiac imaging

    NASA Astrophysics Data System (ADS)

    Bom, Nicolaas; Lancee, Charles T.; de Jong, Nico; van der Steen, Anton F. W.; Roelandt, J. R.

    1999-06-01

    Trans-Esophageal Echocardiographic probes were introduced around 1982. The development ranges over the years from single plane, phased array transducers at low frequency to today's multiplane probes with a large number of elements. Further miniaturization and higher frequencies allow paediatric applications. Recent development includes a probe with 48 elements at 7 MHz with a shaft diameter of only 5 mm.

  20. Left atrial ball thrombus with acute mesenteric ischemia: anesthetic management and role of transesophageal echocardiography.

    PubMed

    Makhija, Neeti; Malankar, Dhananjay; Singh, Pooja; Goyal, Sameer; Patel, Kartik; Jagia, Priya

    2014-01-01

    A 62 year old female with severe mitral stenosis, large left atrial ball thrombus and acute mesenteric ischemia emergently underwent mitral valve replacement, left atrial clot removal and emergency laparotomy for mesenteric ischemia. Peri-operative management issues, particularly, the anesthetic challenges and the role of transesophageal echocardiography are discussed.

  1. Cardiac shear-wave elastography using a transesophageal transducer: application to the mapping of thermal lesions in ultrasound transesophageal cardiac ablation.

    PubMed

    Kwiecinski, Wojciech; Bessière, Francis; Colas, Elodie Constanciel; N'Djin, W Apoutou; Tanter, Mickaël; Lafon, Cyril; Pernot, Mathieu

    2015-10-21

    Heart rhythm disorders, such as atrial fibrillation or ventricular tachycardia can be treated by catheter-based thermal ablation. However, clinically available systems based on radio-frequency or cryothermal ablation suffer from limited energy penetration and the lack of lesion's extent monitoring. An ultrasound-guided transesophageal device has recently successfully been used to perform High-Intensity Focused Ultrasound (HIFU) ablation in targeted regions of the heart in vivo. In this study we investigate the feasibility of a dual therapy and imaging approach on the same transesophageal device. We demonstrate in vivo that quantitative cardiac shear-wave elastography (SWE) can be performed with the device and we show on ex vivo samples that transesophageal SWE can map the extent of the HIFU lesions. First, SWE was validated with the transesophageal endoscope in one sheep in vivo. The stiffness of normal atrial and ventricular tissues has been assessed during the cardiac cycle (n = 11) and mapped (n = 7). Second, HIFU ablation has been performed with the therapy-imaging transesophageal device in ex vivo chicken breast samples (n  =  3), then atrial (left, n = 2) and ventricular (left n = 1, right n = 1) porcine heart tissues. SWE provided stiffness maps of the tissues before and after ablation. Areas of the lesions were obtained by tissue color change with gross pathology and compared to SWE. During the cardiac cycle stiffness varied from 0.5   ±   0.1 kPa to 6.0   ±   0.3 kPa in the atrium and from 1.3   ±   0.3 kPa to 13.5   ±   9.1 kPa in the ventricles. The thermal lesions were visible on all SWE maps performed after ablation. Shear modulus of the ablated zones increased to 16.3   ±   5.5 kPa (versus 4.4   ±   1.6 kPa before ablation) in the chicken breast, to 30.3   ±   10.3 kPa (versus 12.2   ±   4.3 kPa) in the atria and to 73.8

  2. Cardiac shear-wave elastography using a transesophageal transducer: application to the mapping of thermal lesions in ultrasound transesophageal cardiac ablation.

    PubMed

    Kwiecinski, Wojciech; Bessière, Francis; Colas, Elodie Constanciel; N'Djin, W Apoutou; Tanter, Mickaël; Lafon, Cyril; Pernot, Mathieu

    2015-10-21

    Heart rhythm disorders, such as atrial fibrillation or ventricular tachycardia can be treated by catheter-based thermal ablation. However, clinically available systems based on radio-frequency or cryothermal ablation suffer from limited energy penetration and the lack of lesion's extent monitoring. An ultrasound-guided transesophageal device has recently successfully been used to perform High-Intensity Focused Ultrasound (HIFU) ablation in targeted regions of the heart in vivo. In this study we investigate the feasibility of a dual therapy and imaging approach on the same transesophageal device. We demonstrate in vivo that quantitative cardiac shear-wave elastography (SWE) can be performed with the device and we show on ex vivo samples that transesophageal SWE can map the extent of the HIFU lesions. First, SWE was validated with the transesophageal endoscope in one sheep in vivo. The stiffness of normal atrial and ventricular tissues has been assessed during the cardiac cycle (n = 11) and mapped (n = 7). Second, HIFU ablation has been performed with the therapy-imaging transesophageal device in ex vivo chicken breast samples (n  =  3), then atrial (left, n = 2) and ventricular (left n = 1, right n = 1) porcine heart tissues. SWE provided stiffness maps of the tissues before and after ablation. Areas of the lesions were obtained by tissue color change with gross pathology and compared to SWE. During the cardiac cycle stiffness varied from 0.5   ±   0.1 kPa to 6.0   ±   0.3 kPa in the atrium and from 1.3   ±   0.3 kPa to 13.5   ±   9.1 kPa in the ventricles. The thermal lesions were visible on all SWE maps performed after ablation. Shear modulus of the ablated zones increased to 16.3   ±   5.5 kPa (versus 4.4   ±   1.6 kPa before ablation) in the chicken breast, to 30.3   ±   10.3 kPa (versus 12.2   ±   4.3 kPa) in the atria and to 73.8

  3. Cardiac shear-wave elastography using a transesophageal transducer: application to the mapping of thermal lesions in ultrasound transesophageal cardiac ablation

    NASA Astrophysics Data System (ADS)

    Kwiecinski, Wojciech; Bessière, Francis; Constanciel Colas, Elodie; Apoutou N'Djin, W.; Tanter, Mickaël; Lafon, Cyril; Pernot, Mathieu

    2015-10-01

    Heart rhythm disorders, such as atrial fibrillation or ventricular tachycardia can be treated by catheter-based thermal ablation. However, clinically available systems based on radio-frequency or cryothermal ablation suffer from limited energy penetration and the lack of lesion’s extent monitoring. An ultrasound-guided transesophageal device has recently successfully been used to perform High-Intensity Focused Ultrasound (HIFU) ablation in targeted regions of the heart in vivo. In this study we investigate the feasibility of a dual therapy and imaging approach on the same transesophageal device. We demonstrate in vivo that quantitative cardiac shear-wave elastography (SWE) can be performed with the device and we show on ex vivo samples that transesophageal SWE can map the extent of the HIFU lesions. First, SWE was validated with the transesophageal endoscope in one sheep in vivo. The stiffness of normal atrial and ventricular tissues has been assessed during the cardiac cycle (n=11 ) and mapped (n= 7 ). Second, HIFU ablation has been performed with the therapy-imaging transesophageal device in ex vivo chicken breast samples (n  =  3), then atrial (left, n= 2 ) and ventricular (left n=1 , right n=1 ) porcine heart tissues. SWE provided stiffness maps of the tissues before and after ablation. Areas of the lesions were obtained by tissue color change with gross pathology and compared to SWE. During the cardiac cycle stiffness varied from 0.5   ±   0.1 kPa to 6.0   ±   0.3 kPa in the atrium and from 1.3   ±   0.3 kPa to 13.5   ±   9.1 kPa in the ventricles. The thermal lesions were visible on all SWE maps performed after ablation. Shear modulus of the ablated zones increased to 16.3   ±   5.5 kPa (versus 4.4   ±   1.6 kPa before ablation) in the chicken breast, to 30.3   ±   10.3 kPa (versus 12.2   ±   4.3 kPa) in the atria and to 73.8   ±   13

  4. [Intraoperative Visual Evoked Potential Monitoring].

    PubMed

    Hayashi, Hironobu; Kawaguchi, Masahiko

    2015-05-01

    Visual evoked potential (VEP) is recorded from the back of the head, which is elicited by retinal stimulation transmitted through optic nerve, optic chiasm, optic tract lateral geniculate body, optic radiation and finally cortical visual area. VEP monitoring did not prevail since 1990s because marked intra-individual difference and instability of VEP recording limited the clinical usefulness under inhalation anesthetic management and techniques of VEP monitoring at the time. However, recent advances in techniques including a new light-stimulating device consisting of high-luminosity LEDs and induction of electroretinography to ascertain the arrival of the stimulus at the retina provided better conditions for stable VEP recording under general anesthesia. In addition, the introduction of total intravenous anesthesia using propofol is important for the successful VEP recordings because inhaled anesthetics have suppressive effect on VEP waveform. Intraoperative VEP has been considered to monitor the functional integrity of visual function during neurosurgical procedures, in which the optic pathway is at a risk of injury. Intraoperative VEP monitoring may allow us to detect reversible damage to the visual pathway intraoperatively and enable us to prevent permanent impairment.

  5. Feasibility of measuring superior mesenteric artery blood flow during cardiac surgery under hypothermic cardiopulmonary bypass using transesophageal echocardiography: An observational study

    PubMed Central

    Singh, Naveen G.; Nagaraja, P. S.; Gopal, Divya; Manjunath, V.; Nagesh, K. S.; Manjunatha, N.; Patel, Guru Police; Mishra, Satish Kumar

    2016-01-01

    Background: Abdominal complications being rare but results in high mortality, commonly due to splanchnic organ hypoperfusion during the perioperative period of cardiac surgery. There are no feasible methods to monitor intraoperative superior mesenteric artery blood flow (SMABF). Hence, the aim of this study was to evaluate the feasibility and to measure SMABF using transesophageal echocardiography (TEE) during cardiac surgery under hypothermic cardiopulmonary bypass (CPB). Methodology: Thirty-five patients undergoing elective cardiac surgery under CPB were enrolled. Heart rate, mean arterial pressure (MAP), cardiac output (CO), SMABF, superior mesenteric artery (SMA) diameter, superior mesentric artery blood flow over cardiac output (SMA/CO) ratio and arterial blood lactates were recorded at three time intervals. T0: before sternotomy, T1: 30 min after initiation of CPB and T2: after sternal closure. Results: SMA was demonstrated in 32 patients. SMABF, SMA diameter, SMA/CO, MAP and CO decreased significantly (P < 0.0001) between T0 and T1, increased significantly (P ≤ 0.001) between T0 and T2. Lactates increased progressively from T0 to T2. Conclusion: Study shows that there is decrease in SMABF during CPB and returns to baseline after CPB. Hence, it is feasible to measure SMABF using TEE in patients undergoing cardiac surgery under hypothermic CPB. TEE can be a promising tool in detecting and preventing splanchnic hypoperfusion during perioperative period. PMID:27397442

  6. Intraoperative laparoscopic complications for urological cancer procedures

    PubMed Central

    Montes, Sergio Fernández-Pello; Rodríguez, Ivan Gonzalez; Ugarteburu, Rodrigo Gil; Villamil, Luis Rodríguez; Mendez, Begoña Diaz; Gil, Patricio Suarez; Madera, Javier Mosquera

    2015-01-01

    AIM: To structure the rate of intraoperative complications that requires an intraoperative or perioperative resolution. METHODS: We perform a literature review of Medline database. The research was focused on intraoperative laparoscopic procedures inside the field of urological oncology. General rate of perioperative complications in laparoscopic urologic surgery is described to be around 12.4%. Most of the manuscripts published do not make differences between pure intraoperative, intraoperative with postoperative consequences and postoperative complications. RESULTS: We expose a narrative statement of complications, possible solutions and possible preventions for most frequent retroperitoneal and pelvic laparoscopic surgery. We expose the results with the following order: retroperitoneal laparoscopic surgery (radical nephrectomy, partial nephrectomy, nephroureterectomy and adrenalectomy) and pelvic laparoscopic surgery (radical prostatectomy and radical cystectomy). CONCLUSION: Intraoperative complications vary from different series. More scheduled reports should be done in order to better understand the real rates of complications. PMID:25984519

  7. Intraoperative ultrasonography (IOUS) in thoracolumbar fractures.

    PubMed

    Blumenkopf, B; Daniels, T

    1988-01-01

    The thoracolumbar levels are the second most common region for spinal trauma. A major surgical effort often entails removal of retropulsed bone fragments with decompression of the spinal contents or realignment of vertebral subluxations. The ability to determine intraoperatively the completeness of such a procedure could impact on the surgical approach and, ultimately, the operative result. The intraoperative use of ultrasonography has gained popularity and applicability. This comparison study of intraoperative ultrasonography versus postoperative computed tomography (CT) assessed the accuracy of intraoperative ultrasonography in determining the status of the spinal canal following surgical intervention in a group of 21 patients with thoracolumbar fractures. In all cases a patent ventral subarachnoid space or complete spinal canal decompression was deduced following intraoperative ultrasonography. The postoperative assessment by CT concurred in 20 of 21 (95%) situations. Intraoperative ultrasonography proved useful during the operative management of these fractures and gave good supportive evidence that the neural elements were decompressed by surgical procedure. PMID:2980067

  8. Endovascular treatment of painless aortic ulcer detected by transesophageal echocardiography as an incidental finding.

    PubMed

    Citro, Rodolfo; Bossone, Eduardo; Patella, Marco Mariano; Provenza, Gennaro; Luongo, Francesco; Galasso, Luigi; Meucci, Eugenio; Gregorio, Giovanni; Masip, Arturo Evangelista

    2007-12-01

    Penetrating aortic ulcer (PAU) is defined as an ulcerating atherosclerotic lesion that disrupts the aortic wall layers, penetrating the internal elastic lamina. The natural history of the disease and the preferred treatment are still debated. We report a case of painless PAU in a 78-year-old man detected by transesophageal echocardiography at the level of proximal descending aorta as an incidental finding. The patient underwent endovascular stent-graft placement without any complications at early and late follow-up.

  9. Transesophageal echo diagnosis of perioperative unusual transient left ventricular apical ballooning syndrome

    PubMed Central

    Mantilla, Hugo Andrés; Montes, Felix Ramón; Amaya, William F.

    2016-01-01

    Stress cardiomyopathy, or Takotsubo syndrome, is a widely recognized cardiac pathology with a clinical presentation similar to acute coronary syndrome and related to physical or emotional stress. Perioperatively, it is challenging to identify it given the variety of forms and scenarios in which it can present. We describe a 22-year-old patient with an atypical presentation of Takotsubo syndrome during anesthesia induction, which highlights the usefulness of transesophageal echocardiography for the initial diagnosis. PMID:27716708

  10. Multiplane transesophageal echocardiography in the diagnosis of congenital coronary artery fistula.

    PubMed

    Lin, F C; Chang, H J; Chern, M S; Wen, M S; Yeh, S J; Wu, D

    1995-12-01

    The purpose of this study was to examine the advantages of multiplane transesophageal echocardiography in the diagnosis of congenital coronary artery fistula, specifically in depicting the origin, the course, and the drainage site. Seven consecutive patients ranging in age from 20 to 72 years with a suspected coronary artery fistula underwent conventional transthoracic and multiplane transesophageal echocardiographic studies between March 1993 and July 1994. When a coronary artery fistula was noted, the origin, the course, and the drainage site were carefully searched for. All patients then underwent a cardiac catheterization with the performance of coronary angiography. A large right coronary artery fistula was detected in three patients; one of them had a drainage to the posterior left ventricle, one to the lateral right ventricle, and the other to the medial aspect of the right ventricle just below the insertion of the septal leaflet of the tricuspid valve. A small coronary artery fistula arising from the left coronary artery was noted in four patients, two from the left anterior descending artery and the other two from the left circumflex artery. Three of these four patients had a drainage to the main pulmonary artery and one to the left ventricle. The drainage site was clearly depicted in all seven patients, whereas the origin and the course were precisely defined in five patients by using multiplane transesophageal echocardiographic examination. The multiplane transesophageal echocardiography provides a panoramic view of the coronary artery and the fistulous vessel with a precise definition of the origin, the course, and the drainage site of the fistula. Therefore it is the noninvasive diagnostic mode of choice. PMID:7484775

  11. Usefulness of multiplane transesophageal echocardiography to improve the assessment of severity of mitral regurgitation.

    PubMed

    Pieper, E P; Hamer, H P; Sluijs, R A; Ravelli, A C; Tijssen, J G; Crijns, H J; Lie, K I; Visser, C A

    1996-11-15

    This study was designed to examine the accuracy of multiplane transesophageal echocardiography (TEE) color Doppler measurements in comparison to monoplane or biplane measurements in estimating the severity of mitral regurgitation (MR). Multiplane TEE potentially increases diagnostic accuracy of transesophageal examinations; it is unknown if multiplane is more accurate in assessing the severity of MR than monoplane or biplane TEE. Left ventricular cineangiograms of 91 patients with MR (40 no or mild, 30 moderate, and 21 severe) were compared with systolic pulmonary venous flow reversal and transesophageal color Doppler measurements: jet area and length in the transverse and longitudinal plane, maximal and average of those 2 planes (biplane), and maximal and average of 11 different planes (multiplane). Flow reversal (16 patients) identified severe MR with a specificity of 96% and a sensitivity of 62%; these were 96% and only 10% to 43%, respectively, for color Doppler measurements. In the absence of flow reversal, multiplane maximal jet area predicted severe MR with a sensitivity of 88% and a specificity of 75%, which were 85% and 76%, respectively, for no or mild MR; this did not differ significantly from results obtained by monoplane or biplane measurements. Color Doppler measurements of eccentric jets were not reliable for identification of severe MR. Systolic pulmonary venous flow reversal identifies 2 of 3 patients with severe MR with a high accuracy. In patients without flow reversal, multiplane color Doppler TEE is very capable of assessing MR severity, but biplane and monoplane TEE are equally accurate.

  12. Innovative therapies: intraoperative intracavitary chemotherapy.

    PubMed

    Chang, Michael Y; Sugarbaker, David J

    2004-11-01

    Both phase I studies demonstrated that high-dose cisplatin can be delivered safely with acceptable complication rates. The maximum tolerated doses of 225 mg/m2 and 250 mg/m2 cisplatin, respectively, are higher than any other published report of intrapleural cisplatin. The intrapleural cisplatin doses reported in other trials have been 80 mg/m2, 100 mg/m2, and 200 mg/m2. Despite the use of high-dose intraoperative chemotherapy, the group of 50 patients who underwent EPP experienced mortality and morbidity comparable to the contemporaneous group of 41 patients who did not participate in the protocol, except for increased rates of deep venous thrombosis and diaphragmatic patch failure. The 44 patients who underwent P/D experienced a slightly higher mortality rate and creatinine toxicity rate than the first phase I trial. Given the demographics of this patient cohort (higher age, lower FEV1, and inability to withstand pneumonectomy because of limited cardiopulmonary reserve), however, the mortality and morbidity rates seem acceptable. The pharmacologic data from both studies support our hypothesis that high regional doses of cisplatin can be delivered with less systemic absorption than can be achieved with intravenous administration (data not shown). With the maximum tolerated dose of intracavitary cisplatin and safety of intraoperative administration after surgical resection firmly established by these phase I trials, we are prepared to implement phase II and III studies of EPP and P/D with intraoperative cisplatin lavage. We aim to monitor tumor recurrence and patient survival prospectively and compare these results with historic controls. We also intend to document prospectively the morbidity and mortality of the treatment protocols. Finally, we plan to evaluate the pharmacokinetics of cisplatin by measuring tissue and perfusate levels of active and inactive cisplatin. By approaching the problem of local recurrence after resection of MPM in a careful and methodical

  13. Intraoperative OCT in Surgical Oncology

    NASA Astrophysics Data System (ADS)

    South, Fredrick A.; Marjanovic, Marina; Boppart, Stephen A.

    The global incidence of cancer is rising, putting an increasingly heavy burden upon health care. The need to effectively detect and treat cancer is one of the most significant problems faced in health care today. Effective cancer treatment typically depends upon early detection and, for most solid tumors, successful removal of the cancerous tumor tissue via surgical procedures. Difficulties arise when attempting to differentiate between normal and tumor tissue during surgery. Unaided visual examination of the tissue provides only superficial, low-resolution information and often with little visual contrast. Many imaging modalities widely used for cancer screening and diagnostics are of limited use in the operating room due to low spatial resolution. OCT provides cellular resolution allowing for more precise localization of the tumor tissue. It is also relatively inexpensive and highly portable, making it well suited for intraoperative applications.

  14. Intraoperative radiotherapy for breast cancer

    PubMed Central

    Williams, Norman R.; Pigott, Katharine H.; Brew-Graves, Chris

    2014-01-01

    Intra-operative radiotherapy (IORT) as a treatment for breast cancer is a relatively new technique that is designed to be a replacement for whole breast external beam radiotherapy (EBRT) in selected women suitable for breast-conserving therapy. This article reviews twelve reasons for the use of the technique, with a particular emphasis on targeted intra-operative radiotherapy (TARGIT) which uses X-rays generated from a portable device within the operating theatre immediately after the breast tumour (and surrounding margin of healthy tissue) has been removed. The delivery of a single fraction of radiotherapy directly to the tumour bed at the time of surgery, with the capability of adding EBRT at a later date if required (risk-adaptive technique) is discussed in light of recent results from a large multinational randomised controlled trial comparing TARGIT with EBRT. The technique avoids irradiation of normal tissues such as skin, heart, lungs, ribs and spine, and has been shown to improve cosmetic outcome when compared with EBRT. Beneficial aspects to both institutional and societal economics are discussed, together with evidence demonstrating excellent patient satisfaction and quality of life. There is a discussion of the published evidence regarding the use of IORT twice in the same breast (for new primary cancers) and in patients who would never be considered for EBRT because of their special circumstances (such as the frail, the elderly, or those with collagen vascular disease). Finally, there is a discussion of the role of the TARGIT Academy in developing and sustaining high standards in the use of the technique. PMID:25083504

  15. Intraoperative radiotherapy: the Japanese experience. [Betatron

    SciTech Connect

    Abe, M.; Takahashi, M.

    1981-07-01

    Clinical results of intraoperative radiotherapy (IOR) which have been obtained since 1964 in Japan were reviewed. In this radiotherapy a cancerocidal dose can be delivered safely to the lesions, since critical organs are shifted from the field so that the lesions may be exposed directly to radiation. Intraoperative radiotherapy has spread in Japan and the number of institutions in which this radiotherapy is performed has continued to increase to a total of 26 in 1979. The total number of patients treated was 717. It has been demonstrated that intraoperative radiotherapy has definite effects on locally advanced abdominal neoplasms and unresectable radioresistant tumors.

  16. [Morpho-Functional Changes of Thoracic Aorta in Atherosclerosis: Multiplane Transesophageal Ultrasound Study

    PubMed

    Vrublevskiĭ, A. V.; Boshchenko, A. A.; Karpov, R. S.

    2001-01-01

    AIM: To elucidate possibilities of multiplane transesophageal ultrasound for assessment of localization and structure of atherosclerotic plaques in the thoracic aorta as well as relationship between changes of elastic-tonic properties, processes of aortic wall remodeling, stage of aortic atheromatosis, and coronary atherosclerosis. MATERIAL: Patients with chronic ischemic heart disease and atherosclerosis of thoracic aorta (n=120), healthy volunteers (n=11, all men, mean age 51-/+8 years). METHODS: Multiplane transesophageal ultrasound with subsequent calculation of parameters of elasticity and stiffness. The classification of C. Pitsavos et al. (1997) was used for grading aortic atheromatosis. RESULTS. Atherosclerotic plaques were found in 109 patients (91%) and 69 patients (58%) had pronounced (stage 3-5) atheromatosis of thoracic aorta. The plaques were most frequently (87%) localized in descending aorta. Calcinated hyperdense plaques, soft plaques with low density, soft plaques with heterogeneous density prevailed in ascending aorta, aortic arch, and descending aorta, respectively. Sensitivity and specificity of thoracic atherosclerosis as predictor of atherosclerotic lesions in coronary vessels were 90 and 65%, respectively. Pronounced diffuse atherosclerosis of thoracic aorta decreased its elastic-tonic properties as evidenced by significant lowering of parameters of elasticity and increase of stiffness index. This process was associated with remodeling of thoracic aorta (progressive passive dilatation, thickening of its wall and lowering of amplitude of systolic excursion). Atheromatosis stage correlated inversely with systolic excursion and parameters of elasticity and directly with stiffness index, intima-media thickness, systolic and diastolic diameters of the aorta. There was also a direct correlation between stage of aortic atheromatosis and age and total score of coronary artery involvement. CONCLUSION: Multiplane transesophageal echocardiography is a

  17. Characteristics of Patent Foramen Ovale Associated with Cryptogenic Stroke: A Biplane Transesophageal Echocardiography Study

    NASA Technical Reports Server (NTRS)

    Homma, S.; DiTullio, M. R.; Sacco, R. L.; Mihalatos, D..; LiMandri, G.; Mohr, J. P.

    1994-01-01

    Patent foramen ovale is associated with ischemic stroke in patients without a clearly identifiable etiology for stroke (cryptogenic stroke). Paradoxical embolization is thought to be a potential mechanism. However, patent foramen ovale is also found in patients with known cause of stroke. Therefore, using contrast transesophageal echocardiography, we characterized the patent foramen ovale in cryptogenic stroke patients to assess morphological factors that may contribute to paradoxical embolization. Methods: Contrast transesophageal echocardiographic studies of 74 consecutive patients referred for ischemic stroke were reviewed. Twenty-three patients with patent foramen ovale were identified. These patients were classified as having strokes of determined origin or cryptogenic strokes according to criteria developed for the Stroke Data Bank of the National Institute of Neurological Disorders and Stroke. Separation of septum primum from secundum and the number of microbubbles appearing in left atrium were then quantitated. These parameters were compared between patients with cryptogenic stroke and those with known cause of stroke. Results: The patent foramen ovale dimension was significantly larger in patients with cryptogenic stroke compared with patients with an identifiable cause of stroke (2.1+/-1.7 mm versus 057+/-0.78 mm [mean+/-SD]; P<.01). The number of microbubbles was also greater in patients with cryptogenic stroke compared with patients with an identifiable cause of stroke (13.9+/-10.7 versus 1.62+/-0.8 [mean+/-SD]; P<.0005). Conclusions: Patients with cryptogenic stroke have larger patent foramen ovale with more extensive right-to-left inter-atrial shunting than patients with stroke of determined cause. Transesophageal echocardiographically identifiable characteristics of patent foramen ovale may be important in defining the clinical significance of individual patent foramina.

  18. The flail mitral valve: echocardiographic findings by precordial and transesophageal imaging and Doppler color flow mapping.

    PubMed

    Himelman, R B; Kusumoto, F; Oken, K; Lee, E; Cahalan, M K; Shah, P M; Schiller, N B

    1991-01-01

    To determine the echocardiographic and Doppler characteristics of mitral regurgitation associated with a flail mitral valve, precordial and transesophageal echocardiography with pulsed wave and Doppler color flow mapping was performed in 17 patients with a flail mitral valve leaflet due to ruptured chordae tendineae (Group I) and 22 patients with moderate or severe mitral regurgitation due to other causes (Group II). Echocardiograms were performed before or during cardiac surgery; cardiac catheterization was also performed in 28 patients (72%). Mitral valve disease was confirmed at cardiac surgery in all patients. By echocardiography, the presence of a flail mitral valve leaflet was defined by the presence of abnormal mitral leaflet coaptation or ruptured chordae. Using these criteria, transesophageal imaging showed a trend toward greater sensitivity and specificity than precordial imaging in the diagnosis of flail mitral valve leaflet. By Doppler color flow mapping, a flail mitral valve leaflet was also characterized by an eccentric, peripheral, circular mitral regurgitant jet that closely adhered to the walls of the left atrium. The direction of flow of the eccentric jet in the left atrium distinguished a flail anterior from a flail posterior leaflet. By transesophageal echocardiography with Doppler color flow mapping, the ratio of mitral regurgitant jet arc length to radius of curvature was significantly higher in Group I than Group II patients (5.0 +/- 2.3 versus 0.7 +/- 0.6, p less than 0.001); all of the Group I patients and none of the Group II patients had a ratio greater than 2.5.(ABSTRACT TRUNCATED AT 250 WORDS)

  19. In Vivo Evaluations of a Phased Ultrasound Array for Transesophageal Cardiac Ablation

    NASA Astrophysics Data System (ADS)

    Jaiswal, Devina; Werner, Jacob; Park, Eun-Joo; Francischelli, David; Smith, Nadine Barrie

    2010-03-01

    Atrial fibrillation is one of the most common arrhythmias that affects over 2.2 million Americans each year. Catheter ablation, one of the effective treatments, has shown high rate of success in treating paroxysmal atrial fibrillation. Currently, radiofrequency which is being used for catheter ablation is an invasive procedure. Measurable morbidity and significant costs and time are associated with this modality of treatment of permanent or persistent atrial fibrillation. In order to address these issues, a transesophageal ultrasound applicator for noninvasive cardiac ablation was designed, developed and evaluated. The ultrasound energy delivered by the phased array was used to create a lesion in the myocardial tissue. Various factors, simulation results of transducer arrays, current transesophageal medical devices, and throat anatomy, were considered while designing a phased ultrasound transducer that can be inserted into the esophagus. For this research, a two-dimensional sparse phased array with flat tapered elements was fabricated and evaluated in in vivo experiments. Five pigs were anesthetized; the array was passed transesophagealy and positioned over the heart. An operating frequency of 1.6 MHz and 8˜15 minutes of array operation resulted in both single and multiple lesions on atrial and ventricular myocardium. The average size of lesions was 5.1±2.1 mm in diameter and 7.8±2.5 mm in length. Experimental results indicate that the array delivered sufficient power to produce ablation at the focal point while not grossly damaging the tissue surrounding the area of interest. These results demonstrate a potential application of the ultrasound applicator for noninvasive transesophageal cardiac surgery in atrial fibrillation treatment.

  20. Intraoperative Anaphylactic Reaction: Is it the Floseal?

    PubMed Central

    Martin, David; Schloss, Brian; Beebe, Allan; Samora, Walter; Klamar, Jan; Stukus, David; Tobias, Joseph D.

    2016-01-01

    When hemodynamic or respiratory instability occurs intraoperatively, the inciting event must be determined so that a therapeutic plan can be provided to ensure patient safety. Although generally uncommon, one cause of cardiorespiratory instability is anaphylactic reactions. During anesthetic care, these most commonly involve neuromuscular blocking agents, antibiotics, or latex. Floseal is a topical hemostatic agent that is frequently used during orthopedic surgical procedures to augment local coagulation function and limit intraoperative blood loss. As these products are derived from human thrombin, animal collagen, and animal gelatin, allergic phenomenon may occur following their administration. We present 2 pediatric patients undergoing posterior spinal fusion who developed intraoperative hemodynamic and respiratory instability following use of the topical hemostatic agent, Floseal. Previous reports of such reactions are reviewed, and the perioperative care of patients with intraoperative anaphylaxis is discussed. PMID:27713677

  1. Efficacy of intraoperative neurophysiological monitoring.

    PubMed

    Fisher, R S; Raudzens, P; Nunemacher, M

    1995-01-01

    Intraoperative neurophysiological monitoring is of benefit in protecting tissue at risk for trauma or ischemia during surgical procedures. Monitoring modalities include EEG, computer processed EEG, somatosensory (SEP), auditory (BAEP), and visual evoked potentials (VEP), and cranial nerve monitoring. The efficacy of monitoring is controversial, because no properly controlled prospective study of outcome with and without monitoring has been done. The weight of evidence suggests that loss of spontaneous EEG and SEP correlate well with critical reductions of cerebral blood flow. Meta-analysis of series comprising 3,028 patients undergoing carotid endarterectomies shows that SEP deteriorated in 5.6% of cases, with 20% of these having postoperative deficits, but more might have had deficits if they had not been shunted. SEP monitoring can be useful in surgery affecting brain and cord vasculature. Monitoring is not indicated for routine lumbosacral spine surgery. BAEPs have predictive value for preservation of hearing after acoustic neuroma surgery, and other surgery near the brainstem. VEPs have been too variable to be of major use in the operating room. For neurophysiologic monitoring to be useful, it must be performed by an experienced team, and the surgeon must be willing to act on the findings. Under these circumstances, monitoring can reduce surgical complications in selected cases.

  2. Virtual intraoperative surgical photoacoustic microscopy

    NASA Astrophysics Data System (ADS)

    Lee, Changho; Lee, Donghyun; Zhou, Qifa; Kim, Jeehyun; Kim, Chulhong

    2015-07-01

    A virtual intraoperative surgical photoacoustic microscopy at 1064 nm wavelength (VISPAM) system was designed and fabricated by integrating a commercial type surgical microscope and laser scanning photoacoustic microscopy (PAM) with a 1064 nm pulsed laser. Based on simple augmented reality device, VISPAM could simultaneously provide 2D depth-resolved photoacoustic and magnified microscope images of surgery regions on the same vision of surgeon via an eyepiece of the microscope. The invisible 1064 nm laser removed the interruption of surgical sight due to visible laser scanning of previous report, and decreased the danger of tissue damage caused by over irradiated laser. In addition, to approach the real practical surgery application, a needle-type transducer was utilized without a water bath for PA signal coupling. In order to verify our system's performance, we conducted needle guiding as ex vivo phantom study and needle guiding and injection of carbon particles mixtures into a melanoma tumor region as in vivo study. We expect that VISPAM can be essential tool of brain and ophthalmic microsurgery.

  3. The Effect of Perioperative Rescue Transesophageal Echocardiography on the Management of Trauma Patients.

    PubMed

    Griffee, Matthew J; Singleton, Andrew; Zimmerman, Joshua M; Morgan, David E; Nirula, Raminder

    2016-06-15

    To evaluate the effect of rescue transesophageal echocardiography (TEE) on the management of trauma patients, we reviewed imaging and charts of unstable trauma patients at a level I trauma center. Critical rescue TEE findings included acute right ventricular failure, stress cardiomyopathy, type B aortic dissection, mediastinal air, and dynamic left ventricular outflow tract obstruction. Left ventricular filling was classified as low (underfilled) in 57% of all cases. Rescue TEE revealed a variety of new diagnoses and led to a change in resuscitation strategy about half of the time. PMID:27301053

  4. Refractory intraoperative hypotension with elevated serum tryptase

    PubMed Central

    Larson, Kelly J.; Divekar, Rohit D.; Butterfield, Joseph H.; Schwartz, Lawrence B.; Weingarten, Toby N.

    2015-01-01

    Severe intraoperative hypotension has been reported in patients on angiotensin-converting enzyme inhibitors and angiotensin II receptor subtype 1 antagonists. We describe a patient on lisinopril who developed refractory intraoperative hypotension associated with increased serum tryptase level suggesting mast cell activation (allergic reaction). However, allergology workup ruled out an allergic etiology as well as mastocytosis, and hypotension recalcitrant to treatment was attributed to uninterrupted lisinopril therapy. Elevated serum tryptase was attributed to our patient's chronic renal insufficiency. PMID:25653920

  5. Anesthesia for intraoperative radiation therapy in children

    SciTech Connect

    Friesen, R.H.; Morrison, J.E. Jr.; Verbrugge, J.J.; Daniel, W.E.; Aarestad, N.O.; Burrington, J.D.

    1987-06-01

    Intraoperative radiation therapy (IORT) is a relatively new mode of cancer treatment which is being used with increasing frequency. IORT presents several challenges to the anesthesiologist, including patients who are debilitated from their disease or chemotherapy, operations involving major tumor resections, intraoperative interdepartmental transport of patients, and remote monitoring of patients during electron beam therapy. This report discusses the anesthetic management of ten children undergoing IORT. With adequate preparation and interdepartmental communication, complications can be avoided during these challenging cases.

  6. [Intraoperative monitoring of visual evoked potentials].

    PubMed

    Sasaki, Tatsuya; Ichikawa, Tsuyoshi; Sakuma, Jun; Suzuki, Kyouichi; Matsumoto, Masato; Itakura, Takeshi; Kodama, Namio; Murakawa, Masahiro

    2006-03-01

    Our success rate of intraoperative monitoring of visual evoked potential (VEP) had been approximately 30% in the past. In order to improve recording rate of intraoperative VEP, we developed a new stimulating device using high power light emitting diodes. Electroretinogram was simultaneously recorded to understand whether flash stimulation reached the retina. In addition, total venous anesthesia with propofol was used to avoid the adverse effect of inhalation anesthesia. We report the results after introduction of these improvements. Intraoperative monitoring of VEP was attempted in 35 cases. We evaluated success rate of VEP recording, correlation between VEP findings and postoperative visual function, and reasons why recording was not successful. Stable and reproducible waveforms were obtained in 59 sides (84%). Two cases, whose VEP deteriorated intraoperatively, developed postoperative visual disturbance: In 11 sides (16%), stable waveforms were not obtained. There were two main causes. In 8 sides out of 11, the cause was attributed to pre-existing severe visual disturbance. In these 8 sides, VEP in the awake state was not recordable or was recordable, but with very low amplitudes under 1 microV. In the other 3 sides, the cause was attributed to movement of a stimulating device by reflecting the fronto-temporal scalp flap. In conclusion, the successful recording rate was increased to 84% from approximately 30%, after introduction of various trials. We need further improvement in recording intraoperative VEP to establish a reliable intraoperative monitoring method for VEP.

  7. Simulation of intraoperative visualization of cardiac structures and study of dynamic surgical anatomy with real-time three-dimensional echocardiography.

    PubMed

    Schwartz, S L; Cao, Q L; Azevedo, J; Pandian, N G

    1994-03-01

    Most prior efforts of 3-dimensional (3-D) reconstruction of echocardiographic images have focused on quantitation of ventricular size and function. The resulting images have been displayed in the wire mesh format. Recently, a method for 3-D transesophageal echocardiography using a computer-controlled probe that acquires parallel tomographic slices has been described. This technique provides dynamic 3-D volume-rendered images of the heart. This study was designed to determine if surgical visualization of intracardiac anatomy could be simulated using this imaging system. Data acquired from 8 patients with congenital and acquired heart disease were analyzed. Real-time 3-D images of the cardiac chambers and valves were obtained. Images of the cardiac pathology including fibrocalcific nodules on the aortic valve, mitral valve endocarditis, rheumatic mitral stenosis, and an ostium secundum atrial septal defect were displayed in 3 dimensions that simulated surgical exposure of these structures. These 3-D representations of cardiac anatomy were in some ways superior to standard intraoperative visualization in that they demonstrated the heart as a dynamic structure, as opposed to the empty, nonbeating heart observed while on cardiopulmonary bypass. In conclusion, 3-D images of cardiac structures as seen by the surgeon intraoperatively can be provided using a computer-driven tomographic transesophageal echocardiographic probe. This imaging system can be potentially useful in the planning and evaluation of cardiac surgery. Technical improvements such as 3-D representation of flow jets, the ability to manipulate images to simulate cardiac surgery, and on-line reconstruction can make this a powerful tool in the future.

  8. [Intraoperative crisis and surgical Apgar score].

    PubMed

    Oshiro, Masakatsu; Sugahara, Kazuhiro

    2014-03-01

    Intraoperative crisis is an inevitable event to anesthesiologists. The crisis requires effective and coordinated management once it happened but it is difficult to manage the crises properly under extreme stressful situation. Recently, it is reported that the use of surgical crisis checklists is associated with significant improvement in the management of operating-room crises in a high-fidelity simulation study. Careful preoperative evaluation, proper intraoperative management and using intraoperative crisis checklists will be needed for safer perioperative care in the future. Postoperative complication is a serious public health problem. It reduces the quality of life of patients and raises medical cost. Careful management of surgical patients is required according to their postoperative condition for preventing postoperative complications. A 10-point surgical Apgar score, calculated from intraoperative estimated blood loss, lowest mean arterial pressure, and lowest heart rate, is a simple and available scoring system for predicting postoperative complications. It undoubtedly predicts higher than average risk of postoperative complications and death within 30 days of surgery. Surgical Apgar score is a bridge between proper intraoperative and postoperative care. Anesthesiologists should make effort to reduce the postoperative complication and this score is a tool for it.

  9. Intraoperative cerebral blood flow imaging of rodents

    NASA Astrophysics Data System (ADS)

    Li, Hangdao; Li, Yao; Yuan, Lu; Wu, Caihong; Lu, Hongyang; Tong, Shanbao

    2014-09-01

    Intraoperative monitoring of cerebral blood flow (CBF) is of interest to neuroscience researchers, which offers the assessment of hemodynamic responses throughout the process of neurosurgery and provides an early biomarker for surgical guidance. However, intraoperative CBF imaging has been challenging due to animal's motion and position change during the surgery. In this paper, we presented a design of an operation bench integrated with laser speckle contrast imager which enables monitoring of the CBF intraoperatively. With a specially designed stereotaxic frame and imager, we were able to monitor the CBF changes in both hemispheres during the rodent surgery. The rotatable design of the operation plate and implementation of online image registration allow the technician to move the animal without disturbing the CBF imaging during surgery. The performance of the system was tested by middle cerebral artery occlusion model of rats.

  10. Near-Infrared Intraoperative Chemiluminescence Imaging.

    PubMed

    Büchel, Gabriel E; Carney, Brandon; Shaffer, Travis M; Tang, Jun; Austin, Christine; Arora, Manish; Zeglis, Brian M; Grimm, Jan; Eppinger, Jörg; Reiner, Thomas

    2016-09-20

    Intraoperative imaging technologies recently entered the operating room, and their implementation is revolutionizing how physicians plan, monitor, and perform surgical interventions. In this work, we present a novel surgical imaging reporter system: intraoperative chemiluminescence imaging (ICI). To this end, we have leveraged the ability of a chemiluminescent metal complex to generate near-infrared light upon exposure to an aqueous solution of Ce(4+) in the presence of reducing tissue or blood components. An optical camera spatially resolves the resulting photon flux. We describe the construction and application of a prototype imaging setup, which achieves a detection limit as low as 6.9 pmol cm(-2) of the transition-metal-based ICI agent. As a proof of concept, we use ICI for the in vivo detection of our transition metal tracer following both systemic and subdermal injections. The very high signal-to-noise ratios make ICI an interesting candidate for the development of new intraoperative imaging technologies.

  11. [Intraoperative injuries of the biliary tract].

    PubMed

    Burcoveanu, C; Munteanu, Iulia; Stefan, S; Bulat, C; Pădureanu, S

    2008-01-01

    Statistically speaking, the intraoperative lesions of common bile duct are rare clinical cases, but they have a high gravity potential. Our study was made on a lot of 11 operated pacients during 1995-2007 in our Clinic and it shows the tactical and technical approach used in solving these complications. The study also shows the high level of difficulty of these cases, as immediate recognition of this type of intraoperative lesions is needed. The successful evolution of these cases depends on how quickly the lesions are found and solved. PMID:20201251

  12. [Analysis of mediastinal lymphadenopathy in sarcoidosis with transesophageal ultrasonic endoscopy; influences on cardiovascular system].

    PubMed

    Dambara, T; Ueki, J; Aiba, M; Tamaki, S; Saito, H; Matsuda, K; Nukiwa, T; Kira, S

    1989-01-01

    We studied influences of mediastinal lymphadenopathy on cardiovascular system in nine cases of sarcoidosis with transesophageal ultrasonic endoscopy. Chest x-ray films revealed bilateral hilar lymphadenopathy in all cases, whose diagnoses were made histologically with biopsies of peripheral lung through flexible fiber optic bronchoscope and/or of lymph nodes. These findings were typical in this disease. Many compartments of cardiovascular system in mediastinal and hilar regions were visible with this technique in all subjects. And enlarged lymph nodes changed dimensions in these compartments, especially in main pulmonary arteries, left atria, pulmonary veins and aorta. Furthermore, these phenomena were seen in azygos vein and superior caval vein in some cases. It is suggested that these lymph nodes may influence hemodynamics in above-mentioned compartments of cardiovascular system, if this phenomenon deteriorates more progressively. PMID:2657139

  13. In-vivo continuous monitoring of mixed venous oxygen saturation by photoacoustic transesophageal echocardiography (Conference Presentation)

    NASA Astrophysics Data System (ADS)

    Li, Li; Subramaniam, Balachundhar; Aguirre, Aaron D.; Andrawes, Michael N.; Tearney, Guillermo J.

    2016-02-01

    Mixed venous oxygen saturation (SvO2), measured from pulmonary arteries, is a gold-standard measure of the dynamic balance between the oxygen supply and demand in the body. In critical care, continuous monitoring of SvO2 plays a vital role in early detection of circulatory shock and guiding goal-oriented resuscitation. In current clinical practice, SvO2 is measured by invasive pulmonary artery catheters (PAC), which are associated with a 10% risk of severe complications. To address the unmet clinical need for a non-invasive SvO2 monitor, we are developing a new technology termed photoacoustic transesophageal echocardiography (PA-TEE). PA-TEE integrates transesophageal echocardiography with photoacoustic oximetry, and enables continuous assessment of SvO2 through an esophageal probe that can be inserted into the body in a minimally invasive manner. We have constructed a clinically translatable PA-TEE prototype, which features a mobile OPO laser, a modified ultrasonography console and a dual-modality esophageal probe. Comprised of a rotatable acoustic array detector, a flexible optical fiber bundle and a light-integrating acoustic lens, the oximetric probe has an outer diameter smaller than 15 mm and will be tolerable for most patients. Through custom-made C++/Qt software, our device acquires and displays ultrasonic and photoacoustic images in real time to guide the deployment of the probe. SvO2 is calculated on-line and updated every second. PA-TEE has now been used to evaluate SvO2 in living swine. Our findings show that changing the fraction of oxygen in the inspired gas modulates SvO2 measured by PA-TEE. Statistic comparison between SvO2 measurements from PA-TEE in vivo the gold-standard laboratorial analysis on blood samples drawn from PACs will be presented.

  14. Efficacy of anticoagulation in resolving left atrial and left atrial appendage thrombi: A transesophageal echocardiographic study

    NASA Technical Reports Server (NTRS)

    Jaber, W. A.; Prior, D. L.; Thamilarasan, M.; Grimm, R. A.; Thomas, J. D.; Klein, A. L.; Asher, C. R.

    2000-01-01

    BACKGROUND: Transesophageal echocardiography (TEE) is the gold standard for evaluation of the left atrium and the left atrial appendage (LAA) for the presence of thrombi. Anticoagulation is conventionally used for patients with atrial fibrillation to prevent embolization of atrial thrombi. The mechanism of benefit and effectiveness of thrombi resolution with anticoagulation is not well defined. METHODS AND RESULTS: We used a TEE database of 9058 consecutive studies performed between January 1996 and November 1998 to identify all patients with thrombi reported in the left atrium and/or LAA. One hundred seventy-four patients with thrombi in the left atrial cavity (LAC) and LAA were identified (1.9% of transesophageal studies performed). The incidence of LAA thrombi was 6.6 times higher than LAC thrombi (151 vs 23, respectively). Almost all LAC thrombi were visualized on transthoracic echocardiography (90.5%). Mitral valve pathology was associated with LAC location of thrombi (P <.0001), whereas atrial fibrillation or flutter was present in most patients with LAA location of thrombi. Anticoagulation of 47 +/- 18 days was associated with thrombus resolution in 80.1% of the patients on follow-up TEE. Further anticoagulation resulted in limited additional benefit. CONCLUSIONS: LAC thrombi are rare and are usually associated with mitral valve pathology. Transthoracic echocardiography is effective in identifying these thrombi. LAA thrombi occur predominantly in patients with atrial fibrillation or flutter. Short-term anticoagulation achieves a high rate of resolution of LAA and LAC thrombi but does not obviate the need for follow-up TEE.

  15. Rapid Intraoperative Molecular Characterization of Glioma

    PubMed Central

    Shankar, Ganesh M.; Francis, Joshua M.; Rinne, Mikael L.; Ramkissoon, Shakti H.; Huang, Franklin W.; Venteicher, Andrew S.; Akama-Garren, Elliot H.; Kang, Yun Jee; Lelic, Nina; Kim, James C.; Brown, Loreal E.; Charbonneau, Sarah K.; Golby, Alexandra J.; Pedamallu, Chandra Sekhar; Hoang, Mai P.; Sullivan, Ryan J.; Cherniack, Andrew D.; Garraway, Levi A.; Stemmer-Rachamimov, Anat; Reardon, David A.; Wen, Patrick Y.; Brastianos, Priscilla K.; Curry, William T.; Barker, Fred G.; Hahn, William C.; Nahed, Brian V.; Ligon, Keith L.; Louis, David N.; Cahill, Daniel P.; Meyerson, Matthew

    2016-01-01

    IMPORTANCE Conclusive intraoperative pathologic confirmation of diffuse infiltrative glioma guides the decision to pursue definitive neurosurgical resection. Establishing the intraoperative diagnosis by histologic analysis can be difficult in low-cellularity infiltrative gliomas. Therefore, we developed a rapid and sensitive genotyping assay to detect somatic single-nucleotide variants in the telomerase reverse transcriptase (TERT) promoter and isocitrate dehydrogenase 1 (IDH1). OBSERVATIONS This assay was applied to tissue samples from 190 patients with diffuse gliomas, including archived fixed and frozen specimens and tissue obtained intraoperatively. Results demonstrated 96% sensitivity (95% CI, 90%–99%) and 100% specificity (95% CI, 95%–100%) for World Health Organization grades II and III gliomas. In a series of live cases, glioma-defining mutations could be identified within 60 minutes, which could facilitate the diagnosis in an intraoperative timeframe. CONCLUSIONS AND RELEVANCE The genotyping method described herein can establish the diagnosis of low-cellularity tumors like glioma and could be adapted to the point-of-care diagnosis of other lesions that are similarly defined by highly recurrent somatic mutations. PMID:26181761

  16. Intraoperative monitoring of Jones tube function.

    PubMed

    Kartchner, M J; Mather, T R; Dryden, R M

    1989-01-01

    If intraoperative visualization is impossible when placing a secondary Jones tube, the presence of tube drainage may confirm correct intranasal positioning. A simple suction method is presented to evaluate the intranasal position of the Jones tube in the anesthetized or uncooperative patient.

  17. Avoiding and Managing Intraoperative Complications During Cervical Spine Surgery.

    PubMed

    Bible, Jesse; Rihn, Jeffrey A; Lim, Moe R; Brodke, Darrel S; Lee, Joon Y

    2016-01-01

    The incidence of intraoperative complications during cervical spine surgery is low; however, if they do occur, intraoperative complications have the potential to cause considerable morbidity and mortality. Spine surgeons should be familiar with methods to minimize intraoperative complications. If they do occur, surgeons must be prepared to immediately treat each potential complication to reduce any associated morbidity. PMID:27049196

  18. Transesophageal 3-dimensional echocardiography: in vivo determination of left ventricular mass in comparison with magnetic resonance imaging.

    PubMed

    Kühl, H P; Bücker, A; Franke, A; Maul, S; Nolte-Ernsting, C; Reineke, T; Hoffmann, R; Günther, R W; Hanrath, P

    2000-03-01

    The objective of this study was to assess the accuracy and reproducibility of transesophageal 3-dimensional echocardiography (3DE) in comparison with magnetic resonance imaging (MRI) for the in vivo calculation of left ventricular mass (LVM). In addition, mass values obtained by M-mode echocardiography were compared with those calculated by MRI. Three-dimensional reconstruction of the left ventricle was performed from a transesophageal and transgastric transducer position with a multiplane transducer in 20 patients. Left ventricular mass was calculated from both transducer positions by using slices of various thicknesses, ranging from 5 to 20 mm. Reproducibility was determined by 5 repeated measurements of mass in each of 5 randomly selected left ventricles. M-mode echocardiography was performed according to the method described by Devereux. For MRI, multiple short-axis views with 10-mm slice thickness were acquired in inspiration hold. Correlation was high for mass determined by 3DE and MRI (for 10-mm slice thickness: r = 0.99; y = 0.99 x - 0.7 g; standard error of estimate = 8.5 g; P <.001). There was no statistical bias, and the limits of agreement ranged from +/-16.4 g to +/-27.2 g, depending on the slice thickness. Variability was lowest for a slice thickness of 10 mm (SD +/- 8.2 g). The reproducibility of mass determination was excellent (mean width of the 95% CI 12.8 g). Left ventricular mass values calculated from the transgastric and transesophageal transducer position were not different from each other (mean bias 0.6 +/- 9.1 g; P = ns). M-mode-based LVM calculations showed systematic overestimation and large measurement variability (bias 23.7 g; 95% CI +/- 92.8 g). Compared with MRI, transesophageal 3DE is an accurate and reproducible method for the determination of LVM and clearly superior to M-mode echocardiography. PMID:10708469

  19. Diagnostic accuracy of transthoracic and multiplane transesophageal echocardiography for valvular perforation in acute infective endocarditis: correlation with anatomic findings.

    PubMed

    De Castro, S; Cartoni, D; d'Amati, G; Beni, S; Yao, J; Fiorell, M; Gallo, P; Fedele, F; Pandian, N G

    2000-05-01

    We evaluated the diagnostic accuracy of transthoracic and multiplane transesophageal echocardiography (TTE and TEE, respectively) for assessing valvular perforation during active infective endocarditis by correlating the results of TTE and TEE with anatomic findings of 88 valves examined at surgery or autopsy. Compared with TEE, TTE has a low diagnostic sensitivity in the detection of this complication and, in the presence of hemodynamic instability, multiplane TEE should be performed directly.

  20. Value of repeated multiplane transesophageal echocardiography in a patient with mitral valve ring abscess and left ventricular pseudoaneurysm.

    PubMed

    Wisbar, A; Keim, M W; Momper, R; Eschenbruch, E M; Braun, B; Hust, M H

    2001-07-01

    Mitral valve ring abscess and ventricular pseudoaneurysm are rare complications of infective endocarditis. We describe the case of a 58-year-old man who was admitted to our hospital with sepsis caused by Staphylococcus aureus and in whom tricuspid and mitral valve endocarditis developed within 2 weeks. Despite widespread antibiotic therapy, the endocarditis proceeded to form a mitral valve ring abscess and a left ventricular pseudoaneurysm. The diagnosis was set by repeated multiplane transesophageal echocardiography and confirmed by heart surgery.

  1. Multiplane transesophageal echocardiography in diagnosis of anomalous origin of the left coronary artery from the pulmonary artery: a case report.

    PubMed

    Hsu, S Y; Lin, F C; Chang, H J; Yeh, S J; Wu, D

    1998-06-01

    Anomalous origin of the left coronary artery from the pulmonary artery in adults is difficult to identify reliably by transthoracic echocardiography (TTE). We describe a 32-year-old woman with this coronary anomaly mimicking a coronary artery fistula on conventional TTE study. This anomaly was suggested by multiplane transesophageal echocardiography (TEE) and subsequently confirmed by coronary angiography. Multiplane TEE thus may serve as a first-line diagnostic tool for detecting anomalous origin of coronary arteries.

  2. Role of transesophageal echocardiography in the clinical management of a patients with a giant coronary artery aneurysm.

    PubMed

    Wolford, D C; Jost, C M; Madu, E C; Walker, W; Ramanatian, K B

    1997-06-01

    Transthoracic echocardiography (TTE) has substantial limitations for the study of abnormalities of the coronary tree. Transesophageal echocardiography (TEE) allows a more complete examination of the coronary arteries, particularly the proximal segments. This report describes the use of TEE after cardiac catheterization in the clinical management of a patient with unstable angina. While angiography first showed the giant aneurysm of the left circumflex coronary artery. TEE, by revealing an active thrombus of the lumen, prompted an immediate surgical resolution.

  3. Intraoperative tracking of aortic valve plane

    PubMed Central

    Nguyen, Duc Long Hung; Garreau, Mireille; Auffret, Vincent; Le Breton, Hervé; Verhoye, Jean-Philippe; Haigron, Pascal

    2013-01-01

    The main objective of this work is to track the aortic valve plane in intra-operative fluoroscopic images in order to optimize and secure Transcatheter Aortic Valve Implantation (TAVI) procedure. This paper is focused on the issue of aortic valve calcifications tracking in fluoroscopic images. We propose a new method based on the Tracking-Learning-Detection approach, applied to the aortic valve calcifications in order to determine the position of the aortic valve plane in intra-operative TAVI images. This main contribution concerns the improvement of object detection by updating the recursive tracker in which all features are tracked jointly. The approach has been evaluated on four patient databases, providing an absolute mean displacement error less than 10 pixels ≈ 2mm). Its suitability for the TAVI procedure has been analyzed. PMID:24110703

  4. The Art of Intraoperative Glioma Identification

    PubMed Central

    Zhang, Zoe Z.; Shields, Lisa B. E.; Sun, David A.; Zhang, Yi Ping; Hunt, Matthew A.; Shields, Christopher B.

    2015-01-01

    A major dilemma in brain-tumor surgery is the identification of tumor boundaries to maximize tumor excision and minimize postoperative neurological damage. Gliomas, especially low-grade tumors, and normal brain have a similar color and texture, which poses a challenge to the neurosurgeon. Advances in glioma resection techniques combine the experience of the neurosurgeon and various advanced technologies. Intraoperative methods to delineate gliomas from normal tissue consist of (1) image-based navigation, (2) intraoperative sampling, (3) electrophysiological monitoring, and (4) enhanced visual tumor demarcation. The advantages and disadvantages of each technique are discussed. A combination of these methods is becoming widely accepted in routine glioma surgery. Gross total resection in conjunction with radiation, chemotherapy, or immune/gene therapy may increase the rates of cure in this devastating disease. PMID:26284196

  5. [The intraoperative colonic irrigation in emergency surgery].

    PubMed

    Kiss, L

    2001-01-01

    Bowel preparations is frequently impossible in various ante colonic diseases, such as left-sided colonic obstruction. The goal of intraoperative colonic irrigation is to obtain, during surgery, a bowel preparation offering the possibility of primary resection with immediate anastomosis, when preoperative bowel preparation has not been feasible. Technical aspects of intra-operative colonic irrigation are described. Indications for this methods are presented: left-sided obstructing carcinomas, diverticulitis, more rarely inflammatory stenosis or functional obstruction. The surgical management of left colonic emergencies has evolved in the past few decades. Recently, there has been increasing interest in resection with primary anastomosis in selected cases. The post operative mortality rate was 13 per cent. The incidence of clinical anastomotic leakage was 6.65 per cent. PMID:12731192

  6. Intraoperative ultrasound-assisted peripheral nerve surgery.

    PubMed

    Haldeman, Clayton L; Baggott, Christopher D; Hanna, Amgad S

    2015-09-01

    Historically, peripheral nerve surgery has relied on landmarks and fairly extensive dissection for localization of both normal and pathological anatomy. High-resolution ultrasonography is a radiation-free imaging modality that can be used to directly visualize peripheral nerves and their associated pathologies prior to making an incision. It therefore helps in localization of normal and pathological anatomy, which can minimize the need for extensive exposures. The authors found intraoperative ultrasound (US) to be most useful in the management of peripheral nerve tumors and neuromas of nerve branches that are particularly small or have a deep location. This study presents the use of intraoperative US in 5 cases in an effort to illustrate some of the applications of this useful surgical adjunct.

  7. Intraoperative identification of adrenal-renal fusion

    PubMed Central

    Boll, Griffin; Rattan, Rishi; Yilmaz, Osman; Tarnoff, Michael E

    2015-01-01

    Adrenal - renal fusion is a rare entity defined as incomplete encapsulation of the adrenal gland and kidney with histologically adjacent functional tissue. This report describes the first published intraoperative identification of this anomaly during laparoscopic adrenalectomy. The patient was a 59-year-old man with chronic hypertension refractory to multiple antihypertensives found to be caused by a right-sided aldosterone-producing adrenal adenoma in the setting of bilateral adrenal hyperplasia. During laparoscopic adrenalectomy, the normal avascular plane between the kidney and adrenal gland was absent. Pathologic evaluation confirmed adrenal - renal fusion without adrenal heterotopia. Identified intraoperatively, this may be misdiagnosed as invasive malignancy, and thus awareness of this anomaly may help prevent unnecessarily morbid resection. PMID:26195881

  8. Virtual Intraoperative Cholangiogram Using WebCL

    PubMed Central

    YU, Alexander; DEMIREL, Doga; HALIC, Tansel; KOCKARA, Sinan

    2016-01-01

    In this paper, we propose a Virtual Intraoperative Cholangiogram (VIC) training platform. Intraoperative Cholangiogram (IC) is an imaging technique of biliary anatomy with using fluorescent fluids sensitive to the X-Rays. The procedure is often employed to diagnose the difficult cases such as abnormal anatomy or choledocholithiasis during the laparoscopic cholecystectomy. The major challenge in cholangiogram is accurate interpretation of the X-Ray image, which requires extensive case training. However, the training platforms that support generation of various IC cases have been lacking. In this study, we developed a web based platform to generate IC images from any virtual bile duct anatomy. As the generation of X-Ray image from 3D scene is a computationally intensive task, we utilized WebCL technology to parallelize the computation for achieving real-time rates. In this work, we present details of our WebCL IC generation algorithm and benchmark results. PMID:27046623

  9. Virtual Intraoperative Cholangiogram Using WebCL.

    PubMed

    Yu, Alexander; Demirel, Doga; Halic, Tansel; Kockara, Sinan

    2016-01-01

    In this paper, we propose a Virtual Intraoperative Cholangiogram (VIC) training platform. Intraoperative Cholangiogram (IC) is an imaging technique of biliary anatomy with using fluorescent fluids sensitive to the X-Rays. The procedure is often employed to diagnose the difficult cases such as abnormal anatomy or choledocholithiasis during the laparoscopic cholecystectomy. The major challenge in cholangiogram is accurate interpretation of the X-Ray image, which requires extensive case training. However, the training platforms that support generation of various IC cases have been lacking. In this study, we developed a web based platform to generate IC images from any virtual bile duct anatomy. As the generation of X-Ray image from 3D scene is a computationally intensive task, we utilized WebCL technology to parallelize the computation for achieving real-time rates. In this work, we present details of our WebCL IC generation algorithm and benchmark results. PMID:27046623

  10. Trabeculectomy with intraoperative retrobulbar triamcinolone acetonide.

    PubMed

    Kahook, Malik Y; Camejo, Larissa; Noecker, Robert J

    2009-01-01

    Use of topical steroids is an important component of postoperative care after filtration surgery. Efficacy of postoperative medications is affected by patient adherence and physical limitations in the elderly population often prohibit proper dosing of ophthalmic drops. We describe a technique for the use of intraoperative retrobulbar triamcinolone acetonide in trabeculectomy surgery and report on postoperative outcomes. This technique appears safe and may be an attractive method of delivering a steroid depot at the time of trabeculectomy. PMID:19668541

  11. Intraoperative coronary artery dissection in fibromuscular dysplasia.

    PubMed

    Lou, Xiaoying; Mitter, Sumeet S; Blair, John E; Benzuly, Keith; Gambardella, Ivancarmine; Malaisrie, S Chris

    2015-04-01

    A 61-year-old woman with bicuspid aortic stenosis, an ascending aortic aneurysm, and a remote history of renal fibromuscular dysplasia underwent aortic root replacement complicated by extensive dissection of the left circumflex artery extending retrograde into the left anterior descending artery. This was managed by coronary artery bypass grafting, left ventricular support, and percutaneous coronary intervention for propagation of the dissection. This case highlights the prevalence, diagnosis, and management of intraoperative coronary dissection secondary to fibromuscular dysplasia. PMID:25841833

  12. Intraoperative lung ultrasound: A clinicodynamic perspective

    PubMed Central

    Mittal, Amit Kumar; Gupta, Namrata

    2016-01-01

    In the era of evidence-based medicine, ultrasonography has emerged as an important and indispensable tool in clinical practice in various specialties including critical care. Lung ultrasound (LUS) has a wide potential in various surgical and clinical situations for timely and easy detection of an impending crisis such as pulmonary edema, endobronchial tube migration, pneumothorax, atelectasis, pleural effusion, and various other causes of desaturation before it clinically ensues to critical level. Although ultrasonography is frequently used in nerve blocks, airway handling, and vascular access, LUS for routine intraoperative monitoring and in crisis management still necessitates recognition. After reviewing the various articles regarding the use of LUS in critical care, we found, that LUS can be used in various intraoperative circumstances similar to Intensive Care Unit with some limitations. Except for few attempts in the intraoperative detection of pneumothorax, LUS is hardly used but has wider perspective for routine and crisis management in real-time. If anesthesiologists add LUS in their routine monitoring armamentarium, it can assist to move a step ahead in the dynamic management of critically ill and high-risk patients. PMID:27625474

  13. Intraoperative lung ultrasound: A clinicodynamic perspective

    PubMed Central

    Mittal, Amit Kumar; Gupta, Namrata

    2016-01-01

    In the era of evidence-based medicine, ultrasonography has emerged as an important and indispensable tool in clinical practice in various specialties including critical care. Lung ultrasound (LUS) has a wide potential in various surgical and clinical situations for timely and easy detection of an impending crisis such as pulmonary edema, endobronchial tube migration, pneumothorax, atelectasis, pleural effusion, and various other causes of desaturation before it clinically ensues to critical level. Although ultrasonography is frequently used in nerve blocks, airway handling, and vascular access, LUS for routine intraoperative monitoring and in crisis management still necessitates recognition. After reviewing the various articles regarding the use of LUS in critical care, we found, that LUS can be used in various intraoperative circumstances similar to Intensive Care Unit with some limitations. Except for few attempts in the intraoperative detection of pneumothorax, LUS is hardly used but has wider perspective for routine and crisis management in real-time. If anesthesiologists add LUS in their routine monitoring armamentarium, it can assist to move a step ahead in the dynamic management of critically ill and high-risk patients.

  14. Intraoperative lung ultrasound: A clinicodynamic perspective.

    PubMed

    Mittal, Amit Kumar; Gupta, Namrata

    2016-01-01

    In the era of evidence-based medicine, ultrasonography has emerged as an important and indispensable tool in clinical practice in various specialties including critical care. Lung ultrasound (LUS) has a wide potential in various surgical and clinical situations for timely and easy detection of an impending crisis such as pulmonary edema, endobronchial tube migration, pneumothorax, atelectasis, pleural effusion, and various other causes of desaturation before it clinically ensues to critical level. Although ultrasonography is frequently used in nerve blocks, airway handling, and vascular access, LUS for routine intraoperative monitoring and in crisis management still necessitates recognition. After reviewing the various articles regarding the use of LUS in critical care, we found, that LUS can be used in various intraoperative circumstances similar to Intensive Care Unit with some limitations. Except for few attempts in the intraoperative detection of pneumothorax, LUS is hardly used but has wider perspective for routine and crisis management in real-time. If anesthesiologists add LUS in their routine monitoring armamentarium, it can assist to move a step ahead in the dynamic management of critically ill and high-risk patients. PMID:27625474

  15. Comparison of transesophageal Doppler methods with angiography for evaluation of the severity of mitral regurgitation.

    PubMed

    Flachskampf, F A; Frieske, R; Engelhard, B; Grenner, H; Frielingsdorf, J; Beck, F; Reineke, T; Thomas, J D; Hanrath, P

    1998-09-01

    Doppler evaluation of mitral regurgitation remains difficult; thus, a head-to-head comparison of the diagnostic accuracy of Doppler methods was undertaken. Fifty patients with native mitral regurgitation underwent multiplane transesophageal echocardiography within 5 days of catheterization. Angiographic grade of mitral regurgitation and, in 20 patients with grade II-IV regurgitation, invasively determined regurgitant stroke volume were compared with color Doppler area, regurgitant jet diameter, ratio of systolic to diastolic peak pulmonary venous flow velocities, and (based on the proximal convergence zone) maximal regurgitant flow rate and regurgitant orifice area. Rank correlation coefficients of angiographic grade with Doppler parameters were 0.61 for color jet area, -0.61 for pulmonary venous flow velocity ratio, 0.69 for color jet diameter, 0.79 for maximal regurgitant flow rate, and 0.78 for regurgitant orifice area (all P < .01). Convergence zone-based parameters also correlated best (r=0.73) with invasively determined regurgitant stroke volume. Receiver operating characteristic curve analysis confirmed higher diagnostic accuracy for proximal jet width and proximal convergence zone parameters than for color jet area or pulmonary venous flow velocity ratio. Proximal convergence zone parameters and proximal color jet diameter best distinguished severe from mild forms of mitral regurgitation. PMID:9758380

  16. Different transseptal puncture for different procedures: Optimization of left atrial catheterization guided by transesophageal echocardiography

    PubMed Central

    Radinovic, Andrea; Mazzone, Patrizio; Landoni, Giovanni; Agricola, Eustachio; Regazzoli, Damiano; Bella, Paolo Della

    2016-01-01

    Background: Left atrial catheterization through transseptal puncture is frequently performed in cardiac catheterization procedures. Appropriate transseptal puncture is critical to achieve procedural success. Aims: The aim of the study is to evaluate the feasibility of selective transseptal punctures, using a modified radiofrequency (RF) transseptal needle and transesophageal echocardiography (TEE), in different types of procedures that require specific sites of left atrial catheterization. Setting and Design: This was an observational trial in a cardiac catheterization laboratory of a teaching hospital. Materials and Methods: Patients undergoing different percutaneous procedures requiring atrial transseptal puncture such as atrial fibrillation (AF) ablation, left atrial appendage (LAA) occlusion, and mitral valve repair were included in the study. All procedures were guided by TEE and an RF transseptal needle targeting a specific region of the septum to perform the puncture. Statistical Analysis: The statistical analysis was descriptive only. Results: RF-assisted transseptal punctures were performed in six consecutive patients who underwent AF ablation (two patients), LAA closure (two patients), and mitral valve repair (two patients). In all patients, transseptal punctures were performed successfully at the desired site. No adverse events or complications were observed. Conclusions: Selective transseptal puncture, using TEE and an RF needle, is a feasible technique that can be used in multiple approaches requiring a precise site of access for left atrial catheterization. PMID:27716687

  17. Therapeutic implications of transesophageal echocardiography after transthoracic echocardiography on acute stroke patients

    PubMed Central

    de Abreu, Tiago Tribolet; Mateus, Sonia; Carreteiro, Cecilia; Correia, Jose

    2008-01-01

    Background The role of transesophageal echocardiography (TEE) in the evaluation of acute stroke patients is still ill-defined. We conducted a prospective observational study to find the prevalence of TEE findings that indicate anticoagulation as beneficial, in acute ischemic stroke patients without indication for anticoagulation based on clinical, electrocardiographic and transthoracic echocardiography (TTE) findings. Methods We prospectively studied all patients referred to our laboratory for TTE and TEE. Patients were excluded if the diagnosis was not acute ischemic stroke or if they had an indication for anticoagulation based on clinical, electrocardiographic, or TTE data. Patients with TEE findings that might indicate anticoagulation as beneficial were identified. Results A total of 84 patients with acute ischemic stroke and without indication for anticoagulation based on clinical and electrocardiographic or TTE data were included in the study. Findings indicating anticoagulation as beneficial were found in 32.1%: spontaneous echo contrast (1.2%), complex aortic atheroma (27.4%), thrombus (8.3%), and simultaneous patent foramen ovale and atrial septal aneurysm (2.4%). Conclusions The results of our study show that TEE can have therapy implications in 32.1% of ischemic stroke patients in sinus rhythm and with TTE with no indication for anticoagulation. PMID:18629351

  18. Three-dimensional left ventricular wall motion analysis using multiplane transesophageal echocardiography

    NASA Astrophysics Data System (ADS)

    Chen, Ding-Horng; Chen, Shieh-Chu; Lin, Shoa-Lin; Sun, Yung-Nien

    1996-04-01

    The left ventricular (LV) wall motion is the most challenging and interesting task in cardiac evaluation. In this paper, an integrated system that measures and displays left ventricular wall motion is presented. Based on the 3D reconstruction of ventricle from nine rotational cross- sectional images acquired with multiplane transesophageal echocardiography (TEE), a quantitative and visual expression of the motion of LV is presented. Nine images were obtained with the transducer rotating around a central axis passing through LV. A sequence of image processing operations have been developed for detecting left ventricular boundaries from TEE images obtained with different angle in a whole cardiac cycle. The algorithm which integrates 2D boundary information into 3D volume representation is designed based on automata theory. The phantom study for computing the scaling factors between the image metrics and the physical metrics shows a good correlation between the computed results and the specimens in the in vitro study. Finally, the 3D shape visualization of the reconstructed moving ventricle is presented. The performance of proposed experiments shows good feasibility of the new application of TEE in cardiac evaluation.

  19. Evaluation of shunt flow by multiplane transesophageal echocardiography in adult patients with isolated patent ductus arteriosus.

    PubMed

    Chang, Shih-Tai; Hung, Kuo-Chun; Hsieh, I-Chang; Chang, Hern-Jia; Chern, Ming-Shyan; Lin, Fun-Chung; Wu, Delon

    2002-11-01

    The role of multiplane (M) transesophageal echocardiography (TEE) in the diagnosis of isolated patent ductus arteriosus (PDA) in adults and its effectiveness in the assessment of the pulmonary to systemic flow ratio were evaluated and compared with those obtained from cardiac catheterization examination. Eleven consecutive patients, ranging from 17 to 56 years old (mean of 29.5 +/- 12.0), with clinically suspected PDA were subjects of this study. A complete transthoracic echocardiographic study was performed in each patient before MTEE. MTEE with Doppler color flow mapping showed clear visualization of a ductal structure between the descending aorta and pulmonary artery with a continuous turbulent mosaic flow suggestive of PDA in all 11 patients. The pulmonary/systemic flow and vascular resistance ratios obtained by echocardiography and cardiac catheterization correlated well (r = 0.8732, P =.0004; r = 0.623, P =.04, respectively). This study demonstrated that MTEE combined with transthoracic echocardiography examination is an accurate noninvasive means in the diagnosis of PDA and assessment of the pulmonary to systemic flow and vascular resistance ratios in adult patients.

  20. Comparison of multiplane and biplane transesophageal echocardiography in the assessment of aortic stenosis.

    PubMed

    Kim, K S; Maxted, W; Nanda, N C; Coggins, K; Roychoudhry, D; Espinal, M; Fan, P; Camino, A; Sanyal, R; Finch, A; Kirklin, J; Pacifico, A

    1997-02-15

    The aim of the study was to compare the accuracy of multiplane transesophageal echocardiography (TEE) with the more conventional biplane technique in the direct assessment of aortic valve area in patients with aortic stenosis. Short-axis images of the aortic valve adequate for measuring aortic valve area were obtained in all 81 patients studied by multiplane TEE but in only 56 of 64 patients (88%) using the biplane approach. The correlation coefficient for aortic valve area determined by multiplane TEE (r = 0.89; SEE = 0.04 cm2) was higher (p < 0.01) than biplane TEE (r = 0.74; SEE = 0.06 cm2). Correlations were higher for bicuspid valves (multiplane, r = 0.93; biplane, r = 0.75) than tricuspid valves (multiplane, r = 0.87; biplane, r = 0.75). Our study has demonstrated the superiority of multiplane TEE to both biplane TEE and transthoracic echocardiography (TTE) in the direct evaluation of aortic valve area in patients with aortic stenosis.

  1. Pediatric Transesophageal Echocardiography by Means of a Miniature 5-MHz Multiplane Transducer.

    PubMed

    Cromme-Dijkhuis, Adri H.; Djoa, Kie K.; Bom, Nicolaas; Hess, John

    1996-11-01

    The development of a miniature multiplane transesophageal echocardiographic (TEE) transducer for pediatric use is the latest development in TEE. Horizontal, longitudinal, and all possible intermediate oblique planes can be obtained with minimal transducer manipulation. We studied 48 patients with an experimental 5-MHz transducer, which contains 48 transmitting elements. The dimensions of the tip are 27 x 10.6 x 7.9 mm. Patients ages ranged from 2 days to 16 years, their weights from 3.6-67 kg. Multiplane TEE proved to be complementary to the single horizontal plane in assessing the right ventricular outflow tract, the left ventricular outflow tract, ascending aorta, the atrial septum, the atrioventricular (AV) valves, especially in AV septal defects, and double inlet left ventricle (DILV). Moreover, multiplane TEE was extremely helpful in judging the outflow tracts and ventricular septal defects in more complex heart defects such as DILV, double outlet right ventricle, and hearts with discordant connections. Multiplane TEE offered superb monitoring of cardiac interventions. We conclude that multiplane TEE provides new imaging planes and enables visualization of every major structure of the heart by unlimited scan planes. Multiplane TEE is indispensable in congenital heart defects. Thus, multiplane TEE adds to diagnostic assurance and enhances decision making for surgery. (ECHOCARDIOGRAPHY, Volume 13, November 1996)

  2. Multiplane Transesophageal Echocardiography with Dobutamine in Patients with Biventricular Inferior Myocardial Infarction.

    PubMed

    Espinola-Zavaleta, Nilda; Vargas-Barrón, Jesús; Romero-Cárdenas, Angel; Bialostozky, David; Alexanderson, Erick; Martinez-Sanchez, Carlos; Peña-Duque, Marco; Keirns, Candace; Rijlaarsdam, María; Lupi-Herrera, Eulo

    1998-02-01

    The purpose of this study was to evaluate the alterations of ventricular wall movement in patients with acute posteroinferior myocardial infarction with extension to right cavities with multiplane transesophageal echocardiography (TEE), as well as the utility of dobutamine with this technique to analyze myocardial viability. Nine men with a mean age of 51 years fulfilled the inclusion criteria. Myocardial TEE was performed in all the men 72 hours after the acute event with long- and short-axis transgastric images of both ventricles under basal conditions and with dobutamine infusions of 5 and 10 µg/kg per minute. Results were compared with myocardial perfusion findings obtained with Tc-99m Sestamibi SPECT. Left ventricular myocardial viability was demonstrated in 28 of 45 altered segments with dobutamine stress myocardial TEE and Tc-99m Sestamibi SPECT. Right ventricular myocardial viability was identified in 27 of 30 altered segments with dobutamine stress myocardial TEE in transgastric short and long axes, and with Tc-99m Sestamibi SPECT in 23 of 25 segments only in short-axis images. Multiplane TEE provided excellent image resolution and better definition of endocardial and epicardial borders, which facilitated detailed evaluation of ventricular segmental wall movement. Infusion of low doses of dobutamine made it possible to identify viable tissue in both ventricles, and results were comparable to those of nuclear medicine.

  3. Front-end receiver electronics for a matrix transducer for 3-D transesophageal echocardiography.

    PubMed

    Yu, Zili; Blaak, Sandra; Chang, Zu-yao; Yao, Jiajian; Bosch, Johan G; Prins, Christian; Lancée, Charles T; de Jong, Nico; Pertijs, Michiel A P; Meijer, Gerard C M

    2012-07-01

    There is a clear clinical need for creating 3-D images of the heart. One promising technique is the use of transesophageal echocardiography (TEE). To enable 3-D TEE, we are developing a miniature ultrasound probe containing a matrix piezoelectric transducer with more than 2000 elements. Because a gastroscopic tube cannot accommodate the cables needed to connect all transducer elements directly to an imaging system, a major challenge is to locally reduce the number of channels, while maintaining a sufficient signal-to-noise ratio. This can be achieved by using front-end receiver electronics bonded to the transducers to provide appropriate signal conditioning in the tip of the probe. This paper presents the design of such electronics, realizing time-gain compensation (TGC) and micro-beamforming using simple, low-power circuits. Prototypes of TGC amplifiers and micro-beamforming cells have been fabricated in 0.35-μm CMOS technology. These prototype chips have been combined on a printed circuit board (PCB) to form an ultrasound-receiver system capable of reading and combining the signals of three transducer elements. Experimental results show that this design is a suitable candidate for 3-D TEE.

  4. Quantification of mitral regurgitation: comparison between transthoracic and transesophageal color Doppler flow mapping.

    PubMed

    Mimo, R; Sparacino, L; Nicolosi, G; D'Angelo, G; Dall'Aglio, V; Lestuzzi, C; Pavan, D; Cervesato, E; Zanuttini, D

    1991-11-01

    We reviewed transthoracic (TTE) and transesophageal (TEE) echocardiograms of 100 consecutive patients: 63 male, 37 female, mean age 50 years (range 16-83 years), 32 with neoplastic disease, 18 aortic disease, 28 mitral valve disease, and 22 with other diseases. Absence or presence of mitral regurgitation (defined as mild, moderate, or severe) was assessed. TEE showed mild mitral regurgitation in 26 patients where TTE was negative. The overall estimate of regurgitant lesion severity was concordant at TEE and TTE in 64% of cases. The overall estimate of regurgitant lesion severity was also greater by one grade in 1% of cases at TTE, and in 35% of cases at TEE. Maximal digitized jet areas were 3.60 +/- 6.35 cm 2 at TTE and 3.04 +/- 3.79 cm 2 at TEE (P = NS). Correlation was r = 0.69 (TEE = 0.41 TTE + 1.55; P less than 0.001). TEE yielded a higher prevalence of mitral regurgitation than TTE with a trend toward greater overall estimate of mitral regurgitation at the semi-quantitative analysis. TTE and TEE showed similar mean results at the quantitative assessment of maximal jet areas. However, a highly significant random variability was observed in quantifying mitral regurgitation at TEE.

  5. Parachute mitral valve accompanied by bicuspid aortic valve on three-dimensional transesophageal echocardiography.

    PubMed

    Feng, Tian-Ying; Li, Zhi-An; He, Yi-Hua; Han, Jian-Cheng; Luan, Shu-Rong; Wang, Lin-Lin

    2012-09-01

    We report the findings of three-dimensional (3D) transesophageal echocardiography (TEE) in a patient with a parachute mitral valve (MV) accompanied by aortic valve (AV) malformation. The results indicated an enhanced echo in MV anterior leaves, incrassate, and shortened subvalvular chordae tendineae, and posteromedial papillary muscle that had echo reinforcement, calcification, retroposition, and a significant decrease compared with anterolateral papillary muscle. In addition, the anterolateral papillary muscle was huge, with the bilateral papillary muscles fused partly, and the posterior subvalvular chordae tendineae incrassate, shortened, and attached parachute-like to the anterolateral papillary muscle. The MV appeared dome-shaped for the open limit in diastole with an MV area of 1.6 cm. Moreover, the left ventricle increased in size and the bicuspid AV was malformed. Continuous wave Doppler angiograph showed that the flow rate increased to 398 cm/seconds at the AV orifice area. A 3D form of the MV structure was observed from the left ventricle using 3D-TEE inspection. The anterolateral papillary muscle was fused with its posteromedial homologue. The chordae tendineae was attached to the anterolateral papillary with the parachute-like structure, indicating dome movement.

  6. Multiplane transesophageal echocardiography: image orientation, examination technique, anatomic correlations, and clinical applications.

    PubMed

    Seward, J B; Khandheria, B K; Freeman, W K; Oh, J K; Enriquez-Sarano, M; Miller, F A; Edwards, W D; Tajik, A J

    1993-06-01

    Multiplane transesophageal echocardiography (TEE) consists of a single ultrasound array or imaging sector that can be rotated around the long axis of the ultrasound beam typically in a 180 degrees arc. This capability produces a circular (conical) continuum of tomographic two-dimensional images. The principal advantage of multiple TEE is that the transducer can be rotated to an image-specific orientation and critically optimized. Thus, manipulation of the transducer is less complex than with the biplane technique, and user adaptation is considerably enhanced. The logical image notation (that is, degrees of rotation) and orientation are described in this report. A step-by-step approach to the multiplane TEE examination, which evolved from our initial experience with 400 consecutive patients, is correlated with accompanying tomographic anatomic corroboration. The unique clinical applications are discussed and related to the amplification of diagnostic information. Although the multiplanar TEE transducer is relatively large, all adult patients who weigh 40 kg or more can be examined. No major complications occurred in our initial experience with this promising new technology. PMID:8497131

  7. Integration of trans-esophageal echocardiography with magnetic tracking technology for cardiac interventions

    NASA Astrophysics Data System (ADS)

    Moore, John T.; Wiles, Andrew D.; Wedlake, Chris; Bainbridge, Daniel; Kiaii, Bob; Trejos, Ana Luisa; Patel, Rajni; Peters, Terry M.

    2010-02-01

    Trans-esophageal echocardiography (TEE) is a standard component of patient monitoring during most cardiac surgeries. In recent years magnetic tracking systems (MTS) have become sufficiently robust to function effectively in appropriately structured operating room environments. The ability to track a conventional multiplanar 2D TEE transducer in 3D space offers incredible potential by greatly expanding the cumulative field of view of cardiac anatomy beyond the limited field of view provided by 2D and 3D TEE technology. However, there is currently no TEE probe manufactured with MTS technology embedded in the transducer, which means sensors must be attached to the outer surface of the TEE. This leads to potential safety issues for patients, as well as potential damage to the sensor during procedures. This paper presents a standard 2D TEE probe fully integrated with MTS technology. The system is evaluated in an environment free of magnetic and electromagnetic disturbances, as well as a clinical operating room in the presence of a da Vinci robotic system. Our first integrated TEE device is currently being used in animal studies for virtual reality-enhanced ultrasound guidance of intracardiac surgeries, while the "second generation" TEE is in use in a clinical operating room as part of a project to measure perioperative heart shift and optimal port placement for robotic cardiac surgery. We demonstrate excellent system accuracy for both applications.

  8. Improved Segmentation of Multiple Cavities of the Heart in Wide-View 3-D Transesophageal Echocardiograms.

    PubMed

    Haak, Alexander; Ren, Ben; Mulder, Harriët W; Vegas-Sánchez-Ferrero, Gonzalo; van Burken, Gerard; van der Steen, Antonius F W; van Stralen, Marijn; Pluim, Josien P W; van Walsum, Theo; Bosch, Johannes G

    2015-07-01

    Minimally invasive interventions in the heart such as in electrophysiology are becoming more and more important in clinical practice. Currently, preoperative computed tomography angiography (CTA) is used to provide anatomic information during electrophysiology interventions, but this does not provide real-time feedback and burdens the patient with additional radiation and side effects of the contrast agent. Three-dimensional transesophageal echocardiography (TEE) is an excellent modality for visualization of anatomic structures and instruments in real time, but some cavities, especially the left atrium, suffer from the limited coverage of the 3-D TEE volumes. This leads to difficulty in segmenting the left atrium. We propose replacing or complementing pre-operative CTA imaging with wide-view TEE. We tested this proposal on 20 patients for which TEE image volumes covering the left atrium and CTA images were acquired. The TEE images were manually registered, and wide-view volumes were generated. Five heart cavities in single-view and wide-view TEE were segmented and compared with atlas based-segmentations derived from the CTA images. We found that the segmentation accuracy (Dice coefficients) improved relative to segmentation of single-view images by 5, 15 and 9 percentage points for the left atrium, right atrium and aorta, respectively. Average anatomic coverage was improved by 2, 29, 62 and 49 percentage points for the right ventricle, left atrium, right atrium and aorta, respectively. This finding confirms that wide-view 3-D TEE can be useful in supporting electrophysiology interventions.

  9. Incremental value of live/real time three-dimensional transesophageal echocardiography over the two-dimensional technique in the assessment of a tuberculoma involving the left atrium and appendage.

    PubMed

    Kemaloğlu Öz, Tuğba; Elsayed, Mahmoud; Nanda, Navin C; Kalenderoğlu, Koray; Akyüz, Şükrü; Atasoy, Işıl; Ösken, Altuğ; Onuk, Tolga; Eren, Mehmet

    2016-09-01

    Intracardiac tuberculomas are extremely rare, and cardiac involvement in tuberculosis accounts for only 0.5% of extrapulmonary tuberculosis. We report for the first time incremental value of live/real time three-dimensional transesophageal echocardiography over two-dimensional transesophageal echocardiography in the assessment of a tuberculoma involving the left atrium and left atrial appendage.

  10. In vivo virtual intraoperative surgical photoacoustic microscopy

    SciTech Connect

    Han, Seunghoon Kim, Sehui Kim, Jeehyun E-mail: chulhong@postech.edu; Lee, Changho Jeon, Mansik; Kim, Chulhong E-mail: chulhong@postech.edu

    2013-11-11

    We developed a virtual intraoperative surgical photoacoustic microscopy system by combining with a commercial surgical microscope and photoacoustic microscope (PAM). By sharing the common optical path in the microscope and PAM system, we could acquire the PAM and microscope images simultaneously. Moreover, by employing a beam projector to back-project 2D PAM images onto the microscope view plane as augmented reality, the conventional microscopic and 2D cross-sectional PAM images are concurrently mapped on the plane via an ocular lens of the microscope in real-time. Further, we guided needle insertion into phantom ex vivo and mice skins in vivo.

  11. In vivo virtual intraoperative surgical photoacoustic microscopy

    NASA Astrophysics Data System (ADS)

    Han, Seunghoon; Lee, Changho; Kim, Sehui; Jeon, Mansik; Kim, Jeehyun; Kim, Chulhong

    2013-11-01

    We developed a virtual intraoperative surgical photoacoustic microscopy system by combining with a commercial surgical microscope and photoacoustic microscope (PAM). By sharing the common optical path in the microscope and PAM system, we could acquire the PAM and microscope images simultaneously. Moreover, by employing a beam projector to back-project 2D PAM images onto the microscope view plane as augmented reality, the conventional microscopic and 2D cross-sectional PAM images are concurrently mapped on the plane via an ocular lens of the microscope in real-time. Further, we guided needle insertion into phantom ex vivo and mice skins in vivo.

  12. Reliability of transesophageal pacing in the assessment of sinus node function in patients with sick sinus syndrome.

    PubMed

    Alboni, P; Paparella, N; Cappato, R; Pedroni, P; Candini, G C; Antonioli, G E

    1989-02-01

    The purpose of this study was to find out whether transesophageal pacing could be utilized for assessment of sinus node function in patients with sick sinus syndrome (SSS). In 17 patients with SSS (study group) we compared the results of sinus node tests obtained both in the basal state and after pharmacological autonomic blockade by endocavitary stimulation and, 24 hours later, by transesophageal pacing. In another group of 17 patients with SSS (control group), we compared the results obtained by two endocavitary studies. In "study group", sinus cycle length (SCL) and corrected sinus node recovery time (CSRT) did not show significant differences between the two studies both in the basal state and after autonomic blockade, whereas sinoatrial conduction time (SACT) was more prolonged during esophageal pacing (P less than 0.01). In "control group", sinus node measures did not show significant differences between the two studies. In the "study group," the following coefficients of correlation were obtained in the basal state; SCL, r = 0.65, CSRT, r = 0.57, SACT, r = 0.52 and after autonomic blockade: SCL, r = 0.95, CSRT, r = 0.62 and SACT, r = 0.53. In the basal state, the correlation for SCL and CSRT between the two studies was lower in the "study group" than in the "control group" (P less than 0.05), whereas after autonomic blockade the correlation for sinus node measures did not show significant differences between the two groups of patients. These data suggest that transesophageal study influences the autonomic tone regulating the sinus node; however, it is not responsible for important variations in sinus node measures.(ABSTRACT TRUNCATED AT 250 WORDS)

  13. Characterization of the left atrial vortex flow by two-dimensional transesophageal contrast echocardiography using particle image velocimetry.

    PubMed

    Park, Kyu-Hwan; Son, Jang-Won; Park, Won-Jong; Lee, Sang-Hee; Kim, Ung; Park, Jong-Seon; Shin, Dong-Gu; Kim, Young-Jo; Choi, Jung-Hyun; Houle, Helene; Vannan, Mani A; Hong, Geu-Ru

    2013-01-01

    This article is the first clinical investigation of the quantitative left atrial (LA) vortex flow by two-dimensional (2-D) transesophageal contrast echocardiography (2-D-TECE) using vector particle image velocimetry (PIV). The aims of this study were to assess the feasibility of LA vortex flow analysis and to characterize and quantify the LA vortex flow in controls and in patients with atrial fibrillation (AF). Thirty-five controls and 30 patients with AF underwent transesophageal contrast echocardiography. The velocity vector was estimated by particle image velocimetry. The morphology and pulsatility of the LA vortex flow were compared between the control and AF groups. In all patients, quantitative LA vortex flow analysis was feasible. In the control group, multiple, pulsatile, compact and elliptical-shaped vortices were seen in the periphery of the LA. These vortices were persistently maintained and vectors were directed toward the atrioventricular inflow. In the AF group, a large, merged, lower pulsatile and round-shaped vortex was observed in the center of the LA. In comparisons of vortex parameters, the relative strength was significantly lower in the AF group (1.624 ± 0.501 vs. 2.105 ± 0.226, p < 0.001). It is feasible to characterize and quantify the LA vortex flow by transesophageal contrast echocardiography in patients with AF, which offers a new method to obtain additional information on LA hemodynamics. The approach has the potential for early detection of the LA dysfunction and in decisions regarding treatment strategy and guiding anticoagulation treatment in patients with AF.

  14. Muscle relaxant use during intraoperative neurophysiologic monitoring.

    PubMed

    Sloan, Tod B

    2013-02-01

    Neuromuscular blocking agents have generally been avoided during intraoperative neurophysiological monitoring (IOM) where muscle responses to nerve stimulation or transcranial stimulation are monitored. However, a variety of studies and clinical experience indicate partial neuromuscular blockade is compatible with monitoring in some patients. This review presents these experiences after reviewing the currently used agents and the methods used to assess the blockade. A review was conducted of the published literature regarding neuromuscular blockade during IOM. A variety of articles have been published that give insight into the use of partial pharmacological paralysis during monitoring. Responses have been recorded from facial muscles, vocalis muscles, and peripheral nerve muscles from transcranial or neural stimulation with neuromuscular blockade measured in the muscle tested or in the thenar muscles from ulnar nerve stimulation. Preconditioning of the nervous system with tetanic or sensory stimulation has been used. In patients without neuromuscular pathology intraoperative monitoring using peripheral muscle responses from neural stimulation is possible with partial neuromuscular blockade. Monitoring of muscle responses from cranial nerve stimulation may require a higher degree of stimulation and less neuromuscular blockade. The role of tetanic or sensory conditioning of the nervous system is not fully characterized. The impact of neuromuscular pathology or the effect of partial blockade on monitoring muscle responses from spontaneous neural activity or mechanical nerve stimulation has not been described.

  15. Endoscopic Ultrasound for the Detection of Left Atrial Appendage Thrombus: A Useful Technique in Patients with Transesophageal Echocardiography Contraindication

    PubMed Central

    Jurado-Román, Alfonso; López-Viedma, Bartolomé; Piqueras-Flores, Jesús; López-Lluva, María T.

    2016-01-01

    Endoscopic ultrasound is a diagnostic and therapeutic technique used in specialized centers for patients that have undergone digestive procedures. This technique enables highly precise real-time imaging of the digestive tract wall and surrounding organs. Endoscopic ultrasound is also useful in patients with cardiovascular diseases such as atrial fibrillation. In patients with contraindication for transesophageal echocardiography due to high risk of esophageal bleeding or complications that may require immediate intervention, endoscopic ultrasound may be a safer option for visualizing atrial chambers to rule out the presence of left atrial appendage thrombi before cardioversion.

  16. Endoscopic Ultrasound for the Detection of Left Atrial Appendage Thrombus: A Useful Technique in Patients with Transesophageal Echocardiography Contraindication.

    PubMed

    Marina-Breysse, Manuel; Jurado-Román, Alfonso; López-Viedma, Bartolomé; Piqueras-Flores, Jesús; López-Lluva, María T

    2016-01-01

    Endoscopic ultrasound is a diagnostic and therapeutic technique used in specialized centers for patients that have undergone digestive procedures. This technique enables highly precise real-time imaging of the digestive tract wall and surrounding organs. Endoscopic ultrasound is also useful in patients with cardiovascular diseases such as atrial fibrillation. In patients with contraindication for transesophageal echocardiography due to high risk of esophageal bleeding or complications that may require immediate intervention, endoscopic ultrasound may be a safer option for visualizing atrial chambers to rule out the presence of left atrial appendage thrombi before cardioversion. PMID:27642527

  17. Transesophageal echocardiographic guidance for percutaneous closure of aortic pseudoaneurysm using a type II Amplatzer vascular plug: a case report

    PubMed Central

    Lee, Sangmin Maria; Sung, Kiick; Kang, I-Seok; Min, Jeong Jin; Kim, Eunhee; Park, Jiyeon; Park, Jin Hyoung

    2016-01-01

    Aortic pseudoaneurysm after cardiac surgery is a rare entity, but it is potentially fatal due to its clinical course along with higher morbidity and mortality rates. Instead of open surgical repair, percutaneous procedures have been introduced as other options for managing an aortic pseudoaneurysm. In this case report, we describe transesophageal echocardiography guidance for successful percutaneous closure of an aortic pseudoaneurysm located in the left ventricular outflow tract by using a type II Amplatzer vascular plug in a patient in whom open surgical repair was not recommended. PMID:27482320

  18. Three-Dimensional Transesophageal Echocardiography in the Anatomical Assessment of Isolated Parachute Mitral Valve in an Adult Patient.

    PubMed

    López-Pardo, Francisco; Urbano-Moral, Jose Angel; González-Calle, Antonio; Laviana-Martinez, Fernando; Esteve-Ruiz, Iris; Lagos-Degrande, Oscar; López-Haldon, Jose E

    2015-11-01

    Parachute mitral valve (PMV) is a rare congenital anomaly of the mitral valve apparatus usually evidenced in infants and young children. Adult presentation is extremely rare and is generally mild in terms of mitral stenosis. A 73-year-old woman was admitted to the emergency department due to progressive dyspnea, with NYHA functional class IV symptoms on presentation. The echocardiographic examination identified a PMV with moderate mitral stenosis and a secondary smaller subvalvular mitral orifice. The report shows the usefulness of three-dimensional transesophageal echocardiography in the detection and quantification of this rare anomaly. PMID:26096823

  19. Three-Dimensional Transesophageal Echocardiography in the Anatomical Assessment of Isolated Parachute Mitral Valve in an Adult Patient.

    PubMed

    López-Pardo, Francisco; Urbano-Moral, Jose Angel; González-Calle, Antonio; Laviana-Martinez, Fernando; Esteve-Ruiz, Iris; Lagos-Degrande, Oscar; López-Haldon, Jose E

    2015-11-01

    Parachute mitral valve (PMV) is a rare congenital anomaly of the mitral valve apparatus usually evidenced in infants and young children. Adult presentation is extremely rare and is generally mild in terms of mitral stenosis. A 73-year-old woman was admitted to the emergency department due to progressive dyspnea, with NYHA functional class IV symptoms on presentation. The echocardiographic examination identified a PMV with moderate mitral stenosis and a secondary smaller subvalvular mitral orifice. The report shows the usefulness of three-dimensional transesophageal echocardiography in the detection and quantification of this rare anomaly.

  20. Endoscopic Ultrasound for the Detection of Left Atrial Appendage Thrombus: A Useful Technique in Patients with Transesophageal Echocardiography Contraindication

    PubMed Central

    Jurado-Román, Alfonso; López-Viedma, Bartolomé; Piqueras-Flores, Jesús; López-Lluva, María T.

    2016-01-01

    Endoscopic ultrasound is a diagnostic and therapeutic technique used in specialized centers for patients that have undergone digestive procedures. This technique enables highly precise real-time imaging of the digestive tract wall and surrounding organs. Endoscopic ultrasound is also useful in patients with cardiovascular diseases such as atrial fibrillation. In patients with contraindication for transesophageal echocardiography due to high risk of esophageal bleeding or complications that may require immediate intervention, endoscopic ultrasound may be a safer option for visualizing atrial chambers to rule out the presence of left atrial appendage thrombi before cardioversion. PMID:27642527

  1. The important but underappreciated transgastric right ventricular inflow view for transesophageal echocardiographic evaluation of cardiac implantable device infections.

    PubMed

    Allred, Clint; Crandall, Mark; Auseon, Alex

    2013-01-01

    Device infection is a potential complication of cardiovascular implantable electronic devices. We report a case of a 40-year-old man with nonischemic cardiomyopathy, status post biventricular implantable cardiac defilbrillator placement on continuous home dobutamine, who presented with methicillin-resistant Staphylococcus aureus bacteremia. Transesophageal echocardiography showed a 2.4 cm vegetation near the right ventricular (RV) apex that was only seen in the transgastric RV inflow view. This case demonstrates an atypical distal location for a vegetation and illustrates the importance of obtaining multiple views, including the transgastric RV inflow view, when evaluating for device wire vegetations.

  2. Multiplane Transesophageal and Intracardiac Echocardiography in Large Swine: Imaging Technique, Normal Values, and Research Applications.

    PubMed

    Ren, Jian-Fang; Schwartzman, David; Lighty, George W.; Menz, Volker; Michele, John J.; Li, Kun S.; Dillon, Stephen M.; Marchlinski, Francis E.; Segal, Bernard L.

    1997-03-01

    Transthoracic echocardiographic imaging has been difficult to attain in the swine model. This study: (1) compares multiplane transesophageal echocardiography (TEE) with single plane TEE and intracardiac catheter echocardiography (ICE) for imaging of the swine cardiovascular system; and (2) defines normal values using these techniques in a closed chest large swine model (n = 24, body weight 50-114 kg). Multiplane TEE increased success rate over the single plane (the variable plane array only at 0 degrees ) TEE (P < 0.01) for imaging the left ventricular (LV) long-axis view (100% vs 50%), LV outflow tract (100% vs 33%), right atrium and its appendage (79% vs 33%), ascending aorta (100% vs 58%), and aortic arch (100% vs 17%). TEE-derived normal values at end-diastole (ED) and end-systole (ES) were: LV internal diameter (ID) = 49 +/- 3 mm (ED) and 33 +/- 4 mm (ES); LV wall thickness = 7 +/- 1 mm (ED); right ventricular (RV) ID = 24 +/- 4 mm (ED); RV wall thickness = 4 +/- 2 mm (ED); left atrial ID = 48 +/- 6 mm (ES); aortic root ID = 26 +/- 3 mm (ES); LV volume = 157 +/- 49 ml (ED) and 57 +/- 22 ml (ES). Baseline LV ejection fraction (64% +/- 6%), Doppler-derived stroke volume (86 +/- 14 ml), and cardiac index (107 ml/min per kg) were determined. Basal normal values, except for an elevated cardiac index in swine, are comparable to those reported for human adults. Multiplane TEE provided better overall cardiac imaging than did single plane TEE. ICE provided higher resolution imaging of individual cardiac chambers and structures when the ultrasound catheter was introduced into the right or left heart, but whole heart imaging was limited by ultrasound penetration at 12.5 MHz. Normal indices of chamber size and function provide a reference for the physiological significance of induced pathological states in this relevant animal model.

  3. Multiplane transesophageal echocardiographic acquisition of ascending aortic flow velocities: A comparison with established techniques.

    PubMed

    Harris, S N; Luther, M A; Perrino, A C

    1999-09-01

    Acquisition of ascending aortic flow velocities with monoplane transesophageal echocardiography (TEE) have been problematic because of limitations of available imaging planes and alignment of the Doppler beam with aortic flow. The rotatable imaging array of multiplane TEE (Multi TEE) may provide improved alignment with ascending aortic blood flow. The purpose of this study was to establish the validity of maximal aortic flow velocities (VMax) and velocity time integrals (VTI) obtained by a Multi TEE continuous wave Doppler technique by comparison with those obtained by established echocardiographic techniques, suprasternal Doppler (SSD), and monoplane TEE (Mono TEE). Forty-five patients scheduled for elective surgery were prospectively studied. Multi TEE-obtained VMax and VTI were significantly greater (P <.05), 120 +/- 28.9 cm/s and 25.8 +/- 7 cm, than those obtained by the SSD method, 100.2 +/- 28.6 cm/s and 19.8 +/- 6.8 cm, respectively. Bias analysis revealed that Multi TEE better assessed VMax (mean difference -19.7, SD of the difference of 28 cm/s) and VTI (mean difference -5.9, SD of the difference of 6.4 cm) than the SSD method. Multi TEE exhibited values for VMax 10% or greater than those obtained by SSD in 18 (48. 6%) of 37 patients, and Multi TEE was 10% or greater than SSD in 23 (67%) of 37 patients for VTI determination. Values obtained by Multi TEE and Mono TEE showed close agreement. Multi TEE provides a favorable alignment for continuous wave Doppler interrogation of aortic flow and compared favorably to established techniques. This technique expands the utility of TEE to evaluate aortic valvular function and cardiac performance.

  4. Detailed Transthoracic and Transesophageal Echocardiographic Analysis of Mitral Leaflets in Patients Undergoing Mitral Valve Repair.

    PubMed

    Ghulam Ali, Sarah; Fusini, Laura; Tamborini, Gloria; Muratori, Manuela; Gripari, Paola; Mapelli, Massimo; Zanobini, Marco; Alamanni, Francesco; Pepi, Mauro

    2016-07-01

    A recent histological study of resected scallop-P2 in mitral valve (MV) prolapse, showed that chordae tendinae may be missing or hidden in superimposed fibrous tissue of the leaflets, contributing to their thickening. This may have relevant clinical implication because detailed analysis of MV leaflets has a central role in the evaluation of patients undergoing repair. The aim of this study was to analyze MV leaflets focusing on thickness of prolapsing segments and the presence of chordal rupture (CR). We enrolled 246 patients (age 63 ± 13 years, 72 men) with isolated P2 prolapse and also 50 age-matched patients with normal MV anatomy as control group. Transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) were retrospectively analyzed to quantify the length and the proximal and distal thickness of both anterior (A2) and posterior (P2) MV scallops. Measurements were performed at end diastole in the standard TTE and TEE views. TTE and TEE measurements were feasible in all cases. Echocardiographically 176 patients had CR (group A), 45 had no rupture (group B), and 25 had an uncertain diagnosis (group C). All pathological groups showed thickening and elongation of involved leaflets versus normal, whereas no differences in leaflets characteristics were found among MV groups. Most patients undergoing MV repair had CR with thickening of the prolapsed segment. These findings are in agreement with recent histological studies showing superimposed fibrous tissue on MV leaflets partially including ruptured chordae. This may also explain that in cases without ruptured chordae, thickness of the leaflets is markedly increased (hidden chordae?). In conclusion, detailed analysis of MV apparatus may further improve knowledge of these patients and may influence surgical timing. PMID:27184171

  5. Analysis of right ventricular kinesis by means of transesophageal echocardiography: present problems and perspectives.

    PubMed

    Kozàkovà, M; Palombo, C; Benanti, C; L'Abbate, A; Distante, A

    1994-03-01

    The evaluation of right ventricular (RV) kinesis by two-dimensional echocardiography represents a difficult task. Transthoracic echocardiography can visualize the RV in several projections, but the image quality and the variability of imaging views usually do not allow quantitative analysis. We investigated the potential of transesophageal echocardiography (TEE) for evaluating RV global function and regional kinesis, in 32 controls and in 16 patients with inferior myocardial infarction (MI) and asynergy involving the inferior wall of both ventricles. Good-quality images of at least one horizontal section of the RV were obtained in 73% of subjects by conventional, 90 degrees sector and in 100% of subjects by wide-angle, "panoramic" sector. Images of the RV in short-axis view at medium level were acquired and evaluated in 93% of cases, but at basal and apical levels only in 67% and 39%, respectively. The low percentage of successful detection and evaluation of the RV at apical level can be explained by prominent motion and trabeculation of the apex. Global systolic area changes (SAC) in controls attained similar values at apical and medium levels (60% and 59%, respectively), but were significantly lower (48%, P less than 0.05) at basal level. In patients with previous inferior MI and inferoposterior asynergy, global SAC were significantly (P less than 0.01) lower at medium and basal levels (32% and 27%, respectively) compared with controls. Regional kinesis of RV was assessed as segmental SAC in 12 different segments, by fixed and float system of center of cavity.(ABSTRACT TRUNCATED AT 250 WORDS)

  6. Value of postoperative assessment of cardiac allograft function by transesophageal echocardiography.

    PubMed

    Kaye, D M; Bergin, P; Buckland, M; Esmore, D

    1994-01-01

    Heart transplantation now provides an acceptable therapy for patients with severe end-stage heart disease. Although patient outcome has significantly improved both early and late after heart transplantation, early morbidity and mortality continues to affect overall survival and may be unpredictable. In an attempt to identify factors that may assist in predicting early outcome after orthotopic heart transplantation, we assessed allograft function in 16 patients in the immediate postoperative period, 30 minutes after weaning from cardiopulmonary bypass by measuring the fractional shortening of the left ventricle with transesophageal echocardiography. In addition, standard hemodynamic indexes of allograft function (arterial blood pressure, pulmonary capillary wedge pressure, mean pulmonary artery pressure, and cardiac output) were obtained at this early time point. Early outcome was assessed by the duration and peak dose of inotrope support required after transplantation, requirement for mechanical support, and the duration of stay in the intensive care unit. Left ventricular fractional shortening 30 minutes after cardiopulmonary bypass was significantly lower in those patients requiring inotropic support (28.4% +/- 4.6% versus 43.7% +/- 3.5%, p < 0.05), whereas hemodynamic variables failed to distinguish these groups. In those patients requiring inotropes, there was a significant negative correlation of fractional shortening with the peak dose (r = -0.87, p < 0.01) and the duration of inotropic support (r = -0.62, p < 0.05). The total ischemic time of the allograft (206 +/- 22 minutes, range 77 to 359) did not correlate with the subsequent fractional shortening, but patients requiring inotrope support after the operation had significantly longer ischemic times (259 +/- 22 versus 138 +/- 22 minutes, p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

  7. [Intraoperative localization of space-occupying intracranial processes using ultrasound].

    PubMed

    Raghavendra, B N; Epstein, F J; Cooper, P R; Horii, S C; Ransohoff, J

    1984-10-01

    During a two-year period, intra-operative ultrasonic explorations were performed in 44 patients for the purpose of localisation of intracranial masses. This facilitated accurate intraoperative assessment of the location and consistency of the mass. We consider operative ultrasound to be an invaluable adjunct to surgery of small intracerebral masses.

  8. Improved Visualization of Intracranial Vessels with Intraoperative Coregistration of Rotational Digital Subtraction Angiography and Intraoperative 3D Ultrasound

    PubMed Central

    Podlesek, Dino; Meyer, Tobias; Morgenstern, Ute; Schackert, Gabriele; Kirsch, Matthias

    2015-01-01

    Introduction Ultrasound can visualize and update the vessel status in real time during cerebral vascular surgery. We studied the depiction of parent vessels and aneurysms with a high-resolution 3D intraoperative ultrasound imaging system during aneurysm clipping using rotational digital subtraction angiography as a reference. Methods We analyzed 3D intraoperative ultrasound in 39 patients with cerebral aneurysms to visualize the aneurysm intraoperatively and the nearby vascular tree before and after clipping. Simultaneous coregistration of preoperative subtraction angiography data with 3D intraoperative ultrasound was performed to verify the anatomical assignment. Results Intraoperative ultrasound detected 35 of 43 aneurysms (81%) in 39 patients. Thirty-nine intraoperative ultrasound measurements were matched with rotational digital subtraction angiography and were successfully reconstructed during the procedure. In 7 patients, the aneurysm was partially visualized by 3D-ioUS or was not in field of view. Post-clipping intraoperative ultrasound was obtained in 26 and successfully reconstructed in 18 patients (69%) despite clip related artefacts. The overlap between 3D-ioUS aneurysm volume and preoperative rDSA aneurysm volume resulted in a mean accuracy of 0.71 (Dice coefficient). Conclusions Intraoperative coregistration of 3D intraoperative ultrasound data with preoperative rotational digital subtraction angiography is possible with high accuracy. It allows the immediate visualization of vessels beyond the microscopic field, as well as parallel assessment of blood velocity, aneurysm and vascular tree configuration. Although spatial resolution is lower than for standard angiography, the method provides an excellent vascular overview, advantageous interpretation of 3D-ioUS and immediate intraoperative feedback of the vascular status. A prerequisite for understanding vascular intraoperative ultrasound is image quality and a successful match with preoperative

  9. Intraoperative arterial oxygenation in obese patients.

    PubMed Central

    Vaughan, R W; Wise, L

    1976-01-01

    Although obese patients have been shown to represent a particularly high risk group with respect to hypoxemia both pre and postoperatively, no data exist to delineate the intraoperative arterial oxygenation pattern of these patients. Furthermore, no one has studied the effects of a change in operative position or a subdiaphragmatic laparotomy pack on arterial oxygenation (PaO2). Sixty-four adults undergoing jejunoileal bypass for morbid exogenous obesity, with a mean weight of 142.0 +/- 31.4 kg and a mean age of 33.3 +/- 10.4 years, were studied. Twenty-five patients (Group I) were maintained in the supine position throughout the operative procedure, while the remaining 39 patients (Group II) were changed to a 15 degrees head down position 15 minutes after a control blood sample was taken. Four additional markedly obese patients were studied to determine the effect of an abdominal pack of PaO2 values. The following findings were demonstrated: 1) 40% oxygen did not uniformly produce adequate arterial oxygenation for intra-abdominal surgery in otherwise healthy obese patients; 2) placement of a subdiaphragmatic abdominal laparotomy pack without a change in operative position resulted in a consistent fall in PaO2 in each patient to less than 65 mm Hg even though 40% oxygen was being administered; and 3) a change from supine to a 15 degrees head down operative position resulted in a significant (P less than 0.001) reduction in mean PaO2 (73.0 +/- 26.3 mm Hg). Seventy-seven per cent of these patients demonstrated PaO2 values of less than 80 mm Hg on 40% oxygen. Because of these findings, serious consideration should be given to the routine use of the Trendelenberg position intraoperatively in obese patients. However, if one elects this posture, prudence would dictate careful monitoring and maintenance of arterial oxygenation. Certainly, in obese patients, the intraoperative combination of the head down position and a subdiaphragmatic laparotomy pack should be avoided

  10. Coblation tonsillectomy versus dissection tonsillectomy: a comparison of intraoperative time, intraoperative blood loss and post-operative pain.

    PubMed

    Izny Hafiz, Z; Rosdan, S; Mohd Khairi, M D

    2014-04-01

    The objective of this study was to compare the intraoperative time, intraoperative blood loss and post operative pain between coblation tonsillectomy and cold tonsillectomy in the same patient. A prospective single blind control trial was carried out on 34 patients whom underwent tonsillectomy. The patients with known bleeding disorder, history of unilateral peritonsillar abscess and unilateral tonsillar hypertrophy were excluded. Operations were done by a single surgeon using cold dissection tonsillectomy in one side while coblation tonsillectomy in the other. Intraoperative time, intraoperative blood loss and post operative pain during the first 3 days were compared between the two methods. Results showed that the intraoperative time was significantly shorter (p<0.001) and intraoperative blood loss was significantly lesser (p<0.001) in coblation tonsillectomy as compared to cold tonsillectomy. Post operative pain score was significantly less at 6 hours post operation (p<0.001) in coblation tonsillectomy as compared to cold tonsillectomy. However, there were no differences in the post operative pain scores on day 1, 2 and 3. In conclusion, coblation tonsillectomy does have superiority in improving intraoperative efficiency in term of intraoperative time and bleeding compared to cold dissection tonsillectomy. The patient will benefit with minimal post operative pain in the immediate post surgery duration.

  11. [Intraoperative frozen sections of the thyroid gland].

    PubMed

    Synoracki, S; Ting, S; Siebolts, U; Dralle, H; Koperek, O; Schmid, K W

    2015-07-01

    The goal of evaluation of intraoperative frozen sections of the thyroid gland is to achieve a definitive diagnosis which determines the subsequent surgical management as fast as possible; however, due to the specific methodological situation of thyroid frozen sections evaluation a conclusive diagnosis can be made in only some of the cases. If no conclusive histological diagnosis is possible during the operation, subsequent privileged processing of the specimen allows a final diagnosis at the latest within 48 h in almost all remaining cases. Applying this strategy, both pathologists and surgeons require a high level of communication and knowledge regarding the specific diagnostic and therapeutic peculiarities of thyroid malignancies because different surgical strategies must be employed depending on the histological tumor subtype.

  12. Intraoperative photodynamic therapy for larynx carcinomas

    NASA Astrophysics Data System (ADS)

    Loukatch, Erwin V.; Latyshevska, Galina; Fekeshgazi, Ishtvan V.

    1995-05-01

    We made an experimental and clinical researches to examine Intraoperative Photodynamic Therapy (IPT) as a method to prevent the recidives of tumors. In experimental researches on models with radio-inducated fibrosarcomas and Erlich carcinomas of mice the best method of IPT was worked out. The therapeutic effect was studied also on patients with laryngeal cancer. In researches on C3H mice the antirecidive effect of IPT established with local administration of methylene blue and Ar-laser. We found that IPT (He-Ne laser combined with methylene blue administration) was endured by patients with laryngeal cancers without problems. We got good results of treatment 42 patients with laryngeal cancers with middle localization during three years with using IPT method. This can show the perspectives of using this method in treatment of other ENT-oncological diseases.

  13. Intraoperative neuromonitoring in major vascular surgery.

    PubMed

    So, V C; Poon, C C M

    2016-09-01

    There has been a growing interest in using intraoperative neuromonitoring to reduce the incidence of stroke and paralysis in major vascular interventions. Electroencephalography, various neurophysiological evoked potential measurements, transcranial Doppler, and near-infrared spectroscopy are some of the modalities currently used to detect neural injuries. A good understanding of these modalities and their interactions with anaesthesia is important to maximize their value and to allow meaningful interpretation of their results. In view of the inter-individual differences in anatomy, physiological reserves, and severity of pathological processes, neuromonitoring may be a valuable method to evaluate the well-being of the nervous system during and after surgical interventions. In this review, we summarize some of their applications, efficacies, and drawbacks in major carotid and aortic surgeries. PMID:27566804

  14. Optical technologies for intraoperative neurosurgical guidance.

    PubMed

    Valdés, Pablo A; Roberts, David W; Lu, Fa-Ke; Golby, Alexandra

    2016-03-01

    Biomedical optics is a broadly interdisciplinary field at the interface of optical engineering, biophysics, computer science, medicine, biology, and chemistry, helping us understand light-tissue interactions to create applications with diagnostic and therapeutic value in medicine. Implementation of biomedical optics tools and principles has had a notable scientific and clinical resurgence in recent years in the neurosurgical community. This is in great part due to work in fluorescence-guided surgery of brain tumors leading to reports of significant improvement in maximizing the rates of gross-total resection. Multiple additional optical technologies have been implemented clinically, including diffuse reflectance spectroscopy and imaging, optical coherence tomography, Raman spectroscopy and imaging, and advanced quantitative methods, including quantitative fluorescence and lifetime imaging. Here we present a clinically relevant and technologically informed overview and discussion of some of the major clinical implementations of optical technologies as intraoperative guidance tools in neurosurgery.

  15. Intraoperative, real-time, functional MRI.

    PubMed

    Gering, D T; Weber, D M

    1998-01-01

    Functional MRI (fMRI) methods have been demonstrated to noninvasively identify motor-sensory, visual, and other areas of eloquent cortex for guiding surgical intervention. Typically, fMRI data are acquired preoperatively during a conventional surgical planning MRI examination. Unlike direct cortical stimulation at the time of surgery, however, preoperative fMRI methods do not account for the potential movement of tissues (relative to the time of functional imaging) that may occur in the surgical suite as a direct result of the intervention. Recently, an MRI device has been demonstrated for use in the surgical suite that has the potential to reduce the extent of cortical exposure required for the intervention. However, the invasive requirements of cortical mapping may supersede the invasive requirements of the surgical intervention itself. Consequently, we demonstrate here a modification to the intraoperative MRI device that facilitates a noninvasive, real-time, functional MR examination in the surgical suite.

  16. Electroencephalographic responses to intraoperative subthalamic stimulation.

    PubMed

    Colloca, Luana; Benedetti, Fabrizio; Bergamasco, Bruno; Vighetti, Sergio; Zibetti, Maurizio; Ducati, Alessandro; Lanotte, Michele; Lopiano, Leonardo

    2006-10-01

    This study reports the effects of intraoperative stimulation of the subthalamic nucleus on brain electrical activity in advanced Parkinson's patients. To our knowledge, this is the first study about electroencephalographic responses in the very early phase of deep brain stimulation, during the implantation of the electrodes. We found an increase of gamma band bilaterally over the sensorimotor cortex in the range 45-55 Hz, which was associated with clinical improvement as assessed by means of muscle rigidity decrease. These results indicate that the electroencephalographic gamma responses to deep brain stimulation are present at the very beginning of the treatment process, and may help better understand the short and long-tem effects of deep brain stimulation.

  17. [Intraoperative sonography to exclude thoracic injury].

    PubMed

    Baranyai, Zsolt; Jósa, Valéria; Jakab, Ferenc; Szabó, Gyozo János

    2007-08-12

    The authors present the case of a 29-year-old female with stab wound to the abdomen. After the initial fluid resuscitation and preliminary radiographic examinations immediate laparotomy was indicated due to hypovolaemic circulatory collapse. Splenectomy and gastric suture were necessary. Following the urgent interventions a wound of the left diaphragm was noticed during the extended abdominal exploration. According to the prior examinations and the operative situation it was not clear whether the injury is penetrating. In order to avoid explorative thoracotomy intraoperative ultrasonography was performed: the transducer and the acoustic gel were placed into sterile plastic bag and the organs above the diaphragm were examined from the abdominal cavity. With this method intrathoracic injury close to the diaphragm could be clearly excluded.

  18. [Intraoperative neurophysiological monitoring improves outcome in neurosurgery].

    PubMed

    Sarnthein, J; Krayenbühl, N; Actor, B; Bozinov, O; Bernays, R

    2012-01-18

    Intraoperative Neurophysiological Mo-nitoring (IONM) identifies eloquent areas or nerves fibers during neurosurgical interventions and monitors their function. For several interventions IONM has become mandatory in neurosurgery. IONM increases patient safety during surgery as the risk of neurological deficits is reduced. Safer surgery reduces the time needed for the intervention and thereby reduces risk. IONM contributes to complete resection of tumors, which in turn prolongs patients' survival. Complicated surgical interventions associated with an elevated risk of neurological deficits have only become possible due to IONM. IONM comprises a variety of procedures that are selected for a particular intervention. With appropriate selection of the procedures IONM has been shown to improve neurological and functional outcome after neurosurgical interventions. PMID:22252591

  19. Intraoperative patient information handover between anesthesia providers

    PubMed Central

    Choromanski, Dominik; Frederick, Joel; McKelvey, George Michael; Wang, Hong

    2014-01-01

    Abstract Currently, no reported studies have evaluated intraoperative handover among anesthesia providers. Studies on anesthetic handover in the US recovery room setting observed that handover processes are insufficient and, in many instances, significant intraoperative events are disregarded. An online survey tool was sent to anesthesia providers at US anesthesia residency programs nationwide (120 out of the 132 US programs encompassing around 4500 residents and their academic MDAs) and a smaller survey selection of CRNAs (10 institutions about 300 CRNAs in the metropolitan area of Detroit, MI, USA) to collect information on handover practices. The response rate to this survey (n = 216) was comprised of approximately 5% (n = 71) of the resident population in US anesthesia programs, 5% (n = 87) of MDAs , and 20% (n = 58) of the CRNAs. Out of all respondents (n = 212), 49.1 % had no hand-over protocol at their institution and 88% of respondents who did have institutional handover protocols believed them insufficient for effective patient handover. In addiiton, 84.8% of all responders reported situations where there was insufficient information received during a patient handover. Only 7% of the respondents reported never experiencing complications or mismanagement due to poor or incomplete hand-overs. In contrast, 60% reported rarely having complications, 31% reported sometimes having complications, and 3% reported frequent complications. In conclusion, handover transition of patient care is a vulnerable and potentially life-threatening event in the operating room. Our preliminary study suggests that current intraoperatvive handover practices among anesthesia providers are suboptimal and that national patient handover guidelines are required to improve patient safety. PMID:25332710

  20. Intraoperative radiation therapy in recurrent ovarian cancer

    SciTech Connect

    Yap, O.W. Stephanie . E-mail: stbeast@stanford.edu; Kapp, Daniel S.; Teng, Nelson N.H.; Husain, Amreen

    2005-11-15

    Purpose: To evaluate disease outcomes and complications in patients with recurrent ovarian cancer treated with cytoreductive surgery and intraoperative radiation therapy (IORT). Methods and Materials: A retrospective study of 24 consecutive patients with ovarian carcinoma who underwent secondary cytoreduction and intraoperative radiation therapy at our institution between 1994 and 2002 was conducted. After optimal cytoreductive surgery, IORT was delivered with orthovoltage X-rays (200 kVp) using individually sized and beveled cone applications. Outcomes measures were local control of disease, progression-free interval, overall survival, and treatment-related complications. Results: Of these 24 patients, 22 were available for follow-up analysis. Additional treatment at the time of and after IORT included whole abdominopelvic radiation, 9; pelvic or locoregional radiation, 5; chemotherapy, 6; and no adjuvant treatment, 2. IORT doses ranged from 9-14 Gy (median, 12 Gy). The anatomic sites treated were pelvis (sidewalls, vaginal cuff, presacral area, anterior pubis), para-aortic and paracaval lymph node beds, inguinal region, or porta hepatitis. At a median follow-up of 24 months, 5 patients remain free of disease, whereas 17 patients have recurred, of whom 4 are alive with disease and 13 died from disease. Five patients recurred within the radiation fields for a locoregional relapse rate of 32% and 12 patients recurred at distant sites with a median time to recurrence of 13.7 months. Five-year overall survival was 22% with a median survival of 26 months from time of IORT. Nine patients (41%) experienced Grade 3 toxicities from their treatments. Conclusion: In carefully selected patients with locally recurrent ovarian cancer, combined IORT and tumor reductive surgery is reasonably tolerated and may contribute to achieving local control and disease palliation.

  1. [The source and influential factors in signals of trans-esophageal oxygen saturation].

    PubMed

    Yu, Siyuan; Mu, Ling; Wei, Wei

    2012-04-01

    This paper is aimed to investigate the signal source and influential factors in signals of trans-esophageal pulse oxygen saturation (SeO2). The red light of the SeO2 probe was faced directly to the descending aorta (DA) of the mongrel dogs. The readings and waveform of SeO2 signals were recorded under following conditions: before and after DA was shield; before and after the blood supply of esophagus was cut off; under the different touch pressures between the SeO2 probe and the esophageal wall. The readings and waveform of SeO2 signals were also recorded respectively at both different esophageal depth and directions when mechanical ventilation was on and off. The tongue oxygen saturation (StO2) was recorded simultaneously as control. The waveform of SeO2 signals disappeared after DA was shield (P < 0.001). No significant difference was found in the SeO2 signals before and after the blood supply of esophagus was cut off (P > 0.05). Compared with the StO2 readings when the SeO2 probe was placed at different esophageal depth, the waldeyer ring, cervical area and thoracic inlet,the readings of SeOz significantly decreased (P < 0.05) while mechanical ventilation was on and off. However, there was no significant difference in the readings between SeO2 signals from DA, aortic arch (AA) and left subclavian artery and the StO2 signals recorded simultaneously. Mechanical ventilation had a remarkable effect on the SeO2 signals at different esophageal depth (P < 0.05), but the StO2 signals lay in its insensitivity to its influence. The readings of StO2 signals were significantly different from that of StO2 signals when the touch pressure between the SeO2 probe and the esophageal wall below 40 mmHg (P < 0.01). The directions of the optimum SeO2 signals acquired at different esophageal depth were not the same. The SeO2 signals were primarily derived from deeper arteries around the esophagus. All of Mechanical ventilation, location of the SeO2 probe in the esophagus and the

  2. Intraoperative urinary cyclic AMP monitoring in primary hyperparathyroidism.

    PubMed Central

    Schenk, W G; Wills, M; MacLeod, M S; Hanks, J B

    1993-01-01

    OBJECTIVE: This study examined the utility of intraoperative urinary cyclic 3'5' adenosine monophosphate (UcAMP), an indicator of parathyroid (PTH) hormone end-organ activity, as a "biochemical frozen section," signaling the real-time resolution of PTH hyperactivity during surgery for primary hyperparathyroidism. SUMMARY BACKGROUND DATA: The unsuccessful initial neck exploration for primary hyperparathyroidism, leaving the patient with persistent hyperfunctioning parathyroid tissue, results in part from the surgeon's inability intraoperatively to correlate a gland's gross appearance and size estimation with physiologic function. Preoperative imaging, intraoperative imaging, and intraoperative histologic/cytologic surveillance have not resolved this dilemma. METHODS: Twenty-seven patients underwent a prospective intraoperative UcAMP monitoring protocol. The patients all had a clinical diagnosis of primary hyperparathyroidism and an average preoperative serum calcium of 12.0 +/- 0.3 mg/dl. UcAMP was assayed intraoperatively using 20-minute nonequilibrium radioimmunoassay providing real-time feedback to the operating team. RESULTS: All patients had an elevated UcAMP confirming PTh hyperactivity at the beginning of the procedure. One patient, subsequently found to have an supernumerary ectopic adenoma, had four normal glands identified intraoperatively, and his intraoperative UcAMP values corroborated persistent hyperparathyroidism, the UcAMP of the remaining 26 patients decreased from 7.0 +/- 1.1 to 2.7 +/- 0.7 nm.dl GF (p < .00005) after complete adenoma excision, and they remain normocalcemic. The protocol provided useful and relevant information to the operating team, and aided in surgical decision-making, in 10 of the 27 cases (37%). CONCLUSION: Intraoperative biochemical surveillance with ucAMP monitoring reliably signals resolution of PTH hyperfunction. It is a useful adjunct to the surgeon's skill, judgment, and experience in parathyroid surgery. PMID:8387765

  3. Migratory intradural disk herniation and a strategy for intraoperative localization.

    PubMed

    Daffner, Scott D; Sedney, Cara L; Rosen, Charles L

    2015-02-01

    Study Design Case report. Objective Describe a case of intradural disk herniation and a method for intraoperative localization. Methods Intradural disk herniations are uncommon but well described. The diagnosis of these lesions is often difficult, and sometimes they may be diagnosed only through an intradural exploration after an expected disk fragment cannot be located. We report the case of an intradural disk herniation with an additional diagnostic difficulty-a migrated intradural disk. Results We present the first intraoperative imaging evidence of disk migration and propose a strategy to locate intradural disk fragments prior to durotomy. Conclusion Intradural disk herniations should be suspected when intraoperative findings are not congruent with imaging findings. An intraoperative myelogram may be helpful. PMID:25648315

  4. Using intraoperative MRI to assess bleeding

    NASA Astrophysics Data System (ADS)

    Liu, Haiying; Hall, Walter A.; Martin, Alastair J.; Truwit, Charles L.

    2001-05-01

    Immediate detector of any surgically induced hemorrhage prior to the closure is important for minimizing the unnecessary post surgical complications. In the case of hemorrhage, the surgical site of interests often involves hemorrhagic blood in the presence of CSF as well as air pockets. It is known that the hemorrhagic blood or air has a different magnetic susceptibility from its surrounding tissue, and CSF has long T1 and T2. Based on these differences, a set of complimentary imaging techniques (T2, FLAIR, and GE) were optimized to reveal the existence of surgically induced acute hemorrhage. Among 330 neurosurgical cases, one relatively severe hemorrhage has been successfully found intra-operatively using the concept. During the case, a new hyperintense area close to the primary motor cortex was initially noticed on T2 weighted HASTE images. As soon as it was found to increase in size rapidly, the patient was treated immediately via craniotomy for aspiration of the intra-parenchymal blood. Owing to early detection and treatment, the patient was completely free of motor deficits. Besides, there were ten much less severe hemorrhages have been noticed using the method. The proper post-surgical care was planned to closely follow-up the patient for any sign of hemorrhage.

  5. Intraoperative imaging using intravascular contrast agent

    NASA Astrophysics Data System (ADS)

    Watson, Jeffrey R.; Martirosyan, Nikolay; Garland, Summer; Lemole, G. Michael; Romanowski, Marek

    2016-03-01

    Near-infrared (NIR) contrast agents are becoming more frequently studied in medical imaging due to their advantageous characteristics, most notably the ability to capture near-infrared signal across the tissue and the safety of the technique. This produces a need for imaging technology that can be specific for both the NIR dye and medical application. Indocyanine green (ICG) is currently the primary NIR dye used in neurosurgery. Here we report on using the augmented microscope we described previously for image guidance in a rat glioma resection. Luc-C6 cells were implanted in a rat in the left-frontal lobe and grown for 22 days. Surgical resection was performed by a neurosurgeon using augmented microscopy guidance with ICG contrast. Videos and images were acquired to evaluate image quality and resection margins. ICG accumulated in the tumor tissue due to enhanced permeation and retention from the compromised bloodbrain- barrier. The augmented microscope was capable of guiding the rat glioma resection and intraoperatively highlighted tumor tissue regions via ICG fluorescence under normal illumination of the surgical field.

  6. Intraoperative Electroretinograms before and after Core Vitrectomy

    PubMed Central

    Yagura, Kazuma; Shinoda, Kei; Matsumoto, Soiti; Terauchi, Gaku; Watanabe, Emiko; Matsumoto, Harue; Akiyama, Goichi; Mizota, Atsushi; Miyake, Yozo

    2016-01-01

    Purpose To evaluate retinal function by intraoperative electroretinograms (ERGs) before and after core vitrectomy. Design Retrospective consecutive case series. Method Full-field photopic ERGs were recorded prior to the beginning and just after core vitrectomy using a sterilized contact lens electrode in 20 eyes that underwent non-complicated vitreous surgery. A light-emitted diode was embedded into the contact lens, and a stimulus of 150 ms on and 350 ms off at 2 Hz was delivered. The amplitudes and latencies of the a-, b-, and d-waves, photopic negative response (PhNR), and oscillatory potentials (OPs) were analyzed. The intraocular temperature at the mid-vitreous was measured at the beginning and just after the surgery with a thermoprobe. Results The intraocular temperature was 33.2 ± 1.3°C before and 29.4 ± 1.7°C after the vitrectomy. The amplitudes of the PhNR and OPs were significantly smaller after surgery, and the latencies of all components were prolonged after the surgery. These changes were not significantly correlated with the changes of the temperature. Conclusion Retinal function is reduced just after core vitrectomy in conjunction with significant temperature reduction. The differences in the degree of alterations of each ERG component suggests different sensitivity of each type of retinal neuron. PMID:27010332

  7. Intraoperative determination and display of cortical function

    NASA Astrophysics Data System (ADS)

    Bass, W. Andrew; Galloway, Robert L., Jr.; Dawant, Benoit M.; Maciunas, Robert J.

    1997-05-01

    One of the most important issues in neurosurgical lesion resection is margin definition. And while there is still some effort required to exactly determine lesion boundaries from tomographic images, the lesions are at least perceptible on the scans. What is not visible is the location of function. Functional imaging such as PET and fMRI hold some promise for cortical function localization; however, intraoperative cortical mapping can provide exact localization of function without ambiguity. Since tomographic images can provide lesion margin definition and cortical mapping can provide functional information we have developed a system for combining the two in our Interactive, Image-Guided system. For cortical surface mapping we need a surface description. Brain contours are extracted from a MRI volume using a deformable model approach and rendered from multiple angular positions. As the surgeon moves a probe, its position is displayed on the view closes to the angular position of the probe. During functional mapping, positive response to stimulation result in a color overlay 'dot' added to the cortical surface display. Different colored dots are used to distinguish between motor function and language function. And a third color is used to display overlapping functionality. This information is used to guide the resection around functionally eloquent areas of the cortex.

  8. A dosimetry intercomparison phantom for intraoperative radiotherapy.

    PubMed

    Armoogum, Kris; Watson, Colin

    2008-01-01

    Intraoperative radiotherapy (IORT) using very low kV x-rays is a promising new treatment modality and has proven to be effective for managing breast and neurological tumours. We have treated in excess of 75 patients using four Zeiss Intrabeam x-ray sources (XRS). To date there has been no published data of any dosimetric intercomparison of this type of x-ray source used at other cancer centres worldwide. This paper describes the design of a simple dosimetry intercomparison phantom for use with these very low kV x-ray sources. A prototype polymethyl methacrylate (PMMA) phantom has been manufactured, the dimensions of which were determined by the dimensions of the XRS, the beam energy and the attenuating properties of PMMA. The phantom is used in conjunction with Gafchromic XR Type-R film (GC-XRR) and its purpose is to measure the absorbed dose at a fixed distance from the effective point source at the tip of the XRS. The utility of this phantom is further enhanced through the use of an interlock, which eliminates the need to use the mobile gantry. We have used this phantom to conduct a qualitative dosimetric intercomparison of four Zeiss Intrabeam x-ray sources with positive results. This phantom is low cost, easy to manufacture, simple to use and could be adopted as a standard method of dosimetric intercomparison for Intrabeam x-ray sources as this mode of IORT becomes more widespread. PMID:18705612

  9. Intraoperative neurophysiological monitoring in spinal surgery

    PubMed Central

    Park, Jong-Hwa; Hyun, Seung-Jae

    2015-01-01

    Recently, many surgeons have been using intraoperative neurophysiological monitoring (IOM) in spinal surgery to reduce the incidence of postoperative neurological complications, including level of the spinal cord, cauda equina and nerve root. Several established technologies are available and combined motor and somatosensory evoked potentials are considered mandatory for practical and successful IOM. Spinal cord evoked potentials are elicited compound potentials recorded over the spinal cord. Electrical stimulation is provoked on the dorsal spinal cord from an epidural electrode. Somatosensory evoked potentials assess the functional integrity of sensory pathways from the peripheral nerve through the dorsal column and to the sensory cortex. For identification of the physiological midline, the dorsal column mapping technique can be used. It is helpful for reducing the postoperative morbidity associated with dorsal column dysfunction when distortion of the normal spinal cord anatomy caused by an intramedullary cord lesion results in confusion in localizing the midline for the myelotomy. Motor evoked potentials (MEPs) consist of spinal, neurogenic and muscle MEPs. MEPs allow selective and specific assessment of the functional integrity of descending motor pathways, from the motor cortex to peripheral muscles. Spinal surgeons should understand the concept of the monitoring techniques and interpret monitoring records adequately to use IOM for the decision making during the surgery for safe surgery and a favorable surgical outcome. PMID:26380823

  10. Thin-Profile Transducers for Intraoperative Hemostasis

    NASA Astrophysics Data System (ADS)

    Zderic, Vesna; Mera, Thomas; Vaezy, Shahram

    2005-03-01

    Our goal has been to develop thin-profile HIFU applicators for intraoperative hemostasis. The HIFU device consisted of a concave PZT element encased in a spoon-shaped aluminum housing with the diameter of 4 cm and thickness of 1 cm. The housing front surface had a thickness of 3/4 ultrasound wavelength in aluminum (0.92 mm) to provide acoustic matching. The device had a resonant frequency of 6.26 MHZ, and efficiency of 42%. The ultrasound field was observed using hydrophone field mapping and radiation force balance. The full-width half-maximum (FWHM) dimensions of the focal region were 0.6 mm and 2.2 mm in lateral and axial direction, respectively. The maximal intensity at the focus was 9,500 W/cm2 (in water). The device was tested using BSA-polyacrylamide gel phantom and rabbit kidney in vivo. HIFU application for 10 s produced lesions in the gel phantom (lesion width of 3 mm), and rabbit kidney in vivo (lesion width of 8 mm). A thin-profile HIFU applicator has advantages of high efficiency, simple design, and small dimensions.

  11. [Intraoperative radiotherapy in malignant bone tumors].

    PubMed

    Yamamuro, T; Kotoura, Y

    1993-06-01

    When a bone tumor is confirmed to be malignant by biopsy and has not expanded into the soft tissue, intraoperative radiation therapy (IORT) is indicated for most parts of the four extremities. The irradiation area is exposed through an extensive skin incision, and the soft tissues are opened and retracted away from the irradiation area, leaving a layer of normal tissue directly covering the tumor. The irradiation is performed with 12-26 MeV electron beams from a betatron at a dose of 50-100 Gy, depending on the radiosensitivity of each tumor. The multifocal bilateral irradiation method is the best for minimizing complications of the soft tissues. Since 1978, we have performed IORT in combination with chemotherapy in 41 cases of malignant bone tumors and experienced only five cases of tumor recurrence one in the irradiated area and four in the non-irradiated area. Joint function in the irradiated limb was excellent. However, due to the high incidence of pathological fracture after IORT in osteolytic tumors, the limb eventually had to be replaced by a prosthesis. After 1984 when cisplatinum was introduced to our chemotherapy protocol, the cumulative 5 year survival rate increased to 81%, with the irradiated lesion preserved in situ in osteoblastic tumors and replaced with a prosthesis in osteolytic tumors.

  12. Intraoperative Neurophysiological Monitoring (IONM) for Cordotomy Procedures.

    PubMed

    Jahangiri, Faisal R

    2015-09-01

    This case illustrates the benefits of utilizing intraoperative neurophysiological monitoring (IONM) for preventing injury to sensory/motor pathways of the spinal cord during a cordotomy procedure to relieve pain. Cordotomy has been used effectively in the treatment of visceral pain but comes with a high risk of damaging motor and sensory pathways due to close proximity of lesion. The subject is a 47-year-old female with a pancoast tumor of the left lung, left brachialplexopathy, and severe neuropathic pain syndrome, refractory to medical therapy. A palliative cordotomy procedure was elected for pain control. Baseline bilateral posterior tibial and median nerve somatosensory evoked potentials (SSEP) were present except in the left upper extremity. Transcranial electric motor evoked potential (TCeMEP) baselines were present in all extremities except the left upper. Total intravenous anesthesia was used. The spine was exposed at C2-C3 and a right single anterolateral cordotomy was performed with an immediate drop in TCeMEPs (70-80% amplitude reduction) in the right upper and right lower extremities. The surgeon decided to stop the cordotomy at that point. Postoperatively, the patient had no sensory or motor deficit. In this patient, TCeMEPs were used effectively to guide the surgeon in preventing damage to the spinal cord that could lead to motor deficits. PMID:26630809

  13. Intraoperative complications in pediatric neurosurgery: review of 1807 cases.

    PubMed

    van Lindert, Erik J; Arts, Sebastian; Blok, Laura M; Hendriks, Mark P; Tielens, Luc; van Bilsen, Martine; Delye, Hans

    2016-09-01

    OBJECTIVE Minimal literature exists on the intraoperative complication rate of pediatric neurosurgical procedures with respect to both surgical and anesthesiological complications. The aim of this study, therefore, was to establish intraoperative complication rates to provide patients and parents with information on which to base their informed consent and to establish a baseline for further targeted improvement of pediatric neurosurgical care. METHODS A clinical complication registration database comprising a consecutive cohort of all pediatric neurosurgical procedures carried out in a general neurosurgical department from January 1, 2004, until July 1, 2012, was analyzed. During the study period, 1807 procedures were performed on patients below the age of 17 years. RESULTS Sixty-four intraoperative complications occurred in 62 patients (3.5% of procedures). Intraoperative mortality was 0.17% (n = 3). Seventy-eight percent of the complications (n = 50) were related to the neurosurgical procedures, whereas 22% (n = 14) were due to anesthesiology. The highest intraoperative complication rates were for cerebrovascular surgery (7.7%) and tumor surgery (7.4%). The most frequently occurring complications were cerebrovascular complications (33%). CONCLUSIONS Intraoperative complications are not exceptional during pediatric neurosurgical procedures. Awareness of these complications is the first step in preventing them. PMID:27231823

  14. [Amplatzer® Vascular Plug III, for closing residual mitral paravalvular leak: three-dimensional transesophageal echocardiography image].

    PubMed

    Reyes-Gómez, Carlos Alberto; García-Montes, José Antonio; Arias-Godínez, Antonio; Zabal-Cerdeira, Carlos

    2015-01-01

    Paravalvular leak is a significant complication after surgical valve replacement. Traditionally, redo surgery has been considered the treatment of choice, but is associated with high morbidity and mortality as well as increase risk of developing new leaks. Percutaneous treatment of paravalvular leak appears as an attractive alternative. Such treatment has been made possible by the current ability to integrate multiple imaging modalities that have helped to define the anatomy of the defect and planning and guiding the percutaneous closure procedure, thus resulting in better outcomes. The Amplatzer® Vascular Plug III (St. Jude Medical) is the first device specifically designed for percutaneous closure of paravalvular leak with promising results. We present the three-dimensional transesophageal echocardiographic images of a successful outcome of percutaneous closure of a residual mitral paravalvular leak with an Amplatzer® Vascular Plug III device (St. Jude Medical), after an initial procedure of percutaneous closure with an Amplatzer® duct occluder (St. Jude Medical). PMID:25912709

  15. Coronary artery fistula: 64-slice computed tomographic delineation and correlation with multiplane transesophageal echocardiography and surgical findings.

    PubMed

    Joshi, Jonathan K; Beache, Garth M; Slaughter, Mark S; Sobieski, Michael A; Schneider, William; Stoddard, Marcus F

    2012-03-01

    A 49-year-old female who presented with 3 weeks of exertional chest pain had an abnormal mediastinal finding at chest x-ray imaging. Conventional, nongated computed tomography of the chest revealed a "mass" in proximity to the right atrium. 64-slice, cardiac gated computed tomographic coronary angiography, and transesophageal echocardiography delineated the "mass" as a coronary artery fistula structure. The fistula originated from the left main as a tubular vessel that continued into an aneurysmal sac-like cavity that emptied into the superior vena cava near the right atrium. Computed tomographic coronary angiography showed otherwise normal coronary arteries. Findings were ultimately confirmed at cardiac catheterization. Coronary steal was clinically diagnosed and she underwent surgical ligation and resection of the fistula and aneurysm. Her subsequent course was uncomplicated.

  16. Our intraoperative boost radiotherapy experience and applications

    PubMed Central

    Günay, Semra; Alan, Ömür; Yalçın, Orhan; Türkmen, Aygen; Dizdar, Nihal

    2016-01-01

    Objective: To present our experience since November 2013, and case selection criteria for intraoperative boost radiotherapy (IObRT) that significantly reduces the local recurrence rate after breast conserving surgery in patients with breast cancer. Material and Methods: Patients who were suitable for IObRT were identified within the group of patients who were selected for breast conserving surgery at our breast council. A MOBETRON (mobile linear accelerator for IObRT) was used for IObRt during surgery. Results: Patients younger than 60 years old with <3 cm invasive ductal cancer in one focus (or two foci within 2 cm), with a histologic grade of 2–3, and a high possibility of local recurrence were admitted for IObRT application. Informed consent was obtained from all participants. Lumpectomy and sentinel lymph node biopsy was performed and advancement flaps were prepared according to the size and inclination of the conus following evaluation of tumor size and surgical margins by pathology. Distance to the thoracic wall was measured, and a radiation oncologist and radiation physicist calculated the required dose. Anesthesia was regulated with slower ventilation frequency, without causing hypoxia. The skin and incision edges were protected, the field was radiated (with 6 MeV electron beam of 10 Gy) and the incision was closed. In our cases, there were no major postoperative surgical or early radiotherapy related complications. Conclusion: The completion of another stage of local therapy with IObRT during surgery positively effects sequencing of other treatments like chemotherapy, hormonotherapy and radiotherapy, if required. IObRT increases disease free and overall survival, as well as quality of life in breast cancer patients. PMID:26985156

  17. A light blanket for intraoperative photodynamic therapy

    NASA Astrophysics Data System (ADS)

    Hu, Yida; Wang, Ken; Zhu, Timothy C.

    2009-06-01

    A novel light source - light blanket composed of a series of parallel cylindrical diffusing fibers (CDF) is designed to substitute the hand-held point source in the PDT treatment of the malignant pleural or intraperitoneal diseases. It achieves more uniform light delivery and less operation time in operating room. The preliminary experiment was performed for a 9cmx9cm light blanket composed of 8 9-cm CDFs. The linear diffusers were placed in parallel fingerlike pockets. The blanket is filled with 0.2 % intralipid scattering medium to improve the uniformity of light distribution. 0.3-mm aluminum foil is used to shield and reflect the light transmission. The full width of the profile of light distribution at half maximum along the perpendicular direction is 7.9cm and 8.1cm with no intralipid and with intralipid. The peak value of the light fluence rate profiles per input power is 11.7mW/cm2/W and 8.6mW/cm2/W respectively. The distribution of light field is scanned using the isotropic detector and the motorized platform. The average fluence rate per input power is 8.6 mW/cm2/W and the standard deviation is 1.6 mW/cm2/W for the scan in air, 7.4 mW/cm2/W and 1.1 mW/cm2/W for the scan with the intralipid layer. The average fluence rate per input power and the standard deviation are 20.0 mW/cm2/W and 2.6 mW/cm2/W respectively in the tissue mimic phantom test. The light blanket design produces a reasonably uniform field for effective light coverage and is flexible to confirm to anatomic structures in intraoperative PDT. It also has great potential value for superficial PDT treatment in clinical application.

  18. Automated intraoperative calibration for prostate cancer brachytherapy

    SciTech Connect

    Kuiran Chen, Thomas; Heffter, Tamas; Lasso, Andras; Pinter, Csaba; Abolmaesumi, Purang; Burdette, E. Clif; Fichtinger, Gabor

    2011-11-15

    Purpose: Prostate cancer brachytherapy relies on an accurate spatial registration between the implant needles and the TRUS image, called ''calibration''. The authors propose a new device and a fast, automatic method to calibrate the brachytherapy system in the operating room, with instant error feedback. Methods: A device was CAD-designed and precision-engineered, which mechanically couples a calibration phantom with an exact replica of the standard brachytherapy template. From real-time TRUS images acquired from the calibration device and processed by the calibration system, the coordinate transformation between the brachytherapy template and the TRUS images was computed automatically. The system instantly generated a report of the target reconstruction accuracy based on the current calibration outcome. Results: Four types of validation tests were conducted. First, 50 independent, real-time calibration trials yielded an average of 0.57 {+-} 0.13 mm line reconstruction error (LRE) relative to ground truth. Second, the averaged LRE was 0.37 {+-} 0.25 mm relative to ground truth in tests with six different commercial TRUS scanners operating at similar imaging settings. Furthermore, testing with five different commercial stepper systems yielded an average of 0.29 {+-} 0.16 mm LRE relative to ground truth. Finally, the system achieved an average of 0.56 {+-} 0.27 mm target registration error (TRE) relative to ground truth in needle insertion tests through the template in a water tank. Conclusions: The proposed automatic, intraoperative calibration system for prostate cancer brachytherapy has achieved high accuracy, precision, and robustness.

  19. Intraoperative value of the thompson test.

    PubMed

    Cuttica, Daniel J; Hyer, Christopher F; Berlet, Gregory C

    2015-01-01

    The purpose of the present study was to assess the validity of the Thompson sign and determine whether the deep flexors of the foot can produce a falsely intact Achilles tendon.Ten unmatched above-the-knee lower extremity cadaveric specimens were studied. In group 1, the Achilles tendon was sectioned into 25% increments. The Thompson maneuver was performed after each sequential sectioning of the Achilles tendon, including after it had been completely sectioned. If the Thompson sign was still intact after complete release of the Achilles tendon, we proceeded to release the tendon, and tendon flexor hallucis longus, flexor digitorum longus, and posterior tibial tendons. The Thompson test was performed after the release of each tendon. In group 2, the tendon releases were performed in a reverse order to that of group 1, with the Thompson test performed after each release. In group 1, the Thompson sign remained intact in all specimens after sectioning of 25%, 50%, and 75% of the tendon. After complete (100%) release of the tendon, the Thompson sign was absent in all specimens. In group 2, the Thompson sign remained intact after sectioning of the posterior tibial, flexor digitorum longus, and flexor hallucis longus tendons in all specimens. The Thompson sign remained intact in all specimens after sectioning of 25%, 50%, and 75% of the Achilles tendon. After complete release of the tendon, the Thompson sign was absent in all specimens.The Thompson test is an accurate clinical test for diagnosing complete Achilles tendon ruptures. However, it might not be a useful test for diagnosing partial Achilles tendon ruptures. Our findings also call into question the usefulness of the Thompson test in the intraoperative setting.

  20. The value of transthoracic and transesophageal echocardiography for the diagnosis of the native aortic infective endocarditis valve complications: a case report and literature review.

    PubMed

    Molnar, Adrian; Sacui, Diana; Manole, Simona; Radulescu, Amanda; Beyer, Ruxandra

    2016-06-01

    Despite its current limitations transthoracic echocardiography is still widely used for the anatomical and functional evaluation of patients with infective endocarditis. However, all these limitations can be overcome by using transesophageal echocardiography. We present the case of a 42-year-old male patient, diagnosed with aortic valve infective endocarditis, whose transthoracic echocardiography showed only a cusp vegetation and aortic regurgitation, but raised the suspicion of periannular complications. The transesophageal echocardiography revealed a circular aortic root abscess and a ventricular septal defect with left-to-right shunt, and consequently leads to a complete different surgical tactical approach. The patient was urgently referred for surgery due to the rapid deterioration of the hemodynamic status, and had a good outcome on the short-term follow-up.

  1. The use of intraoperative computed tomography navigation in pituitary surgery promises a better intraoperative orientation in special cases

    PubMed Central

    Linsler, Stefan; Antes, Sebastian; Senger, Sebastian; Oertel, Joachim

    2016-01-01

    Objective: The safety of endoscopic skull base surgery can be enhanced by accurate navigation in preoperative computed tomography (CT) and magnetic resonance imaging (MRI). Here, we report our initial experience of real-time intraoperative CT-guided navigation surgery for pituitary tumors in childhood. Materials and Methods: We report the case of a 15-year-old girl with a huge growth hormone-secreting pituitary adenoma with supra- and perisellar extension. Furthermore, the skull base was infiltrated. In this case, we performed an endonasal transsphenoidal approach for debulking the adenoma and for chiasma decompression. We used an MRI neuronavigation (Medtronic Stealth Air System) which was registered via intraoperative CT scan (Siemens CT Somatom). Preexisting MRI studies (navigation protocol) were fused with the intraoperative CT scans to enable three-dimensional navigation based on MR and CT imaging data. Intraoperatively, we did a further CT scan for resection control. Results: The intraoperative accuracy of the neuronavigation was excellent. There was an adjustment of <1 mm. The navigation was very helpful for orientation on the destroyed skull base in the sphenoid sinus. After opening the sellar region and tumor debulking, we did a CT scan for resection control because the extent of resection was not credible evaluable in this huge infiltrating adenoma. Thereby, we were able to demonstrate a sufficient decompression of the chiasma and complete resection of the medial part of the adenoma in the intraoperative CT images. Conclusions: The use of intraoperative CT/MRI-guided neuronavigation for transsphenoidal surgery is a time-effective, safe, and technically beneficial technique for special cases.

  2. The use of intraoperative computed tomography navigation in pituitary surgery promises a better intraoperative orientation in special cases

    PubMed Central

    Linsler, Stefan; Antes, Sebastian; Senger, Sebastian; Oertel, Joachim

    2016-01-01

    Objective: The safety of endoscopic skull base surgery can be enhanced by accurate navigation in preoperative computed tomography (CT) and magnetic resonance imaging (MRI). Here, we report our initial experience of real-time intraoperative CT-guided navigation surgery for pituitary tumors in childhood. Materials and Methods: We report the case of a 15-year-old girl with a huge growth hormone-secreting pituitary adenoma with supra- and perisellar extension. Furthermore, the skull base was infiltrated. In this case, we performed an endonasal transsphenoidal approach for debulking the adenoma and for chiasma decompression. We used an MRI neuronavigation (Medtronic Stealth Air System) which was registered via intraoperative CT scan (Siemens CT Somatom). Preexisting MRI studies (navigation protocol) were fused with the intraoperative CT scans to enable three-dimensional navigation based on MR and CT imaging data. Intraoperatively, we did a further CT scan for resection control. Results: The intraoperative accuracy of the neuronavigation was excellent. There was an adjustment of <1 mm. The navigation was very helpful for orientation on the destroyed skull base in the sphenoid sinus. After opening the sellar region and tumor debulking, we did a CT scan for resection control because the extent of resection was not credible evaluable in this huge infiltrating adenoma. Thereby, we were able to demonstrate a sufficient decompression of the chiasma and complete resection of the medial part of the adenoma in the intraoperative CT images. Conclusions: The use of intraoperative CT/MRI-guided neuronavigation for transsphenoidal surgery is a time-effective, safe, and technically beneficial technique for special cases. PMID:27695249

  3. Use of intraoperative ultrasonography in canine spinal cord lesions.

    PubMed

    Nanai, Beatrix; Lyman, Ronald; Bichsel, Pierre S

    2007-01-01

    The purpose of this retrospective study was to describe the intraoperative appearance of various spinal cord conditions, and to investigate how intraoperative ultrasonography assisted in modification of surgical and postoperative treatment plans. Intraoperative ultrasonography (B-mode, and power Doppler mode) was used in 25 dogs undergoing spinal surgery. The neurologic conditions included cervical spondylomyelopathy, intervertebral disc (IVD) protrusion, IVD extrusion, spinal tumors, nerve sheath mass, granulomatous myelitis, and discospondylitis. All of these diagnoses were supported by histopathologic and/or cytologic evaluation. It was possible to visualize the spinal cord and the abnormal spinal tissue in all of the patients. Power Doppler imaging allowed assessment of the spinal cord microcirculation, and assisted in judgment of the degree of decompression. Ultrasound imaging directly impacted the surgical and the medical treatment plans in four patients. Owing to the intraoperative imaging, two hemilaminectomies were extended cranially and caudally, and additional disc spaces were fenestrated, one hemilaminectomy site was extended dorsally to retrieve the disc material from the opposite side, and one intramedullary cervical spinal cord lesion was discovered, aspirated, and consequently diagnosed as granulomatous inflammation, which altered the long-term medication protocol in that dog. This study suggests that intraoperative sonographic spinal cord imaging is a useful and viable technique.

  4. Rate of intraoperative complications during cataract surgery following intravitreal injections.

    PubMed

    Hahn, P; Jiramongkolchai, K; Stinnett, S; Daluvoy, M; Kim, T

    2016-08-01

    PurposeTo investigate the effect of prior intravitreal injections on intraoperative and postoperative complication rates associated with cataract surgery.MethodsA retrospective cohort analysis reviewed 10 105 cataract surgery procedures performed by experienced surgeons at the Duke Eye Center from 1 January 2005 to 10 December 2012. A group of 197 eyes with prior intravitreal injections was compared with an equal number of matched control eyes without prior injection using the Fisher's exact test of difference in proportions and the Wilcoxon rank-sum test of difference in means. Outcomes analyzed included baseline demographic information, preoperative clinical characteristics, prevalence of intraoperative complications, and postoperative intraocular pressure, glaucoma surgery, and glaucoma medication requirement through 1 year following cataract surgery.ResultsAn increased rate of intraoperative complications was identified during cataract surgery in eyes with prior intravitreal injections compared with control eyes (3 vs 0%, P=0.030). Injection eyes required more glaucoma medications at 1 year, but no difference was identified if steroid injections were excluded. No difference in postoperative IOP or glaucoma surgery was identified. No cases of endophthalmitis were reported.ConclusionsA history of intravitreal injections may be a risk factor for cataract surgery-related intraoperative complications. We hypothesize this may be due to unidentified iatrogenic lens trauma during intravitreal injections. Particular attention to the posterior capsule during preoperative assessment and intraoperatively is recommended in eyes undergoing cataract surgery with a prior history of intravitreal injections.

  5. Intraoperative bowel cleansing tool in active locomotion capsule endoscopy.

    PubMed

    Ciuti, G; Tognarelli, S; Verbeni, A; Menciassi, A; Dario, P

    2013-01-01

    Capsule endoscopy (CE) can be considered an example of "disruptive technology" since it represents a bright alternative to traditional diagnostic methodologies. If compared with traditional endoscopy, bowel cleansing procedure in CE becomes of greater importance, due to the impossibility to intraoperatively operate on unclean gastrointestinal tract areas. Considering the promising results and benefits obtained in the field of CE for gastrointestinal diagnosis and intervention, the authors approached the bowel cleansing issue with the final aim to propose an innovative and easy-to-use intraoperative cleansing system to be applied to an active locomotion softly-tethered capsule device, already developed by the authors. The system, that has to be intended as an additional tool for intraoperatively cleansing procedure of the colonic tract, is composed by a flexible tube with a metallic deflector attached to the distal end; it can be headed to the target area through the capsule operating channel. Performances of the colonoscopic capsule and intraoperative cleansing capabilities were successfully confirmed both in an in-vitro and ex-vivo experimental session. The innovative intraoperative cleansing system demonstrated promising results in terms of water injection, colonic wall cleansing procedure and subsequent water suction, thus guaranteeing to reduce the risk of inadequate visualization of the mucosa in endoscopic procedures. PMID:24110819

  6. Indocyanine green for intraoperative localization of ureter.

    PubMed

    Siddighi, Sam; Yune, Junchan Joshua; Hardesty, Jeffrey

    2014-10-01

    Intraurethral injection of indocyanine green (ICG; Akorn, Lake Forest, IL) and visualization under near-infrared (NIR) light allows for real-time delineation of the ureter. This technology can be helpful to prevent iatrogenic ureteral injury during pelvic surgery. Patients were scheduled to undergo robot-assisted laparoscopic sacrocolpopexy. Before the robotic surgery started, the tip of a 6-F ureteral catheter was inserted into the ureteral orifice. Twenty-five milligrams of ICG was dissolved in 10-mL of sterile water and injected through the open catheter. The same procedure was repeated on the opposite side. The ICG reversibly stained the inside lining of the ureter by binding to proteins on urothelial layer. During the course of robotic surgery, the NIR laser on the da Vinci Si surgical robot (Intuitive Surgical, Inc, Sunnyvale, CA) was used to excite ICG molecules, and infrared emission was captured by the da Vinci filtered lens system and electronically converted to green color. Thus, the ureter fluoresced green, which allowed its definitive identification throughout the entire case. In all cases of >10 patients, we were able to visualize bilateral ureters with this technology, even though there was some variation in brightness that depended on the depth of the ureter from the peritoneal surface. For example, in a morbidly obese patient, the ureters were not as bright green. There were no intraoperative or postoperative adverse effects attributable to ICG administration for up to 2 months of observation. In our experience, this novel method of intraurethral ICG injection was helpful to identify the entire course of ureter and allowed a safe approach to tissues that were adjacent to the urinary tract. The advantage of our technique is that it requires the insertion of just the tip of ureteral catheter. Despite our limited cohort of patients, our findings are consistent with previous reports of the excellent safety profile of intravenous and intrabiliary ICG

  7. Quantitative Intraoperative Torsional Forced Duction Test

    PubMed Central

    Jung, Jae Ho; Holmes, Jonathan M.

    2015-01-01

    Purpose We developed a method for quantifying intraoperative torsional forced ductions and validated the new test by comparing patients with oblique dysfunction and controls. Design Comparative case series Subjects We studied 33 eyes with oblique dysfunction (9 presumed congenital superior oblique palsy (SOP), 13 acquired SOP, 7 Brown syndrome, and 4 Inverted Brown syndrome) and 31 controls. We also studied maximal excyclorotation after superior oblique (SO) disinsertion in 6 eyes and maximal incyclorotation after inferior oblique (IO) disinsertion in 2 eyes. Methods Under deep general anesthesia, the 12 and 6 o’clock positions at the limbus were marked and the globe was maximally excyclorotated and incyclorotated without retroplacement until the first resistance was felt, and the angle of rotation (in degrees) was read on a Mendez ring by the surgeon. A photograph was taken in each position to be read by a masked observer. Main outcome measures Maximal excyclorotation and maximal incyclorotation in each oblique dysfunction and in controls, by both surgeon’s report and photographic assessment. We duplicated the photographs to evaluate test-retest reliability and to evaluate agreement between the surgeon’s assessments and photographic assessment. Results Surgeon’s assessment revealed greater maximal excyclorotation in presumed congenital SOP than controls (median, 40 degrees versus 30 degrees). Maximal excyclorotation in acquired SOP was similar to controls (30 degrees in both). Eyes with Brown syndrome and Inverted Brown syndrome had lower maximal excyclorotation than controls (10 degrees and 20 degrees versus 30 degrees, respectively). Maximal incyclorotation in inverted Brown syndrome was lower than controls (12.5 degrees versus 30 degrees) whereas it was similar to controls in presumed congenital SOP, acquired SOP and Brown syndrome (30 degrees in each condition). Median maximal excyclorotation after SO disinsertion was 62.5 degrees and maximal

  8. Mitral paravalvular leak closure by antegrade percutaneous approach: three-dimensional transesophageal echocardiographic guided multiple Amplatzer implantation by a modified sequential anchoring-based technique.

    PubMed

    Tarantini, Giuseppe; Mojoli, Marco; Napodano, Massimo

    2013-10-01

    We describe the technical aspects and the possible advantages of a modified anchoring-based technique for the implantation of multiple Amplatzer devices, in a case of large anteroseptal mitral paravalvular leak causing massive regurgitation, which was manaed by antegrade transseptal, single-stage, percutaneous approach. Real-time three-dimensional transesophageal echocardiographic guidance was crucial to ensure successful recrossings of the target defect and the optimal anatomical closure. PMID:23613380

  9. [Constant-frequency trans-esophageal electric atrial stimulation for evaluation of the severity of illness in patients with stenocardia and the anti-angina effect of erinit].

    PubMed

    Gasilin, V S; Sidorenko, B A; Lazarev, I A; Smirnov, M Iu

    1990-12-01

    Constant-frequency transesophageal atrial pacing was used in 87 patients with coronary heart disease concurrent with stable angina pectoris of various functional classes (I-IV). This technique, as a bicycle ergometric test, allows one to assess the functional class of patients with angina and to ascertain the antianginal effect of agents, which was exemplified by erinit given in doses of 80 and 120 mg.

  10. Three-dimensional transesophageal echocardiography with agitated saline injection to differentiate between atrial septal defects and echo drop-out artifacts.

    PubMed

    Alherbish, Aws; Shanks, Miriam; Choy, Jonathan

    2014-12-01

    The diagnosis of multiple atrial septal defects is less challenging with 3-D transesophageal echocardiography. However, the common occurrence of echo drop-out (acoustic shadow) artifacts with 3-D echocardiography can make the differentiation between a second defect and an artifact challenging. Agitated saline injection with direct visualization using 3-D echocardiography can help resolve this by allowing visualization of the bubbles crossing from true defects.

  11. Choose the best route: ultrasound-guided transbronchial and transesophageal needle aspiration with echobronchoscope in the diagnosis of mediastinal and pulmonary lesions.

    PubMed

    Mondoni, M; D'Adda, A; Terraneo, S; Carlucci, P; Radovanovic, D; DI Marco, F; Santus, P

    2015-10-01

    Nodal mediastinal staging is a crucial part of the diagnostic workup of patients with non-small-cell lung cancer (NSCLC) for planning optimal treatment. Transesophageal endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and real-time endobronchial ultrasounds transbronchial needle aspiration (EBUS-TBNA) are accurate, minimally invasive and safe diagnostic techniques for mediastinal staging. Because of the different accessibility to the mediastinum, they are considered complementary and their combination increases the diagnostic yield as compared with the either alone. Recent studies have shown that endosonography represents the best initial test for invasive mediastinal evaluation in NSCLC. Endoscopic ultrasound (with bronchoscope)-guided fine needle aspiration (EUS-B-FNA) is a recently introduced procedure consisting of a transesophageal needle aspiration using an ultrasound bronchoscope. It allows to perform both transbronchial and transesophageal needle sampling with the same instrument, in the same session and by one operator only, thus maximizing time and costs savings. In a recent study Oki et al. randomized 110 patients with hilar/mediastinal adenopathies or lung abnormalities adjoining both the esophagus and the bronchi, to undergo EBUS-TBNA or EUS-FNA performed by pulmonologists with an echobronchoscope. The Authors demonstrated that both procedures provide a high diagnostic yield, without any difference in the number of adverse events and a good comparable tolerance. Nevertheless, the transesophageal approach guaranteed a significantly lower dose of anesthetics and sedatives, a shorter procedural time, fewer oxygen desaturations, a significantly lower cough score and a higher operator satisfaction. In this review our aim was to discuss the findings by Oki et al. in the context of medical literature, highlighting the importance of the EUS-B needle aspiration technique in diagnosing mediastinal and lung lesions, when EBUS-TBNA is deemed less

  12. Intraoperative intracardiac thrombosis in a liver transplant patient

    PubMed Central

    Sibulesky, Lena; Peiris, Prith; Taner, C Burcin; Kramer, David J; Canabal, Juan M; Nguyen, Justin H

    2010-01-01

    A 66-year-old female with cryptogenic cirrhosis complicated by ascites, hepatic encephalopathy, variceal bleeding and malnutrition with MELD of 34 underwent orthotopic deceased donor liver transplantation performed with piggyback technique. Extensive eversion thromboendovenectomy was performed for a portal vein thrombus which resulted in an excellent portal vein flow. The liver graft was recirculated without any hemodynamic instability. Subsequently, the patient became hypotensive progressing to asystole. She was resuscitated and a transesophageal probe was inserted which revealed a mobile right atrial thrombus and an underfilled poorly contractile right ventricle. The patient was noted to be coagulopathic at the time. She became progressively more stable with a TEE showing complete resolution of the intracardiac thrombus. PMID:21160996

  13. Patent Foramen Ovale: Association between the Degree of Shunt by Contrast Transesophageal Echocardiography and the Risk of Future Ischemic Neurologic Events

    NASA Technical Reports Server (NTRS)

    Stone, David A.; Godard, Joel; Godard, Joel; Corretti, mary C.; Kittner, Steven J.; Sample, Cindy; Price, Thomas R.; Plotnick, Gary D.

    1996-01-01

    This study investigated whether there is an association between the degree of interatrial shunting across a patent foramen ovale, as determined by saline contrast transesophageal echocardiography, and the risk of subsequent systemic embolic events, including stroke. Thirty-four patients found to have patent foramen ovale during transesophageal echocardiography were divided into two groups on the basis of the maximum number of microbubbles in the left heart in any single frame after intravenous saline contrast injection: group 1 (n = 16) with a "large" degree of shunt (220 microbubbles) and group 2 (n = 18) with a "small" degree of shunt (23 but <20 microbubbles). Patients were followed up over a mean period of 21 months for subsequent systemic embolic events, including transient ischemic attack and stroke. Five (31%) of the patients with large shunts had subsequent ischemic neurologic events, whereas none of the patients with small shunts had embolic events (p= 0.03). These events occurred in spite of antiplatelet or anticoagulant therapy. We conclude that patients with a large degree of shunt across a patent foramen ovale, as determined by contrast transesophageal echocardiography, are at a significantly higher risk for subsequent adverse neurologic events compared with patients with a small degree of shunt.

  14. Robust endoscopic pose estimation for intraoperative organ-mosaicking

    NASA Astrophysics Data System (ADS)

    Reichard, Daniel; Bodenstedt, Sebastian; Suwelack, Stefan; Wagner, Martin; Kenngott, Hannes; Müller-Stich, Beat Peter; Dillmann, Rüdiger; Speidel, Stefanie

    2016-03-01

    The number of minimally invasive procedures is growing every year. These procedures are highly complex and very demanding for the surgeons. It is therefore important to provide intraoperative assistance to alleviate these difficulties. For most computer-assistance systems, like visualizing target structures with augmented reality, a registration step is required to map preoperative data (e.g. CT images) to the ongoing intraoperative scene. Without additional hardware, the (stereo-) endoscope is the prime intraoperative data source and with it, stereo reconstruction methods can be used to obtain 3D models from target structures. To link reconstructed parts from different frames (mosaicking), the endoscope movement has to be known. In this paper, we present a camera tracking method that uses dense depth and feature registration which are combined with a Kalman Filter scheme. It provides a robust position estimation that shows promising results in ex vivo and in silico experiments.

  15. The Use of Optical Coherence Tomography in Intraoperative Ophthalmic Imaging

    PubMed Central

    Hahn, Paul; Migacz, Justin; O’Connell, Rachelle; Maldonado, Ramiro S.; Izatt, Joseph A.; Toth, Cynthia A.

    2012-01-01

    Optical coherence tomography (OCT) has transformed diagnostic ophthalmic imaging but until recently has been limited to the clinic setting. The development of spectral-domain OCT (SD-OCT), with its improved speed and resolution, along with the development of a handheld OCT scanner, enabled portable imaging of patients unable to sit in a conventional tabletop scanner. This handheld SD-OCT unit has proven useful in examinations under anesthesia and, more recently, in intraoperative imaging of preoperative and postoperative manipulations. Recently, several groups have pioneered the development of novel OCT modalities, such as microscope-mounted OCT systems. Although still immature, the development of these systems is directed toward real-time imaging of surgical maneuvers in the intraoperative setting. This article reviews intraoperative imaging of the posterior and anterior segment using the handheld SD-OCT and recent advances toward real-time microscope-mounted intrasurgical imaging. PMID:21790116

  16. Intraoperative brain cancer detection with Raman spectroscopy in humans.

    PubMed

    Jermyn, Michael; Mok, Kelvin; Mercier, Jeanne; Desroches, Joannie; Pichette, Julien; Saint-Arnaud, Karl; Bernstein, Liane; Guiot, Marie-Christine; Petrecca, Kevin; Leblond, Frederic

    2015-02-11

    Cancers are often impossible to visually distinguish from normal tissue. This is critical for brain cancer where residual invasive cancer cells frequently remain after surgery, leading to disease recurrence and a negative impact on overall survival. No preoperative or intraoperative technology exists to identify all cancer cells that have invaded normal brain. To address this problem, we developed a handheld contact Raman spectroscopy probe technique for live, local detection of cancer cells in the human brain. Using this probe intraoperatively, we were able to accurately differentiate normal brain from dense cancer and normal brain invaded by cancer cells, with a sensitivity of 93% and a specificity of 91%. This Raman-based probe enabled detection of the previously undetectable diffusely invasive brain cancer cells at cellular resolution in patients with grade 2 to 4 gliomas. This intraoperative technology may therefore be able to classify cell populations in real time, making it an ideal guide for surgical resection and decision-making.

  17. [Intraoperative monitoring of oxygen tissue pressure: Applications in vascular neurosurgery].

    PubMed

    Arikan, Fuat; Vilalta, Jordi; Torne, Ramon; Chocron, Ivette; Rodriguez-Tesouro, Ana; Sahuquillo, Juan

    2014-01-01

    Ischemic lesions related to surgical procedures are a major cause of postoperative morbidity in patients with cerebral vascular disease. There are different systems of neuromonitoring to detect intraoperative ischemic events, including intraoperative monitoring of oxygen tissue pressure (PtiO2). The aim of this article was to describe, through the discussion of 4 cases, the usefulness of intraoperative PtiO2 monitoring during vascular neurosurgery. In presenting these cases, we demonstrate that monitoring PtiO2 is a reliable way to detect early ischemic events during surgical procedures. Continuous monitoring of PtiO2 in an area at risk allows the surgeon to resolve the cause of the ischemic event before it evolves to an established cerebral infarction. PMID:24934513

  18. Navigation, robotics, and intraoperative imaging in spinal surgery.

    PubMed

    Ringel, Florian; Villard, Jimmy; Ryang, Yu-Mi; Meyer, Bernhard

    2014-01-01

    Spinal navigation is a technique gaining increasing popularity. Different approaches as CT-based or intraoperative imaging-based navigation are available, requiring different methods of patient registration, bearing certain advantages and disadvantages. So far, a large number of studies assessed the accuracy of pedicle screw implantation in the cervical, thoracic, and lumbar spine, elucidating the advantages of image guidance. However, a clear proof of patient benefit is missing, so far. Spinal navigation is closely related to intraoperative 3D imaging providing an imaging dataset for navigational use and the opportunity for immediate intraoperative assessment of final screw position giving the option of immediate screw revision if necessary. Thus, postoperative imaging and a potential revision surgery for screw correction become dispensable.Different concept of spinal robotics as the DaVinci system and SpineAssist are under investigation.

  19. A Comprehensive System for Intraoperative 3D Brain Deformation Recovery

    PubMed Central

    DeLorenzo, Christine; Papademetris, Xenophon; Vives, Kenneth P.; Spencer, Dennis D.; Duncan, James S.

    2010-01-01

    During neurosurgery, brain deformation renders preoperative images unreliable for localizing pathologic structures. In order to visualize the current brain anatomy, it is necessary to nonrigidly warp these preoperative images to reflect the intraoperative brain. This can be accomplished using a biomechanical model driven by sparse intraoperative information. In this paper, a linear elastic model of the brain is developed which can infer volumetric brain deformation given the cortical surface displacement. This model was tested on both a realistic brain phantom and in vivo, proving its ability to account for large brain deformations. Also, an efficient semiautomatic strategy for preoperative cortical feature detection is outlined, since accurate segmentation of cortical features can aid intraoperative cortical surface tracking. PMID:18044612

  20. [Intraoperative ultrasonography for common bile duct exploration during laparoscopic cholecystectomy].

    PubMed

    Bende, Sándor; Botos, Akos; Ottlakán, Aurél; Pásztor, Pál; Pálfi, Attila; Liptay-Wagner, Péter

    2003-12-01

    The "Endomedix Laparoscan" and the "Leopard" and "Panther" intraoperative ultrasounds were successfully used for the detection of unsuspected common bile duct stones during laparoscopic cholecystectomy (LC). Out of 60 patients six had common bile duct (CBD) stones and in one patient sludge has been seen. In patients with CBD stones, four small calculi have been observed in one patient, despite negative intraoperative cholangiography (IC). In an other patient a stone in the retropancreatic part of the CBD was detected. Based on preoperative findings CBD stone was unsuspected. We found that intraoperative ultrasound (IOUS) is useful for in investigating the CBD to detect unsuspected common bile duct stones. It can be used for the examination of other organs (liver, pancreas, hepatoduodenal ligament) as well. The method is easy to perform, fairly simple and informative so it can replace IC during laparoscopic cholecystectomy.

  1. Intraoperative Ultrasound-Fluoroscopy Fusion can Enhance Prostate Brachytherapy Quality

    SciTech Connect

    Orio, Peter F.; Tutar, Ismail B.; Narayanan, Sreeram; Arthurs, Sandra; Cho, Paul S.; Kim, Yongmin; Merrick, Gregory; Wallner, Kent E.

    2007-09-01

    Purpose: To evaluate a transrectal ultrasound (TRUS)-fluoroscopy fusion-based intraoperative dosimetry system. Method and Materials: Twenty-five patients were treated for prostate cancer with Pd-103 implantation. After the execution of the treatment plan, two sets of TRUS images were collected using the longitudinal and axial transducers of a biplanar probe. Then, three fluoroscopic images were acquired at 0, -15 and +15{sup o}. The three-dimensional locations of all implanted seeds were reconstructed from fluoroscopic images. A subset of the implanted seeds was manually identified in TRUS images and used as fiducial markers to perform TRUS-fluoroscopy fusion. To improve the implant quality, additional seeds were placed if adverse isodose patterns were identified during visual inspection. If additional seeds were placed, intraoperative dosimetry was repeated. Day 0 computed tomography-based dosimetry was compared with final intraoperative dosimetry to validate dosimetry achieved in the implant suite. Results: An average of additional 4.0 seeds was implanted in 16 patients after initial intraoperative dose evaluation. Based on TRUS-fluoroscopy fusion-based dosimetry, the V100 improved from 86% to 93% (p = 0.005), whereas D90 increased from 94% to 109% (p = 0.011) with the guided additional seed implantation. No statistical difference was observed in V200 and V300 values. V100 and D90 values were 95 {+-} 4% and 120 {+-} 24%, respectively, based on the final intraoperative dosimetry evaluation, compared with 95 {+-} 4% and 122 {+-} 24%, respectively, based on Day 0 computed tomography-based dosimetry. Conclusions: Implantation of extra seeds based on TRUS-fluoroscopy fusion-based intraoperative dosimetry can improve the final V100 and D90 values with minimal increase in V200 and V300 values.

  2. Intraoperative peripheral nerve injury in colorectal surgery. An update.

    PubMed

    Colsa Gutiérrez, Pablo; Viadero Cervera, Raquel; Morales-García, Dieter; Ingelmo Setién, Alfredo

    2016-03-01

    Intraoperative peripheral nerve injury during colorectal surgery procedures is a potentially serious complication that is often underestimated. The Trendelenburg position, use of inappropriately padded armboards and excessive shoulder abduction may encourage the development of brachial plexopathy during laparoscopic procedures. In open colorectal surgery, nerve injuries are less common. It usually involves the femoral plexus associated with lithotomy position and self-retaining retractor systems. Although in most cases the recovery is mostly complete, treatment consists of physical therapy to prevent muscular atrophy, protection of hypoesthesic skin areas and analgesics for neuropathic pain. The aim of the present study is to review the incidence, prevention and management of intraoperative peripheral nerve injury.

  3. Intraoperative wide bore nasogastric tube knotting: A rare incidence.

    PubMed

    Lamba, Sangeeta; Sethi, Surendra K; Khare, Arvind; Saini, Sudheendra

    2016-01-01

    Nasogastric tubes are commonly used in anesthetic practice for gastric decompression in surgical patients intraoperatively. The indications for its use are associated with a number of potential complications. Knotting of small-bore nasogastric tubes is usually common both during insertion and removal as compared to wide bore nasogastric tubes. Knotting of wide bore nasogastric tube is a rare complication and if occurs usually seen in long standing cases. We hereby report a case of incidental knotting of wide bore nasogastric tube that occurred intraoperatively.

  4. Intraoperative peripheral nerve injury in colorectal surgery. An update.

    PubMed

    Colsa Gutiérrez, Pablo; Viadero Cervera, Raquel; Morales-García, Dieter; Ingelmo Setién, Alfredo

    2016-03-01

    Intraoperative peripheral nerve injury during colorectal surgery procedures is a potentially serious complication that is often underestimated. The Trendelenburg position, use of inappropriately padded armboards and excessive shoulder abduction may encourage the development of brachial plexopathy during laparoscopic procedures. In open colorectal surgery, nerve injuries are less common. It usually involves the femoral plexus associated with lithotomy position and self-retaining retractor systems. Although in most cases the recovery is mostly complete, treatment consists of physical therapy to prevent muscular atrophy, protection of hypoesthesic skin areas and analgesics for neuropathic pain. The aim of the present study is to review the incidence, prevention and management of intraoperative peripheral nerve injury. PMID:26008880

  5. Intraoperative neurophysiology in deep brain surgery for psychogenic dystonia.

    PubMed

    Ramos, Vesper Fe Marie L; Pillai, Ajay S; Lungu, Codrin; Ostrem, Jill; Starr, Philip; Hallett, Mark

    2015-06-01

    Psychogenic dystonia is a challenging entity to diagnose and treat because little is known about its pathophysiology. We describe two cases of psychogenic dystonia who underwent deep brain stimulation when thought to have organic dystonia. The intraoperative microelectrode recordings in globus pallidus internus were retrospectively compared with those of five patients with known DYT1 dystonia using spontaneous discharge parameters of rate and bursting, as well as movement-related discharges. Our data suggest that simple intraoperative neurophysiology measures in single subjects do not differentiate psychogenic dystonia from DYT1 dystonia. PMID:26125045

  6. Intraoperative neurophysiology in deep brain surgery for psychogenic dystonia

    PubMed Central

    Ramos, Vesper Fe Marie L; Pillai, Ajay S; Lungu, Codrin; Ostrem, Jill; Starr, Philip; Hallett, Mark

    2015-01-01

    Psychogenic dystonia is a challenging entity to diagnose and treat because little is known about its pathophysiology. We describe two cases of psychogenic dystonia who underwent deep brain stimulation when thought to have organic dystonia. The intraoperative microelectrode recordings in globus pallidus internus were retrospectively compared with those of five patients with known DYT1 dystonia using spontaneous discharge parameters of rate and bursting, as well as movement-related discharges. Our data suggest that simple intraoperative neurophysiology measures in single subjects do not differentiate psychogenic dystonia from DYT1 dystonia. PMID:26125045

  7. Minimally Invasive Spinal Surgery with Intraoperative Image-Guided Navigation.

    PubMed

    Kim, Terrence T; Johnson, J Patrick; Pashman, Robert; Drazin, Doniel

    2016-01-01

    We present our perioperative minimally invasive spine surgery technique using intraoperative computed tomography image-guided navigation for the treatment of various lumbar spine pathologies. We present an illustrative case of a patient undergoing minimally invasive percutaneous posterior spinal fusion assisted by the O-arm system with navigation. We discuss the literature and the advantages of the technique over fluoroscopic imaging methods: lower occupational radiation exposure for operative room personnel, reduced need for postoperative imaging, and decreased revision rates. Most importantly, we demonstrate that use of intraoperative cone beam CT image-guided navigation has been reported to increase accuracy. PMID:27213152

  8. [Intraoperative protective ventilation reduces postoperative pulmonary complications - PRO].

    PubMed

    Güldner, Andreas; Gama de Abreu, Marcelo

    2015-09-01

    Postoperative pulmonary complications add to higher mortality and morbidity. This risk could be lowered with intraoperative protective ventilation, especially with low tidal volumes. The application of PEEP and the use of recruitment maneuvers can enhance the lung function during surgery, but can also cause haemodynamic instability. In patients with open abdominal surgery and no lung damage or obesity, PEEP and recruitment maneuvers have no protective effect against postoperative pulmonary complications. It is still unclear, wether the use of intraoperative PEEP in other patient groups and during different surgery procedures is relevant for lung protection.

  9. Minimally Invasive Spinal Surgery with Intraoperative Image-Guided Navigation

    PubMed Central

    Kim, Terrence T.; Johnson, J. Patrick; Pashman, Robert; Drazin, Doniel

    2016-01-01

    We present our perioperative minimally invasive spine surgery technique using intraoperative computed tomography image-guided navigation for the treatment of various lumbar spine pathologies. We present an illustrative case of a patient undergoing minimally invasive percutaneous posterior spinal fusion assisted by the O-arm system with navigation. We discuss the literature and the advantages of the technique over fluoroscopic imaging methods: lower occupational radiation exposure for operative room personnel, reduced need for postoperative imaging, and decreased revision rates. Most importantly, we demonstrate that use of intraoperative cone beam CT image-guided navigation has been reported to increase accuracy. PMID:27213152

  10. Factors influencing intraoperative blood loss in orthognathic surgery.

    PubMed

    Thastum, M; Andersen, K; Rude, K; Nørholt, S E; Blomlöf, J

    2016-09-01

    This retrospective study aimed to identify factors of importance for intraoperative blood loss relative to total blood volume in patients undergoing orthognathic surgery. The study included 356 patients treated consecutively at a Danish university hospital between 1 January 2010 and 31 December 2012. Inclusion criteria were (1) patient age ≥18 years and (2) patient undergoing a three-piece Le Fort I osteotomy, a bilateral sagittal split osteotomy, or a combination of the two. The patient-specific relative blood loss was calculated as a percentage by dividing the intraoperative blood loss by the estimated preoperative total blood volume, and then correlated with body mass index (BMI), age, sex, operating time, and treatment modality in a multivariate stepwise regression analysis. Operating time (P<0.001), BMI (P<0.001), and treatment modality (P<0.001) had a significant impact on relative blood loss; no significant effect of age or sex was observed. The coefficient of determination of relative blood loss was R(2)=0.34. In conclusion, this study introduces relative blood loss as a patient-specific measure of intraoperative blood loss. Average relative blood loss in this patient sample was 6.5%. Extensive surgery, a prolonged operating time, and reduced BMI significantly increase the intraoperative relative blood loss in patients undergoing orthognathic surgery.

  11. Capturing intraoperative deformations: research experience at Brigham and Women's Hospital.

    PubMed

    Warfield, Simon K; Haker, Steven J; Talos, Ion-Florin; Kemper, Corey A; Weisenfeld, Neil; Mewes, Andrea U J; Goldberg-Zimring, Daniel; Zou, Kelly H; Westin, Carl-Fredrik; Wells, William M; Tempany, Clare M C; Golby, Alexandra; Black, Peter M; Jolesz, Ferenc A; Kikinis, Ron

    2005-04-01

    During neurosurgical procedures the objective of the neurosurgeon is to achieve the resection of as much diseased tissue as possible while achieving the preservation of healthy brain tissue. The restricted capacity of the conventional operating room to enable the surgeon to visualize critical healthy brain structures and tumor margin has lead, over the past decade, to the development of sophisticated intraoperative imaging techniques to enhance visualization. However, both rigid motion due to patient placement and nonrigid deformations occurring as a consequence of the surgical intervention disrupt the correspondence between preoperative data used to plan surgery and the intraoperative configuration of the patient's brain. Similar challenges are faced in other interventional therapies, such as in cryoablation of the liver, or biopsy of the prostate. We have developed algorithms to model the motion of key anatomical structures and system implementations that enable us to estimate the deformation of the critical anatomy from sequences of volumetric images and to prepare updated fused visualizations of preoperative and intraoperative images at a rate compatible with surgical decision making. This paper reviews the experience at Brigham and Women's Hospital through the process of developing and applying novel algorithms for capturing intraoperative deformations in support of image guided therapy.

  12. High-accuracy registration of intraoperative CT imaging

    NASA Astrophysics Data System (ADS)

    Oentoro, A.; Ellis, R. E.

    2010-02-01

    Image-guided interventions using intraoperative 3D imaging can be less cumbersome than systems dependent on preoperative images, especially by needing neither potentially invasive image-to-patient registration nor a lengthy process of segmenting and generating a 3D surface model. In this study, a method for computer-assisted surgery using direct navigation on intraoperative imaging is presented. In this system the registration step of a navigated procedure was divided into two stages: preoperative calibration of images to a ceiling-mounted optical tracking system, and intraoperative tracking during acquisition of the 3D medical image volume. The preoperative stage used a custom-made multi-modal calibrator that could be optically tracked and also contained fiducial spheres for radiological detection; a robust registration algorithm was used to compensate for the very high false-detection rate that was due to the high physical density of the optical light-emitting diodes. Intraoperatively, a tracking device was attached to plastic bone models that were also instrumented with radio-opaque spheres; A calibrated pointer was used to contact the latter spheres as a validation of the registration. Experiments showed that the fiducial registration error of the preoperative calibration stage was approximately 0.1 mm. The target registration error in the validation stage was approximately 1.2 mm. This study suggests that direct registration, coupled with procedure-specific graphical rendering, is potentially a highly accurate means of performing image-guided interventions in a fast, simple manner.

  13. Capturing intraoperative deformations: research experience at Brigham and Women's Hospital.

    PubMed

    Warfield, Simon K; Haker, Steven J; Talos, Ion-Florin; Kemper, Corey A; Weisenfeld, Neil; Mewes, Andrea U J; Goldberg-Zimring, Daniel; Zou, Kelly H; Westin, Carl-Fredrik; Wells, William M; Tempany, Clare M C; Golby, Alexandra; Black, Peter M; Jolesz, Ferenc A; Kikinis, Ron

    2005-04-01

    During neurosurgical procedures the objective of the neurosurgeon is to achieve the resection of as much diseased tissue as possible while achieving the preservation of healthy brain tissue. The restricted capacity of the conventional operating room to enable the surgeon to visualize critical healthy brain structures and tumor margin has lead, over the past decade, to the development of sophisticated intraoperative imaging techniques to enhance visualization. However, both rigid motion due to patient placement and nonrigid deformations occurring as a consequence of the surgical intervention disrupt the correspondence between preoperative data used to plan surgery and the intraoperative configuration of the patient's brain. Similar challenges are faced in other interventional therapies, such as in cryoablation of the liver, or biopsy of the prostate. We have developed algorithms to model the motion of key anatomical structures and system implementations that enable us to estimate the deformation of the critical anatomy from sequences of volumetric images and to prepare updated fused visualizations of preoperative and intraoperative images at a rate compatible with surgical decision making. This paper reviews the experience at Brigham and Women's Hospital through the process of developing and applying novel algorithms for capturing intraoperative deformations in support of image guided therapy. PMID:15721230

  14. Intraoperative monitoring of motor cranial nerves in skull base surgery.

    PubMed

    Maurer, J; Pelster, H; Amedee, R G; Mann, W J

    1995-01-01

    Intraoperative monitoring of cranial nerves is performed to minimize postoperative cranial nerve dysfunction. We performed electrophysiologic monitoring of motor cranial nerves with a NIM 2 unit from Xomed Treace and a patient multiplexer developed in our clinic. This multiplexer allows simultaneous monitoring of four cranial nerves and is additionally equipped with a bipolar stimulation mode. This intraoperative monitoring was used during 102 skull base operations. Of these, 44 operations were acoustic neuroma removals by translabyrinthine approach and 36 by a middle fossa approach. Various operations, including removal of tumors of the jugular foramen and the infratemporal fossa, were performed in the remaining 22 patients. The facial nerve, being the most frequently monitored nerve, was evaluated both preoperatively and intraoperatively. Electrophysiologic data were evaluated with respect to their predictive value for postoperative facial nerve function. The relative percent decrease in amplitude of the electromyogram after resection compared to that observed before resection seems to be of some predictive value for the postoperative facial nerve function. A 50 to 60% decrease or more is associated with an increase in the House classification. Intraoperative monitoring is a useful tool in skull base surgery, allowing for safer and faster identification of motor nerves in pathologic-anatomic conditions. It allows the surgeon a degree of comfort by providing immediate information regarding the status of the nerve. It may also improve postoperative nerve function and shorten operating time. Additionally, neuromonitoring provides some information about expected postoperative facial nerve function.

  15. Use of intraoperative ultrasound in decision making during spinal operations.

    PubMed

    Theodotou, B C; Powers, S K

    1986-08-01

    The use of intraoperative spinal ultrasonography in 14 cases and its effect on decision making during laminectomy procedures is discussed. The advantages of the technique in operations for syringomyelia, trauma, spondylosis, intramedullary tumors, and neuroablative procedures of the spinal cord are elaborated. PMID:3528907

  16. Avoiding and Managing Intraoperative Complications During Cervical Spine Surgery.

    PubMed

    Bible, Jesse E; Rihn, Jeffrey A; Lim, Moe R; Brodke, Darrel S; Lee, Joon Y

    2015-12-01

    The incidence of intraoperative complications in cervical spine surgery is low. However, when they do occur, such complications have the potential for causing considerable morbidity and mortality. Spine surgeons should be familiar with methods of minimizing such complications. Furthermore, if they do occur, surgeons must be prepared to immediately treat each potential complication to reduce any associated morbidity. PMID:26519429

  17. Fusion of intraoperative force sensoring, surface reconstruction and biomechanical modeling

    NASA Astrophysics Data System (ADS)

    Röhl, S.; Bodenstedt, S.; Küderle, C.; Suwelack, S.; Kenngott, H.; Müller-Stich, B. P.; Dillmann, R.; Speidel, S.

    2012-02-01

    Minimally invasive surgery is medically complex and can heavily benefit from computer assistance. One way to help the surgeon is to integrate preoperative planning data into the surgical workflow. This information can be represented as a customized preoperative model of the surgical site. To use it intraoperatively, it has to be updated during the intervention due to the constantly changing environment. Hence, intraoperative sensor data has to be acquired and registered with the preoperative model. Haptic information which could complement the visual sensor data is still not established. In addition, biomechanical modeling of the surgical site can help in reflecting the changes which cannot be captured by intraoperative sensors. We present a setting where a force sensor is integrated into a laparoscopic instrument. In a test scenario using a silicone liver phantom, we register the measured forces with a reconstructed surface model from stereo endoscopic images and a finite element model. The endoscope, the instrument and the liver phantom are tracked with a Polaris optical tracking system. By fusing this information, we can transfer the deformation onto the finite element model. The purpose of this setting is to demonstrate the principles needed and the methods developed for intraoperative sensor data fusion. One emphasis lies on the calibration of the force sensor with the instrument and first experiments with soft tissue. We also present our solution and first results concerning the integration of the force sensor as well as accuracy to the fusion of force measurements, surface reconstruction and biomechanical modeling.

  18. Laser Doppler imaging for intraoperative human brain mapping.

    PubMed

    Raabe, A; Van De Ville, D; Leutenegger, M; Szelényi, A; Hattingen, E; Gerlach, R; Seifert, V; Hauger, C; Lopez, A; Leitgeb, R; Unser, M; Martin-Williams, E J; Lasser, T

    2009-02-15

    The identification and accurate location of centers of brain activity are vital both in neuro-surgery and brain research. This study aimed to provide a non-invasive, non-contact, accurate, rapid and user-friendly means of producing functional images intraoperatively. To this end a full field Laser Doppler imager was developed and integrated within the surgical microscope and perfusion images of the cortical surface were acquired during awake surgery whilst the patient performed a predetermined task. The regions of brain activity showed a clear signal (10-20% with respect to the baseline) related to the stimulation protocol which lead to intraoperative functional brain maps of strong statistical significance and which correlate well with the preoperative fMRI and intraoperative cortical electro-stimulation. These initial results achieved with a prototype device and wavelet based regressor analysis (the hemodynamic response function being derived from MRI applications) demonstrate the feasibility of LDI as an appropriate technique for intraoperative functional brain imaging.

  19. Volumetric Intraoperative Brain Deformation Compensation: Model Development and Phantom Validation

    PubMed Central

    DeLorenzo, Christine; Papademetris, Xenophon; Staib, Lawrence H.; Vives, Kenneth P.; Spencer, Dennis D.; Duncan, James S.

    2012-01-01

    During neurosurgery, nonrigid brain deformation may affect the reliability of tissue localization based on preoperative images. To provide accurate surgical guidance in these cases, preoperative images must be updated to reflect the intraoperative brain. This can be accomplished by warping these preoperative images using a biomechanical model. Due to the possible complexity of this deformation, intraoperative information is often required to guide the model solution. In this paper, a linear elastic model of the brain is developed to infer volumetric brain deformation associated with measured intraoperative cortical surface displacement. The developed model relies on known material properties of brain tissue, and does not require further knowledge about intraoperative conditions. To provide an initial estimation of volumetric model accuracy, as well as determine the model’s sensitivity to the specified material parameters and surface displacements, a realistic brain phantom was developed. Phantom results indicate that the linear elastic model significantly reduced localization error due to brain shift, from >16 mm to under 5 mm, on average. In addition, though in vivo quantitative validation is necessary, preliminary application of this approach to images acquired during neocortical epilepsy cases confirms the feasibility of applying the developed model to in vivo data. PMID:22562728

  20. A Prototype PZT Matrix Transducer With Low-Power Integrated Receive ASIC for 3-D Transesophageal Echocardiography.

    PubMed

    Chen, Chao; Raghunathan, Shreyas B; Yu, Zili; Shabanimotlagh, Maysam; Chen, Zhao; Chang, Zu-yao; Blaak, Sandra; Prins, Christian; Ponte, Jacco; Noothout, Emile; Vos, Hendrik J; Bosch, Johan G; Verweij, Martin D; de Jong, Nico; Pertijs, Michiel A P

    2016-01-01

    This paper presents the design, fabrication, and experimental evaluation of a prototype lead zirconium titanate (PZT) matrix transducer with an integrated receive ASIC, as a proof of concept for a miniature three-dimensional (3-D) transesophageal echocardiography (TEE) probe. It consists of an array of 9 ×12 piezoelectric elements mounted on the ASIC via an integration scheme that involves direct electrical connections between a bond-pad array on the ASIC and the transducer elements. The ASIC addresses the critical challenge of reducing cable count, and includes front-end amplifiers with adjustable gains and micro-beamformer circuits that locally process and combine echo signals received by the elements of each 3 ×3 subarray. Thus, an order-of-magnitude reduction in the number of receive channels is achieved. Dedicated circuit techniques are employed to meet the strict space and power constraints of TEE probes. The ASIC has been fabricated in a standard 0.18-μm CMOS process and consumes only 0.44 mW/channel. The prototype has been acoustically characterized in a water tank. The ASIC allows the array to be presteered across ±37° while achieving an overall dynamic range of 77 dB. Both the measured characteristics of the individual transducer elements and the performance of the ASIC are in good agreement with expectations, demonstrating the effectiveness of the proposed techniques.

  1. Cleft posterior mitral valve leaflet in an adult with Turner syndrome diagnosed with the use of 3-dimensional transesophageal echocardiography.

    PubMed

    Negrea, Stefania Luminita; Alexandrescu, Clara; Sabatier, Michel; Dreyfus, Gilles D

    2012-01-01

    Turner syndrome is a monosomy (45,X karyotype) in which the prevalence of cardiovascular anomalies is high. However, this aspect of Turner syndrome has received little attention outside of the pediatric medical literature, and the entire spectrum of cardiovascular conditions in adults remains unknown. We present the case of a 34-year-old woman who had Turner syndrome. When she was a teenager, her native bicuspid aortic valve was replaced with a mechanical prosthesis. Fifteen years later, during preoperative examination for prosthesis-patient mismatch, severe mitral regurgitation was detected, and a congenital cleft in the posterior leaflet of the mitral valve was diagnosed with use of 3-dimensional transesophageal echocardiography. The patient underwent concurrent mitral valve repair and aortic valve replacement. To our knowledge, this is the first report of a cleft in the posterior mitral valve leaflet as a cardiovascular defect observed in Turner syndrome, and the first such instance to have been diagnosed with the use of 3-dimensional echocardiography.

  2. Transesophageal Echocardiography and Contrast-TCD in the Detection of a Patent Foramen Ovale: Experience with 111 Patients

    NASA Technical Reports Server (NTRS)

    Klotzsch, Christof; Janben, Gerhard; Berlit, Peter

    1994-01-01

    Patent foramen ovale (PFO) is increasingly recognized in association with cryptogenic stroke. Using transesophageal echocardiography (TEE) and transcranial Doppler sonography with ultrasonic contrast medium contrast-(TCD), we evaluated the frequency of a PFO as the fundamental condition of paradoxical embolism in 111 patients after cerebral ischemia. There was a right-left shunt in 50 patients (45%) with TEE. In 31 of 40 patients with stroke of unknown etiology, a PFO was the only detectable finding associated with cerebral ischemia. Using TEE as he "gold standard," the sensitivity of contrast-TCD was 91.3%, specificity 93.8%, and the overall accuracy 92.8%. contrast-TCD failed to detect a right-left shunt in four patients, but there were four other patients with negative TEE and positive contrast-TCD. We conclude that contrast-TCD is a highly sensitive method for detecting a right-left shunt. Its advantages are low cost, its ability to detect single contrast-medium embolism, and control of the Valsalva maneuver by observing the decrease of cerebral blood flow. Evidence of PFO in cryptogenic stroke should prompt a search for a subclinical venous thrombosis as the embolic source.

  3. Atrial fibrillation in rats induced by rapid transesophageal atrial pacing during brief episodes of asphyxia: a new in vivo model.

    PubMed

    Haugan, Ketil; Lam, Henrik Rye; Knudsen, Carsten Boye; Petersen, Jørgen Søberg

    2004-07-01

    Non-pharmacological in vivo models of atrial fibrillation (AF) have been developed in large animals only. We aimed to develop and characterize a new small animal non-pharmacological in vivo model of AF. AF was induced by transesophageal atrial burst pacing during 35 seconds periods of asphyxia in anesthetized male Sprague-Dawley rats. AF was reproducibly induced in 81% of the rats. The presence of AF was associated with an increased heart rate, and a decreased blood pressure. Treatment with amiodarone, D,L-sotalol, flecainide, and propranolol all reduced duration of AF, whereas verapamil treatment was associated with a marked profibrillatory effect. Increasing gap junction intracellular communication using the antiarrhythmic peptide analogue AAP10 did not affect AF duration. Basal plasma level of epinephrine and norepinephrine were increased 5- to 20-fold relative to values reported by others, but unchanged following 35 seconds of asphyxia. The results from our study demonstrate that the rat model shares several clinical key characteristics with human AF: (1) hemodynamic response to AF; (2) increased autonomic tone; (3) antiarrhythmic effects of clinically used drugs; (4) profibrillatory effect of verapamil. Relative to existing models of AF in larger animals, this model offers rapid, predictive, and inexpensive testing of antiarrhythmic/profibrillatory effects of new drugs.

  4. Experience with use of multiplane transesophageal echocardiography to guide closure of atrial septal defects using the amplatzer device.

    PubMed

    Figueroa, M I; Balaguru, D; McClure, C; Kline, C H; Radtke, W A K; Shirali, G S

    2002-01-01

    By providing unlimited imaging planes, multiplane transesophageal echocardiography (MTEE) should improve real-time guidance of interventional procedures. The potential advantages of MTEE in this scenario have not been systematically evaluated. We retrospectively reviewed our experience with MTEE-guided Amplatzer device closure of atrial septal defects (ASDs) MTEE angles used to obtain images for guiding all measurements and maneuvers were recorded. These angles were compared to the range of MTEE angles that are postulated to be available from biplane TEE. Images obtained using MTEE angles from 21 degrees to 70 degrees and from 111 degrees to l59 degrees were defined as only obtainable by MTEE. The MTEE probe was successfully introduced in all (89) patients. Thirteen patients (15%) had multiple defects. Ninety-five devices (5-32 mm in diameter) were deployed. In 66% of patients, balloon sizing and device deployment necessitated imaging planes that are only obtainable by MTEE. All devices were well positioned, with no impingement on inflows or outflows. At follow-up, 79 of 89 (88.7%) patients had no residual ASDs. Each of the remaining 10 patients (11.3%) had a small (<3 mm) residual defect. MTEE played an important role in guiding device closure of ASD, particularly during the phases of balloon sizing and device deployment.

  5. Physics-based shape matching for intraoperative image guidance

    SciTech Connect

    Suwelack, Stefan Röhl, Sebastian; Bodenstedt, Sebastian; Reichard, Daniel; Dillmann, Rüdiger; Speidel, Stefanie; Santos, Thiago dos; Maier-Hein, Lena; Wagner, Martin; Wünscher, Josephine; Kenngott, Hannes; Müller, Beat P.

    2014-11-01

    Purpose: Soft-tissue deformations can severely degrade the validity of preoperative planning data during computer assisted interventions. Intraoperative imaging such as stereo endoscopic, time-of-flight or, laser range scanner data can be used to compensate these movements. In this context, the intraoperative surface has to be matched to the preoperative model. The shape matching is especially challenging in the intraoperative setting due to noisy sensor data, only partially visible surfaces, ambiguous shape descriptors, and real-time requirements. Methods: A novel physics-based shape matching (PBSM) approach to register intraoperatively acquired surface meshes to preoperative planning data is proposed. The key idea of the method is to describe the nonrigid registration process as an electrostatic–elastic problem, where an elastic body (preoperative model) that is electrically charged slides into an oppositely charged rigid shape (intraoperative surface). It is shown that the corresponding energy functional can be efficiently solved using the finite element (FE) method. It is also demonstrated how PBSM can be combined with rigid registration schemes for robust nonrigid registration of arbitrarily aligned surfaces. Furthermore, it is shown how the approach can be combined with landmark based methods and outline its application to image guidance in laparoscopic interventions. Results: A profound analysis of the PBSM scheme based on in silico and phantom data is presented. Simulation studies on several liver models show that the approach is robust to the initial rigid registration and to parameter variations. The studies also reveal that the method achieves submillimeter registration accuracy (mean error between 0.32 and 0.46 mm). An unoptimized, single core implementation of the approach achieves near real-time performance (2 TPS, 7–19 s total registration time). It outperforms established methods in terms of speed and accuracy. Furthermore, it is shown that the

  6. Stretching skin: undermining is more important than intraoperative expansion.

    PubMed

    Mackay, D R; Saggers, G C; Kotwal, N; Manders, E K

    1990-10-01

    The efficacy of intraoperative expansion in reducing the tension of wound closure was tested in young pigs. The young piglet as a model for studying human skin was characterized by finding a close similarity between the modulus of elasticity of young piglet skin and human abdominoplasty and mammaplasty skin (range 12.8 to 23.7 N/mm2 for piglet skin, 14.3 to 19 N/mm2 for human skin). The tension required to close a standardized wound was determined before undermining, after undermining, and finally after intraoperative expansion. These measurements were performed in 10 young pigs with an average weight of 11.5 kg. Undermining the wound edges resulted in a significant decrease in the force required to close the wounds (p less than 0.0001). Intraoperative expansion did not significantly decrease the tension. Previous work showing the importance of site and direction of pull on the tension for wound closure was confirmed in this study. Analysis of variance demonstrated that the tension required to close a standard wound is greater high on the pig's back than near the belly and near the shoulder as opposed to the hip for midflank wounds (p less than 0.0001). Increasing the extent of undermining from 62 to 136 cm2 significantly decreased the tension for wound closure (p less than 0.05). Further undermining did not result in a significant decrease in wound closure tension. In this model, intraoperative expansion offers no advantage over simple undermining. We suggest that the benefit reported by clinicians using intraoperative expansion may derive from an increase in the extent of undermining required to place expanders under the wound margins.

  7. Transcutaneous vs. intraoperative quantitative ultrasound for staging bovine hepatic steatosis.

    PubMed

    Weijers, Gert; Starke, Alexander; Thijssen, Johan M; Haudum, Alois; Wohlsein, Peter; Rehage, Juergen; de Korte, Chris L

    2012-08-01

    The aim of this study was to test the hypothesis that quantitative analysis of transcutaneous (Transc) ultrasound (US) images can predict the liver fat content with similar accuracy and precision as using intraoperative (Intraop) US. The second goal was to investigate if a tissue mimicking phantom (TMP) might be used as reference for automatic gain compensation (AGC) vs. depth instead of using the data of a set of cows without hepatic alterations. A study was performed in post partum dairy cows (N = 151), as an animal model of human nonalcoholic fatty liver disease (NAFLD), to test these hypotheses. Five Transc and five Intraop US liver images were acquired in each animal and a liver biopsy was taken. In liver tissue samples, triacylglycerol (TAG) content was measured by biochemical analysis and hepatic alterations, other than hepatic steatosis, were excluded by clinical examination. Several preprocessing steps were performed before the ultrasound tissue characteristics (UTC) parameters of B-mode images were derived. Stepwise multiple linear regression analysis was performed on a training set (N = 76) and the results were used on the test group (N = 75) to predict the TAG content in the liver. In all cases, the residual attenuation coefficient (ResAtt) was the only selected parameter. Receiver operating characteristics (ROC) analysis was applied to assess the performance and area under the curve (AUC) of predicting TAG and to compare the sensitivity and specificity of the methods used. High ROC values for AUC (95%), sensitivity (87%) and specificity (83%) for both Intraop and Transc applications with control group as well as with phantom-based AGC were obtained. Consequently, it can be concluded that Transc results are equivalent to Intraop results. Furthermore, equivalent ROC values, when using TMP AGC, indicates the potential use of TMP-based corrections instead of normal group-based corrections. The high predictive values indicate that noninvasive quantitative

  8. Intraoperative magnetic resonance imaging findings during deep brain stimulation surgery

    PubMed Central

    Huston, Olivia O.; Watson, Robert E.; Bernstein, Matt A.; McGee, Kiaran P.; Stead, S. Matt; Gorman, Debb A.; Lee, Kendall H.; Huston, John

    2012-01-01

    Object Deep brain stimulation (DBS) is an established neurosurgical technique used to treat a variety of neurological disorders, including Parkinson disease, essential tremor, dystonia, epilepsy, depression, and obsessive-compulsive disorder. This study reports on the use of intraoperative MR imaging during DBS surgery to evaluate acute hemorrhage, intracranial air, brain shift, and accuracy of lead placement. Methods During a 46-month period, 143 patients underwent 152 DBS surgeries including 289 lead placements utilizing intraoperative 1.5-T MR imaging. Imaging was supervised by an MR imaging physicist to maintain the specific absorption rate below the required level of 0.1 W/kg and always included T1 magnetization-prepared rapid gradient echo and T2* gradient echo sequences with selected use of T2 fluid attenuated inversion recovery (FLAIR) and T2 fast spin echo (FSE). Retrospective review of the intraoperative MR imaging examinations was performed to quantify the amount of hemorrhage and the amount of air introduced during the DBS surgery. Results Intraoperative MR imaging revealed 5 subdural hematomas, 3 subarachnoid hemorrhages, and 1 intra-parenchymal hemorrhage in 9 of the 143 patients. Only 1 patient experiencing a subarachnoid hemorrhage developed clinically apparent symptoms, which included transient severe headache and mild confusion. Brain shift due to intracranial air was identified in 144 separate instances. Conclusions Intraoperative MR imaging can be safely performed and may assist in demonstrating acute changes involving intracranial hemorrhage and air during DBS surgery. These findings are rarely clinically significant and typically resolve prior to follow-up imaging. Selective use of T2 FLAIR and T2 FSE imaging can confirm the presence of hemorrhage or air and preclude the need for CT examinations. PMID:21699482

  9. Does ultrasongraphy predict intraoperative findings at cholecystectomy? An institutional review

    PubMed Central

    Stogryn, Shannon; Metcalfe, Jennifer; Vergis, Ashley; Hardy, Krista

    2016-01-01

    Background Ultrasonography (US) is the mainstay of biliary tract imaging, but few recent studies have tested its ability to diagnose acute cholecystitis (AC). Our objective was to determine how well a US diagnosis of AC correlates with the intraoperative diagnosis. We hypothesize that US underestimates this diagnosis, potentially leading to unexpected findings in the operating room (OR). Methods This retrospective review included all patients admitted to the acute care surgical service of a tertiary hospital in 2011 with suspected biliary pathology who underwent US and subsequent cholecystectomy. We determined the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of US using the intraoperative diagnosis as the gold standard. Further analysis identified which US findings were most predictive of an intraoperative diagnosis of AC. We used a recursive partitioning method with random forests to identify unique combinations of US findings that, together, are most predictive of AC. Results In total, 254 patients underwent US for biliary symptoms; 152 had AC diagnosed, and 143 (94%) of them underwent emergency surgery (median time to OR 23.03 hr). Ultrasonography predicted intraoperative findings with a sensitivity of 73.2%, specificity of 85.5% and PPV of 93.7%. The NPV (52.0%) was quite low. The US indicators most predictive of AC were a thick wall, a positive sonographic Murphy sign and cholelithiasis. Recursive partitioning demonstrated that a positive sonographic Murphy sign is highly predictive of intraoperative AC. Conclusion Ultrasonography is highly sensitive and specific for diagnosing AC. The poor NPV confirms our hypothesis that US can underestimate AC. PMID:26574703

  10. Intraoperative /sup 99m/Tc bone imaging in the treatment of benign osteoblastic tumors

    SciTech Connect

    Sty, J.; Simons, G.

    1982-05-01

    Benign bone tumors can be successfully treated by local resection with the use of intraoperative bone imaging. Intraoperative bone imaging provided accurate localization of an osteoid osteoma in a patella of a 16-year-old girl when standard radiographs failed to demonstrate the lesion. In a case of osteoblastoma of the sacrum in a 12-year old girl, intraoperative scanning was used repeatedly to guide completeness of resection. In these cases in which routine intraoperative radiographs would have failed, intraoperative scanning proved to be essential for success.

  11. Intraoperative bleeding control during cesarean delivery of complete placenta previa with transient occlusion of uterine arteries.

    PubMed

    Kim, Ju Hyun; Joung, Eun-Ju; Lee, Soo-Jung; Kwack, Jae Young; Kwon, Yong Soon

    2015-11-01

    There are few methods to control heavy intra-operative bleeding during cesarean delivery of placenta previa. Transient occlusion of uterine arteries (TOUA) during operation has previously been reported as a quick and safe method to control intra-operative uterine bleeding. We reported 2 cases of cesarean delivery with complete placenta previa in which TOUA was performed to safely reduce intra-operative complication, especially heavy intra-operative bleeding. In the 2 cases, cesarean deliveries were safe and without any complications under the TOUA method. TOUA can be a good method to control heavy intra-operative bleeding during cesarean delivery of complete placenta previa with risk of heavy bleeding.

  12. Incremental value of live/real time three-dimensional transesophageal echocardiography over the two-dimensional technique in the assessment of aortic atherosclerotic thrombi and ulcers.

    PubMed

    Elsayed, Mahmoud; Bulur, Serkan; Kalla, Aditi; Ahmed, Mustafa I; Hsiung, Ming C; Uygur, Begum; Alagic, Nermina; Sungur, Aylin; Singh, Satinder; Nanda, Navin C

    2016-08-01

    We present two cases in whom live/real time three-dimensional transesophageal echocardiography (3DTEE) provided incremental value in the assessment of atherosclerotic disease in the aorta. In one patient, it identified additional atherosclerotic ulcers as well as thrombi within them which were missed by two-dimensional (2D) TEE. In both cases, the size of the large mobile atherosclerotic plaque was underestimated by 2DTEE as compared with 3DTEE. Furthermore, 3DTEE provided volume quantification of the thrombi and ulcers which is not possible by 2DTEE. The echocardiographic findings of atherosclerotic plaques were confirmed by computed tomography in one patient and by surgery in the other.

  13. Angled rigid neuroendoscope for continuous intraoperative visual monitoring: technical note.

    PubMed

    Tamaki, N; Hara, Y; Takaishi, Y; Shimada, S

    2001-03-01

    We developed and tested a new, angled rigid endoscope as a tool for performing continuous visual monitoring during microsurgery. The shaft of the scope is angled 110 degrees at its midportion using a prism. We used the scope continuously in 30 cases including 15 pituitary tumours, 7 brain tumours, 7 cerebral aneurysms, and one hemifacial spasm. For pituitary tumours the tip of the scope was positioned in the sphenoid sinus or in the cavity formed by tumour removal; for cerebral aneurysms it was placed behind the parent artery or the aneurysmal neck. Image quality was acceptable for intraoperative monitoring. In no case did the neuroendoscope have a deleterious impact on th e proper function of the microscope or surgical instruments. This angled rigid scope was more effective for intraoperative monitoring than conventional straight scopes. PMID:11243766

  14. Intraoperative perfluorocarbon liquids in the management of proliferative vitreoretinopathy.

    PubMed

    Chang, S; Ozmert, E; Zimmerman, N J

    1988-12-15

    Three low-viscosity perfluorocarbon liquids were used intraoperatively for hydrokinetic manipulation of the retina during vitreous surgery for retinal detachment with advanced proliferative vitreoretinopathy. All 23 patients had massive proliferative vitreoretinopathy (Grade D, Retina Society classification), and 16 (69.6%) had Grade D-3 with a closed-funnel configuration. In 21 eyes the retina could be flattened intraoperatively by perfluorocarbon liquids without requiring posterior retinotomy for internal drainage of subretinal fluid. The temporary mechanical fixation of the retina provided by this tool facilitated the removal of epiretinal membranes and release of traction. Fifteen eyes (65.2%) maintained long-term retinal reattachment with follow-up of six months or more. These liquids are useful adjuncts in the management of retinal detachment with severe proliferative vitreoretinopathy.

  15. Noise suppressed, multifocus image fusion for enhanced intraoperative navigation.

    PubMed

    Feruglio, Paolo Fumene; Vinegoni, Claudio; Fexon, Lioubov; Thurber, Greg; Sbarbati, Andrea; Weissleder, Ralph

    2013-04-01

    Current intraoperative imaging systems are typically not able to provide 'sharp' images over entire large areas or entire organs. Distinct structures such as tissue margins or groups of malignant cells are therefore often difficult to detect, especially under low signal-to-noise-ratio conditions. In this report, we introduce a noise suppressed multifocus image fusion algorithm, that provides detailed reconstructions even when images are acquired under sub-optimal conditions, such is the case for real time fluorescence intraoperative surgery. The algorithm makes use of the Anscombe transform combined with a multi-level stationary wavelet transform with individual threshold-based shrinkage. While the imaging system is integrated with a respiratory monitor triggering system, it can be easily adapted to any commercial imaging system. The developed algorithm is made available as a plugin for Osirix. PMID:22887724

  16. Intraoperative Dexmedetomidine Promotes Postoperative Analgesia in Patients After Abdominal Colectomy

    PubMed Central

    Ge, Dong-Jian; Qi, Bin; Tang, Gang; Li, Jin-Yu

    2015-01-01

    Abstract Surgery-induced acute postoperative pain may lead to prolonged convalescence. The present study was designed to investigate the effects of intraoperative dexmedetomidine on postoperative analgesia following abdominal colectomy surgeries. Eighty patients scheduled for abdominal colectomy surgery under general anesthesia were divided into 2 groups, which were maintained using propofol/remifentanil/dexmedetomidine (PRD) or propofol/remifentanil/saline (PRS). During surgery, patients in the PRD group had a lower bispectral index (BIS) value, which indicated a deeper anesthetic state, and a higher sedation score right after extubation than patients in the PRS group. During the first 24 hours post surgery, PRD patients consumed less morphine in patient-controlled analgesia (PCA) and had a lower score in the visual analog scale (VAS) testing than their controls from the PRS group. Intraoperative administration of dexmedetomidine appears to promote the analgesic property of morphine-based PCA in patients after abdominal colectomy. PMID:26376397

  17. Transsphenoidal pituitary resection with intraoperative MR guidance: preliminary results

    NASA Astrophysics Data System (ADS)

    Pergolizzi, Richard S., Jr.; Schwartz, Richard B.; Hsu, Liangge; Wong, Terence Z.; Black, Peter M.; Martin, Claudia; Jolesz, Ferenc A.

    1999-05-01

    The use of intraoperative MR image guidance has the potential to improve the precision, extent and safety of transsphenoidal pituitary resections. At Brigham and Women's Hospital, an open-bore configuration 0.5T MR system (SIGNA SP, GE Medical Systems, Milwaukee, WI) has been used to provide image guidance for nine transsphenoidal pituitary adenoma resections. The intraoperative MR system allowed the radiologist to direct the surgeon toward the sella turcica successfully while avoiding the cavernous sinus, optic chiasm and other sensitive structures. Imaging performed during the surgery monitored the extent of resection and allowed for removal of tumor beyond the surgeon's view in five cases. Dynamic MR imaging was used to distinguish residual tumor from normal gland and postoperative changes permitting more precise tumor localization. A heme-sensitive long TE gradient echo sequence was used to evaluate for the presence of hemorrhagic debris. All patients tolerated the procedure well without significant complications.

  18. Trajectory optimization for intra-operative nuclear tomographic imaging.

    PubMed

    Vogel, Jakob; Lasser, Tobias; Gardiazabal, José; Navab, Nassir

    2013-10-01

    Diagnostic nuclear imaging modalities like SPECT typically employ gantries to ensure a densely sampled geometry of detectors in order to keep the inverse problem of tomographic reconstruction as well-posed as possible. In an intra-operative setting with mobile freehand detectors the situation changes significantly, and having an optimal detector trajectory during acquisition becomes critical. In this paper we propose an incremental optimization method based on the numerical condition of the system matrix of the underlying iterative reconstruction method to calculate optimal detector positions during acquisition in real-time. The performance of this approach is evaluated using simulations. A first experiment on a phantom using a robot-controlled intra-operative SPECT-like setup demonstrates the feasibility of the approach. PMID:23706624

  19. Toward Intraoperative Image-Guided Transoral Robotic Surgery.

    PubMed

    Liu, Wen P; Reaugamornrat, Sureerat; Deguet, Anton; Sorger, Jonathan M; Siewerdsen, Jeffrey H; Richmon, Jeremy; Taylor, Russell H

    2013-09-01

    This paper presents the development and evaluation of video augmentation on the stereoscopic da Vinci S system with intraoperative image guidance for base of tongue tumor resection in transoral robotic surgery (TORS). Proposed workflow for image-guided TORS begins by identifying and segmenting critical oropharyngeal structures (e.g., the tumor and adjacent arteries and nerves) from preoperative computed tomography (CT) and/or magnetic resonance (MR) imaging. These preoperative planned data can be deformably registered to the intraoperative endoscopic view using mobile C-arm cone-beam computed tomography (CBCT) [1, 2]. Augmentation of TORS endoscopic video defining surgical targets and critical structures has the potential to improve navigation, spatial orientation, and confidence in tumor resection. Experiments in animal specimens achieved statistically significant improvement in target localization error when comparing the proposed image guidance system to simulated current practice. PMID:25525474

  20. Segmentation-Based Registration of Organs in Intraoperative Video Sequences

    SciTech Connect

    Goddard Jr, James Samuel; Gee, Timothy Felix; Wang, Hengliang; Gorbach, Alexander M

    2006-01-01

    Intraoperative optical imaging of exposed organs in visible, near-infrared, and infrared (IR) wavelengths in the body has the potential to be use-ful for real-time assessment of organ viability and image guidance during surgical intervention. However, the motion of the internal organs presents significant challenges for fast analysis of recorded 2D video sequences. The movement observed during surgery, due to respiration, cardiac motion, blood flow, and mechanical shift accompanying the surgical intervention, causes organ reflection in the image sequence, making optical measurements for further analysis challenging. Correcting alignment is difficult in that the motion is not uniform over the image. This paper describes a Canny edge-based method for segmentation of the specific organ or region under study, along with a moment-based registration method for the segmented region. Experimental results are provided for a set of intraoperative IR image sequences.

  1. [Intraoperative graft assessment using fluorescent imaging system (SPY)].

    PubMed

    Kawashima, T; Naraoka, S; Kakizaki, T

    2009-07-01

    We investigated the efficacy of intraoperative fluorescent imaging system for the assessment of coronary artery bypass grafting (CABG). We used SPY imaging system in 100 CABG (57 off-pump and 43 on-pump CABG), totalling 287 distal anastomoses. The total graft patency rate on postoperative angiography in this series was 96.2% (276/287). Graft revision was done in 10 cases (10.0%) and 13 anastomoses (4.5%) by SPY imaging, which all resulted in good patency at postoperative angiography. On the other hand, 7 distal anastomoses and 1 mammary graft (2.8%) appeared to be successful on intraoperative SPY imaging, but were revealed to be occluded by postoperative angiography. SPY imaging system is useful for graft validation, and may contribute to improvement of coronary bypass graft patency.

  2. Intraoperative perfluorocarbon liquids in the management of proliferative vitreoretinopathy.

    PubMed

    Chang, S; Ozmert, E; Zimmerman, N J

    1988-12-15

    Three low-viscosity perfluorocarbon liquids were used intraoperatively for hydrokinetic manipulation of the retina during vitreous surgery for retinal detachment with advanced proliferative vitreoretinopathy. All 23 patients had massive proliferative vitreoretinopathy (Grade D, Retina Society classification), and 16 (69.6%) had Grade D-3 with a closed-funnel configuration. In 21 eyes the retina could be flattened intraoperatively by perfluorocarbon liquids without requiring posterior retinotomy for internal drainage of subretinal fluid. The temporary mechanical fixation of the retina provided by this tool facilitated the removal of epiretinal membranes and release of traction. Fifteen eyes (65.2%) maintained long-term retinal reattachment with follow-up of six months or more. These liquids are useful adjuncts in the management of retinal detachment with severe proliferative vitreoretinopathy. PMID:3195646

  3. Noise suppressed, multifocus image fusion for enhanced intraoperative navigation.

    PubMed

    Feruglio, Paolo Fumene; Vinegoni, Claudio; Fexon, Lioubov; Thurber, Greg; Sbarbati, Andrea; Weissleder, Ralph

    2013-04-01

    Current intraoperative imaging systems are typically not able to provide 'sharp' images over entire large areas or entire organs. Distinct structures such as tissue margins or groups of malignant cells are therefore often difficult to detect, especially under low signal-to-noise-ratio conditions. In this report, we introduce a noise suppressed multifocus image fusion algorithm, that provides detailed reconstructions even when images are acquired under sub-optimal conditions, such is the case for real time fluorescence intraoperative surgery. The algorithm makes use of the Anscombe transform combined with a multi-level stationary wavelet transform with individual threshold-based shrinkage. While the imaging system is integrated with a respiratory monitor triggering system, it can be easily adapted to any commercial imaging system. The developed algorithm is made available as a plugin for Osirix.

  4. Intraoperative stimulation techniques for functional pathway preservation and glioma resection.

    PubMed

    Sanai, Nader; Berger, Mitchel S

    2010-02-01

    Although a primary tenet of neurosurgical oncology is that survival can improve with greater tumor resection, this principle must be tempered by the potential for functional loss following a radical removal. Preoperative planning with functional and physiological imaging paradigms, combined with intraoperative strategies such as cortical and subcortical stimulation mapping, can effectively reduce the risks associated with operating in eloquent territory. In addition to identifying critical motor pathways, these techniques can be adapted to identify language function reliably. The authors review the technical nuances of intraoperative mapping for low- and high-grade gliomas, demonstrating their efficacy in optimizing resection even in patients with negative mapping data. Collectively, these surgical strategies represent the cornerstone for operating on gliomas in and around functional pathways.

  5. Intraoperative Functional Mapping and Monitoring during Glioma Surgery

    PubMed Central

    SAITO, Taiichi; MURAGAKI, Yoshihiro; MARUYAMA, Takashi; TAMURA, Manabu; NITTA, Masayuki; OKADA, Yoshikazu

    2015-01-01

    Glioma surgery represents a significant advance with respect to improving resection rates using new surgical techniques, including intraoperative functional mapping, monitoring, and imaging. Functional mapping under awake craniotomy can be used to detect individual eloquent tissues of speech and/or motor functions in order to prevent unexpected deficits and promote extensive resection. In addition, monitoring the patient’s neurological findings during resection is also very useful for maximizing the removal rate and minimizing deficits by alarming that the touched area is close to eloquent regions and fibers. Assessing several types of evoked potentials, including motor evoked potentials (MEPs), sensory evoked potentials (SEPs) and visual evoked potentials (VEPs), is also helpful for performing surgical monitoring in patients under general anesthesia (GA). We herein review the utility of intraoperative mapping and monitoring the assessment of neurological findings, with a particular focus on speech and the motor function, in patients undergoing glioma surgery. PMID:25744346

  6. Intraoperative Functional Mapping and Monitoring during Glioma Surgery.

    PubMed

    Saito, Taiichi; Muragaki, Yoshihiro; Maruyama, Takashi; Tamura, Manabu; Nitta, Masayuki; Okada, Yoshikazu

    2015-01-01

    Glioma surgery represents a significant advance with respect to improving resection rates using new surgical techniques, including intraoperative functional mapping, monitoring, and imaging. Functional mapping under awake craniotomy can be used to detect individual eloquent tissues of speech and/or motor functions in order to prevent unexpected deficits and promote extensive resection. In addition, monitoring the patient’s neurological findings during resection is also very useful for maximizing the removal rate and minimizing deficits by alarming that the touched area is close to eloquent regions and fibers. Assessing several types of evoked potentials, including motor evoked potentials (MEPs), sensory evoked potentials (SEPs) and visual evoked potentials (VEPs), is also helpful for performing surgical monitoring in patients under general anesthesia (GA). We herein review the utility of intraoperative mapping and monitoring the assessment of neurological findings, with a particular focus on speech and the motor function, in patients undergoing glioma surgery. PMID:26236798

  7. Intraoperative tumor lysis syndrome in a child with Wilms' tumor.

    PubMed

    Dhar, Mridul; Prakash, Shashi; Pandey, Vaibhav; Pai, Vishal Krishna

    2016-01-01

    Tumor lysis syndrome in an onco-metabolic emergency resulting from massive lysis of rapidly proliferating malignant cells seen commonly in patients with hematological malignancies such as acute lymphocytic leukemia and Burkitt's lymphoma and is quite rare in solid tumors. Spontaneous development of tumor lysis has been described among other trigger factors such as corticosteroid therapy, anesthesia, tumor manipulation during surgery and pyrexia. We describe such a case in a 5-year-old boy posted for excision and staging of a massive Wilms' tumor who developed a hyperkalemic cardiac arrest during the procedure and its subsequent intraoperative and postoperative management. Intraoperative cardiac arrest is a stressful situation for both the anesthesiologist and the surgeon, more so when it involves a child. The aim of this report is to make the anesthesiologist aware of the possibility and occurrence of such a phenomenon in children and be adequately prepared for such an emergency. PMID:26957712

  8. The Incidence of Patent Foramen Ovale in 1,000 Consecutive Patients: A Contrast Transesophageal Echocardiography Study

    NASA Technical Reports Server (NTRS)

    Fisher, Daniel C.; Fisher, Edward A.; Budd, Jacqueline H.; Rosen, Stacey E.; Goldman, Martin E.

    1995-01-01

    Study objective: Patent foramen ovale (PFO) is present in 10 to 35% of people and has been reported to be an important risk factor for cardioembolic cerebrovascular accidents (CVAs) and transient ischemic attacks (TIAS), especially in younger patients. While contrast transthoracic echocardiography has been used to detect PFO, contrast transesophageal echocardiography (TEE) has a greater sensitivity. Prior studies reported the incidence of PFO in patients presenting with a CVA or TIA. Design: To determine the incidence of PFO in a more general population, we reviewed 1,000 consecutive TEES performed with contrast and color Doppler for the presence of PFO and other cardioembolic risk factors, including atrial septal aneurysm (ASA), aortic plaque, atrial fibrillation (AFib), and atrial thrombi. While imaging with monoplane or biplane TEE, multiple injections of agitated saline solution were injected during cough or Valsalva maneuver to detect flow through a PFO. Patients: There were 482 male and 518 female patients with mean age of 60 + 17 years (range 11 to 93 years). Results: Patent foramen ovale was found in 9.2% of all patients and, though seen in all age groups divided by decade, the incidence in patients aged 40 to 49 years was greater than those aged 70 to 79 years (12.96% vs 6.15%',, p=0.03). Contrast TEE had a much higher detection rate than color Doppler alone. Importantly, there was no greater incidence of PFO in patients with CVA vs thos without CVA, or in male vs female patients. Also, there was a very strong correlation between the presence of ASA and PFO (p<.001). Conclusion: Thus, PFO detected by TEE, frequently seen with ASA, is seen in all age groups and does not in itself present a risk factor for CVA. The association of PFO with peripheral thrombosis and CVA needs further study.

  9. Efficient feature-based 2D/3D registration of transesophageal echocardiography to x-ray fluoroscopy for cardiac interventions

    NASA Astrophysics Data System (ADS)

    Hatt, Charles R.; Speidel, Michael A.; Raval, Amish N.

    2014-03-01

    We present a novel 2D/ 3D registration algorithm for fusion between transesophageal echocardiography (TEE) and X-ray fluoroscopy (XRF). The TEE probe is modeled as a subset of 3D gradient and intensity point features, which facilitates efficient 3D-to-2D perspective projection. A novel cost-function, based on a combination of intensity and edge features, evaluates the registration cost value without the need for time-consuming generation of digitally reconstructed radiographs (DRRs). Validation experiments were performed with simulations and phantom data. For simulations, in silica XRF images of a TEE probe were generated in a number of different pose configurations using a previously acquired CT image. Random misregistrations were applied and our method was used to recover the TEE probe pose and compare the result to the ground truth. Phantom experiments were performed by attaching fiducial markers externally to a TEE probe, imaging the probe with an interventional cardiac angiographic x-ray system, and comparing the pose estimated from the external markers to that estimated from the TEE probe using our algorithm. Simulations found a 3D target registration error of 1.08(1.92) mm for biplane (monoplane) geometries, while the phantom experiment found a 2D target registration error of 0.69mm. For phantom experiments, we demonstrated a monoplane tracking frame-rate of 1.38 fps. The proposed feature-based registration method is computationally efficient, resulting in near real-time, accurate image based registration between TEE and XRF.

  10. Atrial Mechanical Function Before and After Electrical or Amiodarone Cardioversion in Atrial Fibrillation: Assessment by Transesophageal Echocardiography and Pulsed Doppler.

    PubMed

    Maria Amuchastegui, Luis; Cravero, Cecilia; Salomone, Oscar; Amuchastegui, Marcos

    1996-03-01

    In some patients with atrial fibrillation (AF), it has been suggested that left atrial mechanical dysfunction can develop after successful electrical cardioversion, justifying postcardioversion anticoagulant treatment. The purpose of this study was to investigate differences in left atrial appendage peak flow velocities and the incidence of left atrial spontaneous echo contrast in patients with AF before and after electrical cardioversion or intravenous amiodarone, studied using transesophageal echocardiography (TEE) and pulsed Doppler. We performed a control TEE in 7 patients in the electrical group and 6 in the amiodarone group, with no significant clinical differences between both groups. A second TEE was performed immediately in the 7 patients with successful electrical cardioversion. The peak flow velocities in the appendage before and after the procedure were: filling 43.3 +/- 22 vs 27.7 +/- 28 cm/sec (P = 0.01) and emptying 35.5 +/- 22 vs 23.6 +/- 17 cm/sec (P = 0.01), respectively. The spontaneous echo contrast increased in 4 of the 7 patients. In 4 patients of the amiodarone group, the peak flow velocities in the appendage during AF and within the first 24 hours after restoration of sinus rhythm were: filling 37.4 +/- 12 vs 37.8 +/- 18 cm/sec and emptying 36.4 +/- 18 vs 35.9 +/- 18 cm/sec, respectively (P = NS). There was no change in spontaneous echo contrast. In conclusion, patients with AF reverted to sinus rhythm using amiodarone did not show changes in left atrial mechanical function; however, patients with electrical cardioversion showed mechanical dysfunction. Further investigations on the effects of amiodarone and other drugs on the mechanical function of the atria are needed to determine if patients reverted pharmacologically require anticoagulation post reversion. (ECHOCARDIOGRAPHY, Volume 13, March 1996)

  11. The value of transesophageal echocardiography in the investigation and management of cryptogenic cerebral ischemia: a single-center experience.

    PubMed

    Katsanos, Aristeidis H; Patsouras, Dimitrios; Tsivgoulis, Georgios; Kosmidou, Maria; Katsanos, Konstantinos H; Kyritsis, Athanassios P; Giannopoulos, Sotirios

    2016-04-01

    The diagnostic utility of transesophageal echocardiography (TEE) has often been challenged in patients with cryptogenic stroke (CS). We estimated the prevalence of different findings on TEE examination of CS patients, their impact on secondary stroke prevention and the presence of potential age or gender disparities. We reviewed all TEE examinations that were performed in a single echocardiography laboratory during a 7-year-old period to identify CS patients that underwent investigation with TEE. Of the 518 total TEE examinations, we identified 88 CS patients. TEE revealed abnormal findings in 69.3 % of them. Patent foramen ovale (PFO) and atrial septal aneurysm (ASA) were identified in 30.6 and 22.7 % of the patients. Ascending aorta and aortic arch atheromatosis was present in 26.1 % of the patients, with complex atheromatosis diagnosed in 14.7 % of them. Cardiac myxomas were uncovered in 2.3 %. Thrombi in the left atrium and in cardiac valves were reported in 3.4 and 2.3 % of the patients, respectively. Based on TEE findings, the therapeutic management would be very likely modified in 9.1 % of the patients. Subgroup analysis revealed no gender disparities on the prevalence of TEE findings and in secondary stroke prevention, while linear regression analyses revealed significant associations of age with the prevalence of PFO, ASA, aorta atheromatosis and complex aorta atheromatosis. TEE examination should be included in the diagnostic work-up of all CS patients, irrespective of age and gender status, since it can reveal potential sources of embolism and has a significant impact for secondary stroke prevention.

  12. Intraoperative Ultrasound in the Treatment of Breast Cancer.

    PubMed

    Eggemann, H; Ignatov, T; Beni, A; Costa, S D; Ortmann, O; Ignatov, A

    2013-10-01

    Purpose: The aim of this study was to investigate the value of intraoperative ultrasound in breast-conserving operations and to compare it with standard procedures. Methods: For this purpose 307 women with palpable breast cancers and 116 patients with non-palpable breast cancers were compared retrospectively. In the group with palpable breast cancers 177 patients were treated by US-guided operations and 130 patients underwent palpation-guided breast-conserving operations. As primary outcomes, the resection margins and the rate of re-operations were evaluated. Results: With regard to disease-free resection margins, intraoperative ultrasound was significantly superior to palpation alone. In the group of patients in whom the tumours were extirpated with the help of palpation, R1 resections were observed almost twice as often (16.9 %) as in the US-guided group (8.5 %). In the group with non-palpable breast cancers, intraoperative ultrasound was employed in 61 patients. As a control, 43 cases were evaluated in whom the breast-conserving operation was performed after wire marking. In this group US-guided tumour removal proved to be superior to that after wire marking for tumours that did not exhibit any intraductal components. Otherwise the redo resection rate was reduced by use of ultrasound. Furthermore, the surgeon was able by means of intraoperative ultrasound to identify "problematic" margins and to excise them in the same sitting. Conclusions: The US-guided, breast-conserving operations led to a lower rate of R1 resections and redo operations in comparison to operations with palpation alone or those after wire marking.

  13. Intraoperative positioning and care of the obese patient.

    PubMed

    Dybec, Robert B

    2004-01-01

    The perioperative nurse involved in the intraoperative care of the obese patient is faced with numerous issues and challenges. As a growing number of these patients present for medical care, the nurse must consider the special positioning needs for surgery and the equipment needed to promote the safest environment for the patient. This article addresses positioning considerations for the obese patient and special equipment needs and selection in the operating room.

  14. Intraoperative MRI in pediatric neurosurgery—an update

    PubMed Central

    2014-01-01

    Since the advent of intraoperative magnetic resonance imaging (ioMRI) at the Brigham and Women’s Hospital in 1994, ioMRI has spread widely and in many different forms. This article traces the developmental history of ioMRI and reviews the relevant literature regarding it’s effectiveness in pediatric neurosurgery. While of considerable expense, current trends in healthcare essentially mandate the use of ioMRI in a growing number of cases. PMID:26835341

  15. [Intraoperative navigation, with focus on the skull base].

    PubMed

    Wirtz, C R

    2016-09-01

    Intraoperative navigation systems are widely used in ENT, oral and maxillofacial, and neurosurgery. The benefits of such systems have been demonstrated in various applications, including intracranial and skull base surgery. Intraoperative shift, "brain shift" and changes in anatomy caused by the surgical procedure itself impair the accuracy of navigation and represent factors limiting its application, particularly in glioma and metastatic brain surgery. For this reason, intraoperative imaging was incorporated into neurosurgery. A specific application of navigation is thus skull base surgery, where shifts are often negligible due to the bony structures in which pathologies are embedded. Development of new systems with seamless integration into the operative workflow propagated routine use of navigation in neuro- and ENT surgery. Navigation proved especially helpful in interdisciplinary surgery with pathologies located in anatomic regions where competences of different surgical disciplines overlap, as in the skull base. While this increased radicality in tumour resection, there was a high risk of morbidity. The integration of electrophysiological function monitoring served to preserve function and reduce morbidity, and has led to less invasive and radical strategies in skull base surgery. New radiosurgical methods to adjuvantly treat possible tumour remnants have also supported this development. Systems allowing resection borders to be marked in the navigational coordinates would enable direct linking of these data to radiotherapy planning and better interpretation of follow-up imaging. Navigation is thus a valuable tool supporting interdisciplinary cooperation in skull base surgery for the benefit of patients. PMID:27566369

  16. SEP Montage Variability Comparison during Intraoperative Neurophysiologic Monitoring

    PubMed Central

    Hanson, Christine; Lolis, Athena Maria; Beric, Aleksandar

    2016-01-01

    Intraoperative monitoring is performed to provide real-time assessment of the neural structures that can be at risk during spinal surgery. Somatosensory evoked potentials (SEPs) are the most commonly used modality for intraoperative monitoring. SEP stability can be affected by many factors during the surgery. This study is a prospective review of SEP recordings obtained during intraoperative monitoring of instrumented spinal surgeries that were performed for chronic underlying neurologic and neuromuscular conditions, such as scoliosis, myelopathy, and spinal stenosis. We analyzed multiple montages at the baseline, and then followed their development throughout the procedure. Our intention was to examine the stability of the SEP recordings throughout the surgical procedure on multiple montages of cortical SEP recordings, with the goal of identifying the appropriate combination of the least number of montages that gives the highest yield of monitorable surgeries. Our study shows that it is necessary to have multiple montages for SEP recordings, as it reduces the number of non-monitorable cases, improves IOM reliability, and therefore could reduce false positives warnings to the surgeons. Out of all the typical montages available for use, our study has shown that the recording montage Cz-C4/Cz-C3 (Cz-Cc) is the most reliable and stable throughout the procedure and should be the preferred montage followed throughout the surgery. PMID:27445969

  17. Predictors of intraoperative-acquired surgical wound infections.

    PubMed

    Garibaldi, R A; Cushing, D; Lerer, T

    1991-06-01

    During a 4-year period, we collected prospective epidemiological data and intraoperative wound cultures from 1852 surgery patients at a university-affiliated community hospital in order to identify the critical risk factors for postoperative wound infections and study the impact of perioperative antibiotics on the bacteriology of infected wounds. Stepwise logistic regression analysis revealed four risk factors that were independent of each other and highly predictive for subsequent wound infection. These were the surgical wound class, American Society of Anesthesiology (ASA) physical status grouping, duration of surgery and results of intraoperative cultures. Addition of other variables to our model did not increase the predicted probability of infection. Even though patients with positive intraoperative cultures had an increased rate of infection, this information had limited clinical utility because of its low predictive value, high false-positive rate and poor concordance with isolates from infected wounds. Patients who had received perioperative antibiotics and who developed infections were frequently infected with organisms that were resistant to the perioperative drug regimen, compared with patients who had not received antibiotics.

  18. Intraoperative brain tumor resection cavity characterization with conoscopic holography

    NASA Astrophysics Data System (ADS)

    Simpson, Amber L.; Burgner, Jessica; Chen, Ishita; Pheiffer, Thomas S.; Sun, Kay; Thompson, Reid C.; Webster, Robert J., III; Miga, Michael I.

    2012-02-01

    Brain shift compromises the accuracy of neurosurgical image-guided interventions if not corrected by either intraoperative imaging or computational modeling. The latter requires intraoperative sparse measurements for constraining and driving model-based compensation strategies. Conoscopic holography, an interferometric technique that measures the distance of a laser light illuminated surface point from a fixed laser source, was recently proposed for non-contact surface data acquisition in image-guided surgery and is used here for validation of our modeling strategies. In this contribution, we use this inexpensive, hand-held conoscopic holography device for intraoperative validation of our computational modeling approach to correcting for brain shift. Laser range scan, instrument swabbing, and conoscopic holography data sets were collected from two patients undergoing brain tumor resection therapy at Vanderbilt University Medical Center. The results of our study indicate that conoscopic holography is a promising method for surface acquisition since it requires no contact with delicate tissues and can characterize the extents of structures within confined spaces. We demonstrate that for two clinical cases, the acquired conoprobe points align with our model-updated images better than the uncorrected images lending further evidence that computational modeling approaches improve the accuracy of image-guided surgical interventions in the presence of soft tissue deformations.

  19. A New Measure for Monitoring Intraoperative Somatosensory Evoked Potentials

    PubMed Central

    Jin, Seung-Hyun; Kim, Jeong Eun; Choi, Young Doo

    2014-01-01

    Objective To propose a new measure for effective monitoring of intraoperative somatosensory evoked potentials (SEP) and to validate the feasibility of this measure for evoked potentials (EP) and single trials with a retrospective data analysis study. Methods The proposed new measure (hereafter, a slope-measure) was defined as the relative slope of the amplitude and latency at each EP peak compared to the baseline value, which is sensitive to the change in the amplitude and latency simultaneously. We used the slope-measure for EP and single trials and compared the significant change detection time with that of the conventional peak-to-peak method. When applied to single trials, each single trial signal was processed with optimal filters before using the slope-measure. In this retrospective data analysis, 7 patients who underwent cerebral aneurysm clipping surgery for unruptured aneurysm middle cerebral artery (MCA) bifurcation were included. Results We found that this simple slope-measure has a detection time that is as early or earlier than that of the conventional method; furthermore, using the slope-measure in optimally filtered single trials provides warning signs earlier than that of the conventional method during MCA clipping surgery. Conclusion Our results have confirmed the feasibility of the slope-measure for intraoperative SEP monitoring. This is a novel study that provides a useful measure for either EP or single trials in intraoperative SEP monitoring. PMID:25628803

  20. [Intraoperative navigation, with focus on the skull base].

    PubMed

    Wirtz, C R

    2016-09-01

    Intraoperative navigation systems are widely used in ENT, oral and maxillofacial, and neurosurgery. The benefits of such systems have been demonstrated in various applications, including intracranial and skull base surgery. Intraoperative shift, "brain shift" and changes in anatomy caused by the surgical procedure itself impair the accuracy of navigation and represent factors limiting its application, particularly in glioma and metastatic brain surgery. For this reason, intraoperative imaging was incorporated into neurosurgery. A specific application of navigation is thus skull base surgery, where shifts are often negligible due to the bony structures in which pathologies are embedded. Development of new systems with seamless integration into the operative workflow propagated routine use of navigation in neuro- and ENT surgery. Navigation proved especially helpful in interdisciplinary surgery with pathologies located in anatomic regions where competences of different surgical disciplines overlap, as in the skull base. While this increased radicality in tumour resection, there was a high risk of morbidity. The integration of electrophysiological function monitoring served to preserve function and reduce morbidity, and has led to less invasive and radical strategies in skull base surgery. New radiosurgical methods to adjuvantly treat possible tumour remnants have also supported this development. Systems allowing resection borders to be marked in the navigational coordinates would enable direct linking of these data to radiotherapy planning and better interpretation of follow-up imaging. Navigation is thus a valuable tool supporting interdisciplinary cooperation in skull base surgery for the benefit of patients.

  1. Intraoperative Brain Shift Compensation: Accounting for Dural Septa

    PubMed Central

    Chen, Ishita; Coffey, Aaron M.; Ding, Siyi; Dumpuri, Prashanth; Dawant, Benoit M.; Thompson, Reid C.

    2013-01-01

    Biomechanical models that describe soft tissue deformation provide a relatively inexpensive way to correct registration errors in image-guided neurosurgical systems caused by nonrigid brain shift. Quantifying the factors that cause this deformation to sufficient precision is a challenging task. To circumvent this difficulty, atlas-based methods have been developed recently that allow for uncertainty, yet still capture the first-order effects associated with deformation. The inverse solution is driven by sparse intraoperative surface measurements, which could bias the reconstruction and affect the subsurface accuracy of the model prediction. Studies using intraoperative MR have shown that the deformation in the midline, tentorium, and contralateral hemisphere is relatively small. The dural septa act as rigid membranes supporting the brain parenchyma and compartmentalizing the brain. Accounting for these structures in models may be an important key to improving subsurface shift accuracy. A novel method to segment the tentorium cerebelli will be described, along with the procedure for modeling the dural septa. Results in seven clinical cases show a qualitative improvement in subsurface shift accuracy making the predicted deformation more congruous with previous observations in the literature. The results also suggest a considerably more important role for hyperosmotic drug modeling for the intraoperative shift correction environment. PMID:21097376

  2. The role of intraoperative scrape cytology in vertebroplasty

    PubMed Central

    Inuganti, Renuka Venkata; Mettu, Rami Reddy; Surath, Harsha Vardhan; Surath, Amarnath

    2016-01-01

    Aims: To assess the adequacy of intraoperative scrape cytology during percutaneous vertebroplasty by correlating results with corresponding histopathology. Settings and Design: Vertebroplasty is a procedure increasingly used to treat painful vertebral compression fractures. The history and presentation of osteoporotic fractures are straightforward, but difficulty arises in differentiating infective from neoplastic lesions, especially in cases where the magnetic resonance imaging is equivocal. The procedure involves injection of polymethyl methacrylate (bone cement) into the pathological vertebral body and gives dramatic pain relief. It is indicated in osteoporotic and neoplastic lesions but contraindicated in infections. Hence, intraoperative evaluation of a specimen is essential to aid in the decision of performing vertebroplasty. Subjects and Methods: A total of 128 patients with vertebral lesions underwent core biopsy and scrape cytology from June 2006 to June 2015. Based on the findings of cytological examination, malignant lesions were subjected to vertebroplasty. In lesions with infective etiology, vertebroplasty was abandoned and antibiotic or antituberculous therapy started. Results: The overall diagnostic accuracy of scrape cytology was excellent with 97.58% cases correlating with the final histopathological diagnosis. Specificity was 100%, positive predictive value was 100% and negative predictive value was 33.33%. Conclusion: Scrape cytology is a simple, rapid, accurate cytodiagnostic technique and should be routinely utilized in vertebral lesions for intraoperative consultation and decision making during vertebroplasty. PMID:27298628

  3. Intraoperative diagnostics and elimination of residual microtumours with plasmonic nanobubbles

    NASA Astrophysics Data System (ADS)

    Lukianova-Hleb, Ekaterina Y.; Kim, Yoo-Shin; Belatsarkouski, Ihor; Gillenwater, Ann M.; O'Neill, Brian E.; Lapotko, Dmitri O.

    2016-06-01

    Failure of cancer surgery to intraoperatively detect and eliminate microscopic residual disease (MRD) causes lethal recurrence and metastases, and the removal of important normal tissues causes excessive morbidity. Here, we show that a plasmonic nanobubble (PNB), a non-stationary laser pulse-activated nanoevent, intraoperatively detects and eliminates MRD in the surgical bed. PNBs were generated in vivo in head and neck cancer cells by systemically targeting tumours with gold colloids and locally applying near-infrared, low-energy short laser pulses, and were simultaneously detected with an acoustic probe. In mouse models, between 3 and 30 residual cancer cells and MRD (undetectable with current methods) were non-invasively detected up to 4 mm deep in the surgical bed within 1 ms. In resectable MRD, PNB-guided surgery prevented local recurrence and delivered 100% tumour-free survival. In unresectable MRD, PNB nanosurgery improved survival twofold compared with standard surgery. Our results show that PNB-guided surgery and nanosurgery can rapidly and precisely detect and remove MRD in simple intraoperative procedures.

  4. Noise suppressed, multifocus image fusion for enhanced intraoperative navigation

    PubMed Central

    Feruglio, Paolo Fumene; Vinegoni, Claudio; Fexon, Lyuba; Thurber, Greg; Sbarbati, Andrea; Weissleder, Ralph

    2013-01-01

    Current intraoperative imaging systems are typically not able to provide ‘sharp’ images over entire large areas or entire organs. Distinct structures such as tissue margins or groups of malignant cells are therefore often difficult to detect, especially under low signal-to-noise-ratio conditions. In this report, we introduce a noise suppressed multifocus image fusion algorithm, that provides detailed reconstructions even when images are acquired under sub-optimal conditions, such is the case for real time fluorescence intraoperative surgery. The algorithm makes use of the Anscombe transform combined with a multi-level stationary wavelet transform with individual threshold-based shrinkage. While the imaging system is integrated with a respiratory monitor triggering system, it can be easily adapted to any commercial imaging system. The developed algorithm is made available as a plugin for Osirix. Intraoperative detection of small malignant fluorescent cells using the proposed noise suppressed multifocus image fusion system. Red/Yellow circles indicate small groups of malignant cells. PMID:22887724

  5. A geometric analysis of mastectomy incisions: Optimizing intraoperative breast volume

    PubMed Central

    Chopp, David; Rawlani, Vinay; Ellis, Marco; Johnson, Sarah A; Buck, Donald W; Khan, Seema; Bethke, Kevin; Hansen, Nora; Kim, John YS

    2011-01-01

    INTRODUCTION: The advent of acellular dermis-based tissue expander breast reconstruction has placed an increased emphasis on optimizing intraoperative volume. Because skin preservation is a critical determinant of intraoperative volume expansion, a mathematical model was developed to capture the influence of incision dimension on subsequent tissue expander volumes. METHODS: A mathematical equation was developed to calculate breast volume via integration of a geometrically modelled breast cross-section. The equation calculates volume changes associated with excised skin during the mastectomy incision by reducing the arc length of the cross-section. The degree of volume loss is subsequently calculated based on excision dimensions ranging from 35 mm to 60 mm. RESULTS: A quadratic relationship between breast volume and the vertical dimension of the mastectomy incision exists, such that incrementally larger incisions lead to a disproportionally greater amount of volume loss. The vertical dimension of the mastectomy incision – more so than the horizontal dimension – is of critical importance to maintain breast volume. Moreover, the predicted volume loss is more profound in smaller breasts and primarily occurs in areas that affect breast projection on ptosis. CONCLUSIONS: The present study is the first to model the relationship between the vertical dimensions of the mastectomy incision and subsequent volume loss. These geometric principles will aid in optimizing intra-operative volume expansion during expander-based breast reconstruction. PMID:22654531

  6. SEP Montage Variability Comparison during Intraoperative Neurophysiologic Monitoring.

    PubMed

    Hanson, Christine; Lolis, Athena Maria; Beric, Aleksandar

    2016-01-01

    Intraoperative monitoring is performed to provide real-time assessment of the neural structures that can be at risk during spinal surgery. Somatosensory evoked potentials (SEPs) are the most commonly used modality for intraoperative monitoring. SEP stability can be affected by many factors during the surgery. This study is a prospective review of SEP recordings obtained during intraoperative monitoring of instrumented spinal surgeries that were performed for chronic underlying neurologic and neuromuscular conditions, such as scoliosis, myelopathy, and spinal stenosis. We analyzed multiple montages at the baseline, and then followed their development throughout the procedure. Our intention was to examine the stability of the SEP recordings throughout the surgical procedure on multiple montages of cortical SEP recordings, with the goal of identifying the appropriate combination of the least number of montages that gives the highest yield of monitorable surgeries. Our study shows that it is necessary to have multiple montages for SEP recordings, as it reduces the number of non-monitorable cases, improves IOM reliability, and therefore could reduce false positives warnings to the surgeons. Out of all the typical montages available for use, our study has shown that the recording montage Cz-C4/Cz-C3 (Cz-Cc) is the most reliable and stable throughout the procedure and should be the preferred montage followed throughout the surgery. PMID:27445969

  7. Intraoperative augmented reality for minimally invasive liver interventions

    NASA Astrophysics Data System (ADS)

    Scheuering, Michael; Schenk, Andrea; Schneider, Armin; Preim, Bernhard; Greiner, Guenther

    2003-05-01

    Minimally invasive liver interventions demand a lot of experience due to the limited access to the field of operation. In particular, the correct placement of the trocar and the navigation within the patient's body are hampered. In this work, we present an intraoperative augmented reality system (IARS) that directly projects preoperatively planned information and structures extracted from CT data, onto the real laparoscopic video images. Our system consists of a preoperative planning tool for liver surgery and an intraoperative real time visualization component. The planning software takes into account the individual anatomy of the intrahepatic vessels and determines the vascular territories. Methods for fast segmentation of the liver parenchyma, of the intrahepatic vessels and of liver lesions are provided. In addition, very efficient algorithms for skeletonization and vascular analysis allowing the approximation of patient-individual liver vascular territories are included. The intraoperative visualization is based on a standard graphics adapter for hardware accelerated high performance direct volume rendering. The preoperative CT data is rigidly registered to the patient position by the use of fiducials that are attached to the patient's body, and anatomical landmarks in combination with an electro-magnetic navigation system. Our system was evaluated in vivo during a minimally invasive intervention simulation in a swine under anesthesia.

  8. Intracardiac echocardiography guided transeptal catheter injection of microspheres for assessment of cerebral microcirculation in experimental models.

    PubMed

    Bellapart, Judith; Dunster, Kimble R; Diab, Sara; Platts, David G; Raffel, Christopher; Gabrielian, Levon; Maybauer, Marc O; Barnett, Adrian; Boots, Robert James; Fraser, John F

    2013-01-01

    The use of microspheres for the determination of regional microvascular blood flow (RMBF) has previously used different approaches. This study presents for the first time the intracardiac injection of microspheres using transeptal puncture under intracardiac echocardiography guidance. Five Merino sheep were instrumented and cardiovascularly supported according to local guidelines. Two catheter sheaths into the internal jugular vein facilitated the introduction of an intracardiac probe and transeptal catheter, respectively. Five million colour coded microspheres were injected into the left atrium via this catheter. After euthanasia the brain was used as proof of principle and the endpoint for determination of microcirculation at different time points. Homogeneous allocation of microspheres to different regions of the brain was found over time. Alternate slices from both hemispheres showed the following flow ranges: for slice 02; 0.57-1.02 mL/min/g, slice 04; 0.45-1.42 mL/min/g, slice 06; 0.35-1.87 mL/min/g, slice 08; 0.46-1.77 mL/min/g, slice 10; 0.34-1.28 mL/min/g. A mixed effect regression model demonstrated that the confidence interval did include zero suggesting that the apparent variability intra- and intersubject was not statistically significant, supporting the stability and reproducibility of the injection technique. This study demonstrates the feasibility of the transeptal injection of microspheres, showing a homogeneous distribution of blood flow through the brain unchanged over time and has established a new interventional model for the measurement of RMBF in ovine models.

  9. Intracardiac echocardiography guided transeptal catheter injection of microspheres for assessment of cerebral microcirculation in experimental models.

    PubMed

    Bellapart, Judith; Dunster, Kimble R; Diab, Sara; Platts, David G; Raffel, Christopher; Gabrielian, Levon; Maybauer, Marc O; Barnett, Adrian; Boots, Robert James; Fraser, John F

    2013-01-01

    The use of microspheres for the determination of regional microvascular blood flow (RMBF) has previously used different approaches. This study presents for the first time the intracardiac injection of microspheres using transeptal puncture under intracardiac echocardiography guidance. Five Merino sheep were instrumented and cardiovascularly supported according to local guidelines. Two catheter sheaths into the internal jugular vein facilitated the introduction of an intracardiac probe and transeptal catheter, respectively. Five million colour coded microspheres were injected into the left atrium via this catheter. After euthanasia the brain was used as proof of principle and the endpoint for determination of microcirculation at different time points. Homogeneous allocation of microspheres to different regions of the brain was found over time. Alternate slices from both hemispheres showed the following flow ranges: for slice 02; 0.57-1.02 mL/min/g, slice 04; 0.45-1.42 mL/min/g, slice 06; 0.35-1.87 mL/min/g, slice 08; 0.46-1.77 mL/min/g, slice 10; 0.34-1.28 mL/min/g. A mixed effect regression model demonstrated that the confidence interval did include zero suggesting that the apparent variability intra- and intersubject was not statistically significant, supporting the stability and reproducibility of the injection technique. This study demonstrates the feasibility of the transeptal injection of microspheres, showing a homogeneous distribution of blood flow through the brain unchanged over time and has established a new interventional model for the measurement of RMBF in ovine models. PMID:24102032

  10. Reexamining traditional intraoperative fluid administration: evolving views in the age of goal-directed therapy.

    PubMed

    Gallagher, Kaitlin; Vacchiano, Charles

    2014-06-01

    Intraoperative volume administration has long been a topic of debate in the field of anesthesia. Only recently, however, has the conversation shifted to a discussion of appropriate intraoperative volume. A thorough review of the literature explores the history of today's widely accepted fluid administration equation and discusses possible explanations and consequences of iatrogenically induced hypervolemia. Current studies exploring various volume administration techniques are reviewed, as are emerging technologies available to help guide anesthesia providers with intraoperative fluid management.

  11. Depth-resolved registration of transesophageal echo to x-ray fluoroscopy using an inverse geometry fluoroscopy system

    SciTech Connect

    Hatt, Charles R.; Tomkowiak, Michael T.; Dunkerley, David A. P.; Slagowski, Jordan M.; Funk, Tobias; Raval, Amish N.; Speidel, Michael A.

    2015-12-15

    Purpose: Image registration between standard x-ray fluoroscopy and transesophageal echocardiography (TEE) has recently been proposed. Scanning-beam digital x-ray (SBDX) is an inverse geometry fluoroscopy system designed for cardiac procedures. This study presents a method for 3D registration of SBDX and TEE images based on the tomosynthesis and 3D tracking capabilities of SBDX. Methods: The registration algorithm utilizes the stack of tomosynthetic planes produced by the SBDX system to estimate the physical 3D coordinates of salient key-points on the TEE probe. The key-points are used to arrive at an initial estimate of the probe pose, which is then refined using a 2D/3D registration method adapted for inverse geometry fluoroscopy. A phantom study was conducted to evaluate probe pose estimation accuracy relative to the ground truth, as defined by a set of coregistered fiducial markers. This experiment was conducted with varying probe poses and levels of signal difference-to-noise ratio (SDNR). Additional phantom and in vivo studies were performed to evaluate the correspondence of catheter tip positions in TEE and x-ray images following registration of the two modalities. Results: Target registration error (TRE) was used to characterize both pose estimation and registration accuracy. In the study of pose estimation accuracy, successful pose estimates (3D TRE < 5.0 mm) were obtained in 97% of cases when the SDNR was 5.9 or higher in seven out of eight poses. Under these conditions, 3D TRE was 2.32 ± 1.88 mm, and 2D (projection) TRE was 1.61 ± 1.36 mm. Probe localization error along the source-detector axis was 0.87 ± 1.31 mm. For the in vivo experiments, mean 3D TRE ranged from 2.6 to 4.6 mm and mean 2D TRE ranged from 1.1 to 1.6 mm. Anatomy extracted from the echo images appeared well aligned when projected onto the SBDX images. Conclusions: Full 6 DOF image registration between SBDX and TEE is feasible and accurate to within 5 mm. Future studies will focus on

  12. Depth-resolved registration of transesophageal echo to x-ray fluoroscopy using an inverse geometry fluoroscopy system

    PubMed Central

    Hatt, Charles R.; Tomkowiak, Michael T.; Dunkerley, David A. P.; Slagowski, Jordan M.; Funk, Tobias; Raval, Amish N.; Speidel, Michael A.

    2015-01-01

    Purpose: Image registration between standard x-ray fluoroscopy and transesophageal echocardiography (TEE) has recently been proposed. Scanning-beam digital x-ray (SBDX) is an inverse geometry fluoroscopy system designed for cardiac procedures. This study presents a method for 3D registration of SBDX and TEE images based on the tomosynthesis and 3D tracking capabilities of SBDX. Methods: The registration algorithm utilizes the stack of tomosynthetic planes produced by the SBDX system to estimate the physical 3D coordinates of salient key-points on the TEE probe. The key-points are used to arrive at an initial estimate of the probe pose, which is then refined using a 2D/3D registration method adapted for inverse geometry fluoroscopy. A phantom study was conducted to evaluate probe pose estimation accuracy relative to the ground truth, as defined by a set of coregistered fiducial markers. This experiment was conducted with varying probe poses and levels of signal difference-to-noise ratio (SDNR). Additional phantom and in vivo studies were performed to evaluate the correspondence of catheter tip positions in TEE and x-ray images following registration of the two modalities. Results: Target registration error (TRE) was used to characterize both pose estimation and registration accuracy. In the study of pose estimation accuracy, successful pose estimates (3D TRE < 5.0 mm) were obtained in 97% of cases when the SDNR was 5.9 or higher in seven out of eight poses. Under these conditions, 3D TRE was 2.32 ± 1.88 mm, and 2D (projection) TRE was 1.61 ± 1.36 mm. Probe localization error along the source-detector axis was 0.87 ± 1.31 mm. For the in vivo experiments, mean 3D TRE ranged from 2.6 to 4.6 mm and mean 2D TRE ranged from 1.1 to 1.6 mm. Anatomy extracted from the echo images appeared well aligned when projected onto the SBDX images. Conclusions: Full 6 DOF image registration between SBDX and TEE is feasible and accurate to within 5 mm. Future studies will focus on

  13. Intraoperative examination of sentinel lymph nodes using scrape cytology.

    PubMed

    Mannell, Aylwyn; Wium, Brunton; Thatcher, Charles

    2014-08-08

    Background. In breast cancer, sentinel lymph node biopsy (SLNB) is widely used to assess the axilla when the nodes appear normal on palpation and ultrasonography. When the sentinel lymph nodes (SLNs) are negative, no further dissection is required. Surgical dissection or radiotherapy of the axilla is indicated for macrometastases, as well as adjuvant therapy for macrometastases and micrometastasic spread.Aim. To determine the accuracy of scrape cytology (SC) for intraoperative examination of the SLNs.Methods. SLNB was performed in 100 patients with early breast cancer in whom the axillary nodes appeared normal on clinical examination and ultrasonography. None of the patients with negative SLNs or SLNs with micrometastases only (N1mic, 0.2 - 2 mm) had further axillary dissection. Patients with SLNs containing macrometastases (N1, >2 mm) underwent axillary lymph node dissection. The results of intraoperative cytology were compared with the histopathological findings on examination of serial paraffin-embedded sections of the SLNs.Results. Intraoperative SC identified SLN metastases in 20 patients: 17 had macrometastases and 3 micrometastases. Histopathological examination of the SLNs found macrometastases in 18 patients and micrometastases in 6. SC had a sensitivity of 94% and specificity of 100% for the detection of macrometastases. For micrometastatic spread, the sensitivity and specificity were 50% and 100%, respectively.Conclusion. SC is a rapid, sensitive technique for detection of macrometastases in the SLNs of women with breast cancer. The overall accuracy in identification of any metastatic spread (N1mic, N1) to the SLNs was 85%, rising to 94% in SLNs with macrometastases.

  14. Intraoperative Optical Imaging and Tissue Interrogation During Urologic Surgery

    PubMed Central

    Hsu, Mark; Gupta, Mohit; Su, Li-Ming; Liao, Joseph C.

    2014-01-01

    Purpose of review To review optical imaging technologies in urologic surgery aimed to facilitate intraoperative imaging and tissue interrogation. Recent findings Emerging new optical imaging technologies can be integrated in the operating room environment during minimally invasive and open surgery. These technologies include macroscopic fluorescence imaging that provides contrast enhancement between normal and diseased tissue and microscopic imaging that provides tissue characterization. Summary Optical imaging technologies that have reached the clinical arena in urologic surgery are reviewed, including photodynamic diagnosis, near infrared fluorescence imaging, optical coherence tomography, and confocal laser endomicroscopy. PMID:24240512

  15. Intraoperative photodynamic therapy in laryngeal part of pharynx cancers

    NASA Astrophysics Data System (ADS)

    Loukatch, Erwin V.; Trojan, Vasily; Loukatch, Vjacheslav

    1996-12-01

    In clinic intraoperative photodynamic therapy (IPT) was done in patients with primal squamous cells cancer of the laryngeal part of the pharynx. The He-Ne laser and methylene blue as a photosensibilizator were used. Cobalt therapy in the postoperative period was done in dose 45 Gr. Patients of control groups (1-th group) with only laser and (2-th group) only methylene blue were controlled during three years with the main group. The statistics show certain differences of recidives in the main group compared to the control groups. These facts are allowing us to recommend the use of IPT as an additional method in ENT-oncology diseases treatment.

  16. Intraoperative Neurophysiologic Monitoring: Basic Principles and Recent Update

    PubMed Central

    Kim, Sung-Min; Kim, Seung Hyun; Seo, Dae-Won

    2013-01-01

    The recent developments of new devices and advances in anesthesiology have greatly improved the utility and accuracy of intraoperative neurophysiological monitoring (IOM). Herein, we review the basic principles of the electrophysiological methods employed under IOM in the operating room. These include motor evoked potentials, somatosensory evoked potentials, electroencephalography, electromyography, brainstem auditory evoked potentials, and visual evoked potentials. Most of these techniques have certain limitations and their utility is still being debated. In this review, we also discuss the optimal stimulation/recording method for each of these modalities during individual surgeries as well as the diverse criteria for alarm signs. PMID:24015028

  17. A smart method of intraoperative explantation of an aortic bioprosthesis.

    PubMed

    Erdem, Can C; Park, Soon J

    2009-01-01

    Structural prosthetic valve deterioration and nonstructural dysfunction are two common causes of nonfatal valve events following implantation of a bioprosthetic valve. Using caution and skill, implantation of a bioprosthesis is relatively easy. On the other hand, explantation of a bioprosthesis is a challenging and time-consuming procedure. We have developed a surgical technique by which we were able to ameliorate this troublesome situation in a 79-year-old man with aortic stenosis in whom we had to intraoperatively explant the bioprosthesis that we have put in initially. Another bioprosthesis of the same kind was used to replace the old prosthesis with the rest of his postoperative course until dismissal being eventless.

  18. [Importance of preoperative and intraoperative imaging for operative strategies].

    PubMed

    Nitschke, P; Bork, U; Plodeck, V; Podlesek, D; Sobottka, S B; Schackert, G; Weitz, J; Kirsch, M

    2016-03-01

    Recent advances in preoperative and postoperative imaging have an increasing influence on surgical decision-making and make more complex surgical interventions possible. This improves the possibilities for frequently occurring challenges and promoting improved functional and oncological outcome. This manuscript reviews the role of preoperative and intraoperative imaging in surgery. Various techniques are explained based on examples from hepatobiliary surgery and neurosurgery, in particular real-time procedures, such as the online use of augmented reality and in vivo fluorescence, as well as new and promising optical techniques including imaging of intrinsic signals and vibrational spectroscopy. PMID:26939896

  19. A CASE OF GRANISETRON ASSOCIATED INTRAOPERATIVE CARDIAC ARREST.

    PubMed

    Al Harbi, Mohammed; Al Rifai, Derar; Al Habeeb, Hassan; Wambi, Freddie; Geldhof, Georges; Dimitriou, Vassilios

    2016-02-01

    We report a case of intraoperative severe bradycardia that resulted in asystole and cardiac arrest shortly after (<2 min) intravenous granisetron 1mg for postoperative nausea and vomiting prophylaxis, that occurred in a female patient who underwent an elective total thyroidectomy. After two cycles of cardiopulmonary resuscitation and defibrillation, spontaneous circulation and sinus rhythm returned successfully. Postoperatively, the patient was diagnosed with a drug-induced long QT syndrome. At the time of the event, granisetron was the only medication administered. Furthermore, there was no reason to suspect electrolyte abnormalities. We explore the association of the onset of severe sinus bradycardia with the intravenous administration of granisetron. PMID:27382819

  20. Does the Surgical Apgar Score Measure Intraoperative Performance?

    PubMed Central

    Regenbogen, Scott E.; Lancaster, R. Todd; Lipsitz, Stuart R.; Greenberg, Caprice C.; Hutter, Matthew M.; Gawande, Atul A.

    2008-01-01

    Objective To evaluate whether Surgical Apgar Scores measure the relationship between intraoperative care and surgical outcomes. Summary Background Data With preoperative risk-adjustment now well-developed, the role of intraoperative performance in surgical outcomes may be considered. We previously derived and validated a ten-point Surgical Apgar Score—based on intraoperative blood loss, heart rate, and blood pressure—that effectively predicts major postoperative complications within 30 days of general and vascular surgery. This study evaluates whether the predictive value of this score comes solely from patients’ preoperative risk, or also measures care in the operating room. Methods Among a systematic sample of 4,119 general and vascular surgery patients at a major academic hospital, we constructed a detailed risk-prediction model including 27 patient-comorbidity and procedure-complexity variables, and computed patients’ propensity to suffer a major postoperative complication. We evaluated the prognostic value of patients’ Surgical Apgar Scores before and after adjustment for this preoperative risk. Results After risk-adjustment, the Surgical Apgar Score remained strongly correlated with postoperative outcomes (p<0.0001). Odds of major complications among average-scoring patients (scores 7–8) were equivalent to preoperative predictions (likelihood ratio (LR) 1.05, 95%CI 0.78–1.41), significantly decreased for those who achieved the best scores of 9–10 (LR 0.52, 95%CI 0.35–0.78), and were significantly poorer for those with low scores—LRs 1.60 (1.12–2.28) for scores 5–6, and 2.80 (1.50–5.21) for scores 0–4. Conclusions Even after accounting for fixed preoperative risk—due to patients’ acute condition, comorbidities and/or operative complexity—the Surgical Apgar Score appears to detect differences in intraoperative management that reduce odds of major complications by half, or increase them by nearly three-fold. PMID:18650644

  1. Intraoperative neuropathology of glioma recurrence: cell detection and classification

    NASA Astrophysics Data System (ADS)

    Abas, Fazly S.; Gokozan, Hamza N.; Goksel, Behiye; Otero, Jose J.; Gurcan, Metin N.

    2016-03-01

    Intraoperative neuropathology of glioma recurrence represents significant visual challenges to pathologists as they carry significant clinical implications. For example, rendering a diagnosis of recurrent glioma can help the surgeon decide to perform more aggressive resection if surgically appropriate. In addition, the success of recent clinical trials for intraoperative administration of therapies, such as inoculation with oncolytic viruses, may suggest that refinement of the intraoperative diagnosis during neurosurgery is an emerging need for pathologists. Typically, these diagnoses require rapid/STAT processing lasting only 20-30 minutes after receipt from neurosurgery. In this relatively short time frame, only dyes, such as hematoxylin and eosin (H and E), can be implemented. The visual challenge lies in the fact that these patients have undergone chemotherapy and radiation, both of which induce cytological atypia in astrocytes, and pathologists are unable to implement helpful biomarkers in their diagnoses. Therefore, there is a need to help pathologists differentiate between astrocytes that are cytologically atypical due to treatment versus infiltrating, recurrent, neoplastic astrocytes. This study focuses on classification of neoplastic versus non-neoplastic astrocytes with the long term goal of providing a better neuropathological computer-aided consultation via classification of cells into reactive gliosis versus recurrent glioma. We present a method to detect cells in H and E stained digitized slides of intraoperative cytologic preparations. The method uses a combination of the `value' component of the HSV color space and `b*' component of the CIE L*a*b* color space to create an enhanced image that suppresses the background while revealing cells on an image. A composite image is formed based on the morphological closing of the hue-luminance combined image. Geometrical and textural features extracted from Discrete Wavelet Frames and combined to classify

  2. Intraoperative consultation for the retroperitoneum and adrenal glands.

    PubMed

    Klein, E A; Streem, S B; Novick, A C

    1985-08-01

    An incidentally discovered mass lesion is the most frequent indication for intraoperative consultation involving the retroperitoneum or adrenal gland. The goal of the surgeon is to determine the nature and extent of the lesion and, for solid lesions, to obtain a biopsy adequate for histopathologic diagnosis. Benign lesions may be excised locally, whereas therapy for malignancies depends upon the individual circumstances of the patient, the histology of the lesion, and involvement of adjacent organs. Treatment of hematomas requires early vascular control. Adrenal tissue should be preserved whenever possible.

  3. Intraoperative Evaluation of Breast Tumor Margins with Optical Coherence Tomography

    PubMed Central

    Nguyen, Freddy T.; Zysk, Adam M.; Chaney, Eric J.; Kotynek, Jan G.; Oliphant, Uretz J.; Bellafiore, Frank J.; Rowland, Kendrith M.; Johnson, Patricia A.; Boppart, Stephen A.

    2009-01-01

    As breast cancer screening rates increase, smaller and more numerous lesions are being identified earlier, leading to more breast-conserving surgical procedures. Achieving a clean surgical margin represents a technical challenge with important clinical implications. Optical coherence tomography (OCT) is introduced as an intraoperative high-resolution imaging technique that assesses surgical breast tumor margins by providing real-time microscopic images up to 2 mm beneath the tissue surface. In a study of 37 patients split between training and study groups, OCT images covering 1 cm2 regions were acquired from surgical margins of lumpectomy specimens, registered with ink, and correlated with corresponding histological sections. A 17 patient training set used to establish standard imaging protocols and OCT evaluation criteria demonstrated that areas of higher scattering tissue with a heterogeneous pattern were indicative of tumor cells and tumor tissue, in contrast to lower scattering adipocytes found in normal breast tissue. The remaining 20 patients were enrolled into the feasibility study. Of these lumpectomy specimens, 11 were identified with a positive or close surgical margin and 9 were identified with a negative margin under OCT. Based on histological findings, 9 true positives, 9 true negatives, 2 false positives, and 0 false negatives were found, yielding a sensitivity of 100% and specificity of 82%. These results demonstrate the potential of OCT as a real-time method for intraoperative margin assessment in breast conserving surgeries. PMID:19910294

  4. Intraoperative radiation therapy in malignant glioma: early clinical results.

    PubMed

    Ortiz de Urbina, D; Santos, M; Garcia-Berrocal, I; Bustos, J C; Samblas, J; Gutierrez-Diaz, J A; Delgado, J M; Donckaster, G; Calvo, F A

    1995-08-01

    Intraoperative radiation therapy (IORT) with high energy electron beams is a treatment modality that has been included in multimodal programs in oncology to improve local tumor control. From August 1991 to December 1993, 17 patients with primary (8) or recurrent (9) high grade malignant gliomas, anaplastic astrocytoma (4), anaplastic oligodendroglioma (6) and glioblastoma multiforme (7), underwent surgical resection and a single dose of 10-20 Gy intraoperative radiation therapy was delivered in tumor bed. Fourteen patients received either pre-operative (8) or post-operative (6) external beam radiation therapy. Primary gliomas: 18-months actuarial survival rate has been 56% (range: 1-21+ months) and the median survival time has not yet been achieved. Four patients developed tumor progression (median time to tumor progression: 9 months). Recurrent gliomas: 18-months actuarial survival rate and median survival time has been 47% and 13 months (range: 6-32+ months) respectively. The median time to tumor progression was 11 months. No IORT related mortality has been observed. IORT is an attractive, tolerable and feasible treatment modality as antitumoral intensification procedure in high grade malignant gliomas.

  5. Simulated microsurgery monitoring using intraoperative multimodal surgical microscopy

    NASA Astrophysics Data System (ADS)

    Lee, Donghyun; Lee, Changho; Kim, Sehui; Zhou, Qifa; Kim, Jeehyun; Kim, Chulhong

    2016-03-01

    We have developed an intraoperative multimodal surgical microscopy system that provides simultaneous real-time enlarged surface views and subsurface anatomic information during surgeries by integrating spectral domain optical coherence tomography (SD-OCT), optical-resolution photoacoustic microscopy (OR-PAM), and conventional surgical microscopy. By sharing the same optical path, both OCT and PAM images were simultaneously acquired. Additionally, the custom-made needle-type transducer received the generated PA signals enabling convenient surgical operation without using a water bath. Using a simple augmented device, the OCT and PAM images were projected on the view plane of the surgical microscope. To quantify the performance of our system, we measured spatial resolutions of our system. Then, three microsurgery simulation and analysis were processed: (1) ex vivo needle tracking and monitoring injection of carbon particles in biological tissues, (2) in vivo needle tracking and monitoring injection of carbon particles in tumor-bearing mice, and (3) in vivo guiding of melanoma removal in melanoma-bearing mice. The results indicate that this triple modal system is useful for intraoperative purposes, and can potentially be a vital tool in microsurgeries.

  6. Toward Microendoscopic Electrical Impedance Tomography for Intraoperative Surgical Margin Assessment

    PubMed Central

    Halter, Ryan J.; Kim, Young-Joong

    2015-01-01

    No clinical protocols are routinely used to intraoperatively assess surgical margin status during prostate surgery. Instead, margins are evaluated through pathological assessment of the prostate following radical prostatectomy, when it is too late to provide additional surgical intervention. An intraoperative device potentially capable of assessing surgical margin status based on the electrical property contrast between benign and malignant prostate tissue has been developed. Specifically, a microendoscopic electrical impedance tomography (EIT) probe has been constructed to sense and image, at near millimeter resolution, the conductivity contrast within heterogeneous biological tissues with the goal of providing surgeons with real-time assessment of margin pathologies. This device consists of a ring of eight 0.6-mm diameter electrodes embedded in a 5-mm diameter probe tip to enable access through a 12-mm laparoscopic port. Experiments were performed to evaluate the volume of tissue sensed by the probe. The probe was also tested with inclusions in gelatin, as well as on a sample of porcine tissue with clearly defined regions of adipose and muscle. The probe's area of sensitivity consists of a circular area of 9.1 mm2 and the maximum depth of sensitivity is approximately 1.5 mm. The probe is able to distinguish between high contrast muscle and adipose tissue on a sub-mm scale (~500 μm). These preliminary results suggest that EIT is possible in a probe designed to fit within a 12-mm laparoscopic access port. PMID:24951675

  7. Prevention of intraoperative wound contamination with chlorhexidine shower and scrub.

    PubMed

    Garibaldi, R A

    1988-04-01

    In a prospective, controlled, clinical trial, we found that preoperative showering and scrubbing with 4% chlorhexidine gluconate was more effective than povidone-iodine or triclocarban medicated soap in reducing skin colonization at the site of surgical incision. Mean log colony counts of the incision site were one half to one log lower for patients who showered with chlorhexidine compared to those who showered with the other regimens. No growth was observed on 43% of the post shower skin cultures from patients in the chlorhexidine group compared with 16% of the cultures from patients who had povidone-iodine showers and 5% of those from patients who used medicated soap and water. The frequency of positive intraoperative wound cultures was 4% with chlorhexidine, 9% with povidone-iodine and 14% with medicated soap and water. This study demonstrates that chlorhexidine gluconate is a more effective skin disinfectant than either povidone-iodine or triclocarban soap and water and that its use is associated with lower rates of intraoperative wound contamination.

  8. Intraoperative Indocyanine Green Laser Angiography in Pediatric Autologous Ear Reconstruction

    PubMed Central

    Martins, Deborah B.; Farias-Eisner, Gina; Mandelbaum, Rachel S.; Hoang, Han; Bradley, James P.

    2016-01-01

    Summary: Skin flap vascularity is a critical determinant of aesthetic results in autologous ear reconstruction. In this study, we investigate the use of intraoperative laser-assisted indocyanine green angiography (ICGA) as an adjunctive measure of skin flap vascularity in pediatric autologous ear reconstruction. Twenty-one consecutive pediatric patients undergoing first-stage autologous total ear reconstruction were retrospectively evaluated. The first 10 patients were treated traditionally (non-ICGA), and the latter 11 patients were evaluated with ICGA intraoperatively after implantation of the cartilage construct and administration of suction. Relative and absolute perfusion units in the form of contour maps were generated. Statistical analyses were performed using independent sample Student t test. Statistically significant differences in exposure and infection were not found between the 2 groups. However, decreased numbers of surgical revisions were required in cases with ICGA versus without ICGA (P = 0.03), suggesting that greater certainty in skin flap perfusion correlated with a reduction in revision surgeries. In cases of exposure, we found an average lowest absolute perfusion unit of 14.3, whereas cases without exposure had an average of 26.1 (P = 0.02), thereby defining objective parameters for utilizing ICGA data in tailoring surgical decision making for this special population of patients. Defined quantitative parameters for utilizing ICGA in evaluating skin flap vascularity may be a useful adjunctive technique in pediatric autologous ear reconstruction. PMID:27579233

  9. Intraoperative Indocyanine Green Laser Angiography in Pediatric Autologous Ear Reconstruction.

    PubMed

    Martins, Deborah B; Farias-Eisner, Gina; Mandelbaum, Rachel S; Hoang, Han; Bradley, James P; Lee, Justine C

    2016-05-01

    Skin flap vascularity is a critical determinant of aesthetic results in autologous ear reconstruction. In this study, we investigate the use of intraoperative laser-assisted indocyanine green angiography (ICGA) as an adjunctive measure of skin flap vascularity in pediatric autologous ear reconstruction. Twenty-one consecutive pediatric patients undergoing first-stage autologous total ear reconstruction were retrospectively evaluated. The first 10 patients were treated traditionally (non-ICGA), and the latter 11 patients were evaluated with ICGA intraoperatively after implantation of the cartilage construct and administration of suction. Relative and absolute perfusion units in the form of contour maps were generated. Statistical analyses were performed using independent sample Student t test. Statistically significant differences in exposure and infection were not found between the 2 groups. However, decreased numbers of surgical revisions were required in cases with ICGA versus without ICGA (P = 0.03), suggesting that greater certainty in skin flap perfusion correlated with a reduction in revision surgeries. In cases of exposure, we found an average lowest absolute perfusion unit of 14.3, whereas cases without exposure had an average of 26.1 (P = 0.02), thereby defining objective parameters for utilizing ICGA data in tailoring surgical decision making for this special population of patients. Defined quantitative parameters for utilizing ICGA in evaluating skin flap vascularity may be a useful adjunctive technique in pediatric autologous ear reconstruction. PMID:27579233

  10. Nonrecurrent Laryngeal Nerve in the Era of Intraoperative Nerve Monitoring

    PubMed Central

    Gurleyik, Gunay

    2016-01-01

    Nonrecurrent laryngeal nerve (non-RLN) is an anatomical variation increasing the risk of vocal cord palsy. Prediction and early identification of non-RLN may minimize such a risk of injury. This study assessed the effect of intraoperative neuromonitoring (IONM) on the detection of non-RLN. A total of 462 (236 right) nerves in 272 patients were identified and totally exposed, and all intraoperative steps of IONM were sequentially applied on the vagus nerve (VN) and RLN. Right predissection VN stimulation at a distal point did not create a sound signal in three cases (3/236; 1.27%). Proximal dissection of the right VN under IONM guidance established a proximal point, creating a positive signal. The separation point of non-RLN from VN was discovered in all three patients. Non-RLNs were exposed from separation to laryngeal entry. Positive IONM signals were obtained after resection of thyroid lobes, and postoperative period was uneventful in patients with non-RLN. Absence of distal VN signal is a precise predictor of the non-RLN. IONM-guided proximal dissection of the right VN leads to identification of the non-RLN. The prediction of non-RLN by the absence of the VN signal at an early stage of surgery may prevent or minimize the risk of nerve injury.

  11. Stereoscopic Integrated Imaging Goggles for Multimodal Intraoperative Image Guidance

    PubMed Central

    Mela, Christopher A.; Patterson, Carrie; Thompson, William K.; Papay, Francis; Liu, Yang

    2015-01-01

    We have developed novel stereoscopic wearable multimodal intraoperative imaging and display systems entitled Integrated Imaging Goggles for guiding surgeries. The prototype systems offer real time stereoscopic fluorescence imaging and color reflectance imaging capacity, along with in vivo handheld microscopy and ultrasound imaging. With the Integrated Imaging Goggle, both wide-field fluorescence imaging and in vivo microscopy are provided. The real time ultrasound images can also be presented in the goggle display. Furthermore, real time goggle-to-goggle stereoscopic video sharing is demonstrated, which can greatly facilitate telemedicine. In this paper, the prototype systems are described, characterized and tested in surgeries in biological tissues ex vivo. We have found that the system can detect fluorescent targets with as low as 60 nM indocyanine green and can resolve structures down to 0.25 mm with large FOV stereoscopic imaging. The system has successfully guided simulated cancer surgeries in chicken. The Integrated Imaging Goggle is novel in 4 aspects: it is (a) the first wearable stereoscopic wide-field intraoperative fluorescence imaging and display system, (b) the first wearable system offering both large FOV and microscopic imaging simultaneously, (c) the first wearable system that offers both ultrasound imaging and fluorescence imaging capacities, and (d) the first demonstration of goggle-to-goggle communication to share stereoscopic views for medical guidance. PMID:26529249

  12. Lightweight distributed computing for intraoperative real-time image guidance

    NASA Astrophysics Data System (ADS)

    Suwelack, Stefan; Katic, Darko; Wagner, Simon; Spengler, Patrick; Bodenstedt, Sebastian; Röhl, Sebastian; Dillmann, Rüdiger; Speidel, Stefanie

    2012-02-01

    In order to provide real-time intraoperative guidance, computer assisted surgery (CAS) systems often rely on computationally expensive algorithms. The real-time constraint is especially challenging if several components such as intraoperative image processing, soft tissue registration or context aware visualization are combined in a single system. In this paper, we present a lightweight approach to distribute the workload over several workstations based on the OpenIGTLink protocol. We use XML-based message passing for remote procedure calls and native types for transferring data such as images, meshes or point coordinates. Two different, but typical scenarios are considered in order to evaluate the performance of the new system. First, we analyze a real-time soft tissue registration algorithm based on a finite element (FE) model. Here, we use the proposed approach to distribute the computational workload between a primary workstation that handles sensor data processing and visualization and a dedicated workstation that runs the real-time FE algorithm. We show that the additional overhead that is introduced by the technique is small compared to the total execution time. Furthermore, the approach is used to speed up a context aware augmented reality based navigation system for dental implant surgery. In this scenario, the additional delay for running the computationally expensive reasoning server on a separate workstation is less than a millisecond. The results show that the presented approach is a promising strategy to speed up real-time CAS systems.

  13. Intraoperative neuromonitoring techniques in the surgical management of acoustic neuromas.

    PubMed

    Oh, Taemin; Nagasawa, Daniel T; Fong, Brendan M; Trang, Andy; Gopen, Quinton; Parsa, Andrew T; Yang, Isaac

    2012-09-01

    Unfavorable outcomes such as facial paralysis and deafness were once unfortunate probable complications following resection of acoustic neuromas. However, the implementation of intraoperative neuromonitoring during acoustic neuroma surgery has demonstrated placing more emphasis on quality of life and preserving neurological function. A modern review demonstrates a great degree of recent success in this regard. In facial nerve monitoring, the use of modern electromyography along with improvements in microneurosurgery has significantly improved preservation. Recent studies have evaluated the use of video monitoring as an adjunctive tool to further improve outcomes for patients undergoing surgery. Vestibulocochlear nerve monitoring has also been extensively studied, with the most popular techniques including brainstem auditory evoked potential monitoring, electrocochleography, and direct compound nerve action potential monitoring. Among them, direct recording remains the most promising and preferred monitoring method for functional acoustic preservation. However, when compared with postoperative facial nerve function, the hearing preservation is only maintained at a lower rate. Here, the authors analyze the major intraoperative neuromonitoring techniques available for acoustic neuroma resection. PMID:22937857

  14. [Intraoperative monitoring: visual evoked potentials in surgery of the sellar region].

    PubMed

    Lorenz, M; Renella, R R

    1989-01-01

    During 18 sellar and perisellar operations the optic tract was monitored by visual evoked potentials (VEP). Deteriorations of the cortical responses were recorded in 73%. In this patients there was no close correlation between the intraoperative findings and the postoperative visual function. Only in those patients who showed no remarkable intraoperative changes VEP seemed to be of reliable prognostic value.

  15. Reconstruction of the descending thoracic aorta by multiview compounding of 3-D transesophageal echocardiographic aortic data sets for improved examination and quantification of atheroma burden.

    PubMed

    Carminati, Maria Chiara; Piazzese, Concetta; Weinert, Lynn; Tsang, Wendy; Tamborini, Gloria; Pepi, Mauro; Lang, Roberto Miguel; Caiani, Enrico Gianluca

    2015-05-01

    A robust and efficient approach to reconstruction of the descending thoracic aorta from contiguous 3-D transesophageal echocardiographic (TEE) images is proposed. An ad hoc image acquisition protocol was designed to acquire ordered and partially overlapped 3-D TEE data sets, followed by dedicated image processing to align and fuse all acquired data sets. Alignment strategy implemented pairwise rigid registration guided by a priori knowledge, and it was validated using artificially misaligned images. Image fusion was finally performed to enable visualization and analysis of extended field-of-view of the acquired aorta. The application of different fusion techniques was also investigated. The method was applied to a population of 17 consecutive patients. Qualitative and quantitative results supported the feasibility and accuracy of the proposed approach. In a clinical scenario, its application could allow the quantitative assessment of aortic plaque burden in the descending thoracic aorta from 3-D TEE images. PMID:25684644

  16. Value of real-time transesophageal 3-dimensional echocardiography in guiding ablation of isthmus-dependent atrial flutter and pulmonary vein isolation.

    PubMed

    Faletra, Francesco F; Regoli, François; Acena, Marta; Auricchio, Angelo

    2012-01-01

    In the past decade, both the range of indications and the efficacy and safety of interventional electrophysiology has improved considerably. This progress is attributed to both the accumulating experience of electrophysiologists and the advances in technological tools facilitating the diagnosis and treatment of cardiac arrhythmias. Real-time 3-dimensional transesophageal echocardiography (RT 3D TEE) has emerged as a new imaging tool in the clinical arena. Its ability to image in "real time" cardiac structures "en face" and the almost entire length of intracardiac catheters has made this technique a promising imaging tool to guide percutaneous catheter-based procedures. More recently it has been used in monitoring ablation procedures. In this review, the advantages and current limitations of RT 3D TEE during ablation of cavotricuspid isthmus-dependent atrial flutter and pulmonary vein isolation are described.

  17. The role of contrast enhanced transesophageal echocardiography in the diagnosis and in the morphological and functional characterization of acute aortic syndromes.

    PubMed

    Agricola, Eustachio; Slavich, Massimo; Bertoglio, Luca; Fisicaro, Andrea; Oppizzi, Michele; Marone, Enrico; Melissano, Germano; Tufaro, Vincenzo; Margonato, Alberto; Chiesa, Roberto

    2014-01-01

    The aim of this study is to evaluate the role of contrast transesophageal echocardiography (cTEE) in the diagnostic characterization of acute aortic syndromes (AAS) [aortic dissection, intramural hematoma, penetrating ulcer]. We enrolled 66 non-consecutive patients with clinical suspicion of AAS. Standard transesophageal echocardiography and cTEE were performed prior to gated-CT angiography, which has been assumed as reference standard. cTEE was obtained with a single bolus of contrast agent injection. The definitive diagnosis of AAS was made in 48 patients by gated-CT angiography: 22 aortic dissections, 15 intramural hematomas and 11 penetrating aortic ulcers. Standard TEE and cTEE correctly diagnosed AAS in 87 and 100% (P = 0.03) cases respectively. Standard TEE correctly diagnosed aortic dissection in 20/22 (91%) and cTEE in 22/22 (100 %) (P = 0.5) cases. cTEE was superior than standard TEE in the visualization of false lumen entry tear (22/22 vs. 16/22, P = 0.03). Standard TEE correctly diagnosed intramural hematoma in 11/15 and cTEE 15/15 (P = 0.12) cases. Microtears were identified in 3 patients by cTEE an in 1 patient by standard TEE (P = 0.4). The presence of focal contrast enhancement was identified in 4 and 0 patients by cTEE and standard TEE respectively (P = 0.06). Both standard and cTEE correctly diagnosed penetrating aortic ulcer in 11/11 (100%) (P = 1.0) cases. cTEE provides additional value over standard TEE in the diagnosis and in the anatomic and functional characterization of AAS.

  18. Intraoperative Periprosthetic Femur Fracture: A Biomechanical Analysis of Cerclage Fixation.

    PubMed

    Frisch, Nicholas B; Charters, Michael A; Sikora-Klak, Jakub; Banglmaier, Richard F; Oravec, Daniel J; Silverton, Craig D

    2015-08-01

    Intraoperative periprosthetic femur fracture is a known complication of total hip arthroplasty (THA) and a variety of cerclage systems are available to manage these fractures. The purpose of this study was to examine the in situ biomechanical response of cerclage systems for fixation of periprosthetic femur fractures that occur during cementless THA. We compared cobalt chrome (CoCr) cables, synthetic cables, monofilament wires and hose clamps under axial compressive and torsional loading. Metallic constructs with a positive locking system performed the best, supporting the highest loads with minimal implant subsidence (both axial and angular) after loading. Overall, the CoCr cable and hose clamp had the highest construct stiffness and least reduction in stiffness with increased loading. They were not demonstrably different from each other.

  19. Compact intraoperative imaging device for sentinel lymph node mapping

    NASA Astrophysics Data System (ADS)

    Liu, Yang; Bauer, Adam Q.; Akers, Walter; Sudlow, Gail; Liang, Kexian; Shen, Duanwen; Berezin, Mikhail; Culver, Joseph P.; Achilefu, Samuel

    2011-03-01

    We have developed a novel real-time intraoperative fluorescence imaging device that can detect near-infrared (NIR) fluorescence and map sentinel lymph nodes (SLNs). In contrast to conventional imaging systems, this device is compact, portable, and battery-operated. It is also wearable and thus allows hands-free operation of clinicians. The system directly displays the fluorescence in its goggle eyepiece, eliminating the need for a remote monitor. Using this device in murine lymphatic mapping, the SLNs stained with indocyanine green (ICG) can be readily detected. Fluorescence-guided SLN resection under the new device was performed with ease. Ex vivo examination of resected tissues also revealed high fluorescence level in the SLNs. Histology further confirmed the lymphatic nature of the resected SLNs.

  20. Quality assurance and performance improvement in intraoperative neurophysiologic monitoring programs.

    PubMed

    Tamkus, Arvydas A; Rice, Kent S; McCaffrey, Michael T

    2013-03-01

    Quality assurance (QA) as it relates to intraoperative neurophysiological monitoring (IONM) can be defined as the systematic monitoring, evaluation, and modification of the IONM service to insure that desired standards of quality are being met. In practice, that definition is usually extended to include the concept that the quality of the IONM service will be improved wherever possible and, although there are some differences in the two terms, in this article the term QA will be understood to include quality improvement (QI) processes as well. The measurement and documentation of quality is becoming increasingly important to healthcare providers. This trend is being driven by pressures from accrediting agencies, payers, and patients. The essential elements of a QA program are described. A real-life example of QA techniques and management relevant to IONM providers is presented and discussed.

  1. Intraoperative interstitial microwave-induced hyperthermia and brachytherapy.

    PubMed

    Coughlin, C T; Wong, T Z; Strohbehn, J W; Colacchio, T A; Sutton, J E; Belch, R Z; Douple, E B

    1985-09-01

    Intra-operative placement of 11-gauge nylon catheters into deep-seated unresectable tumors for interstitial brachytherapy permits localized heating of tumors (hyperthermia) using microwave (915 MHz) antennas which are inserted into these catheters. Four preliminary cases are described where epithelial tumors at various sites were implanted with an antenna array and heated for 1 hour, both before and after the iridium-192 brachytherapy. Temperatures were monitored in catheters required for the appropriate radiation dosimetry but not required for the interstitial microwave antenna array hyperthermia (IMAAH) system. Additional thermometry was obtained using nonperturbed fiberoptic thermometry probes inserted into the catheters' housing antennas. No significant complications, such as bleeding or infection, were observed. This approach to cancer therapy is shown to be feasible and it produces controlled, localized hyperthermia, with temperatures of 50 degrees C or more in tumors. This technique may offer a therapeutic option for pelvic, intra-abdominal and head and neck tumors.

  2. [Intraoperative detection of the sentinel lymph nodes in lung cancer].

    PubMed

    Akopov, A L; Papayan, G V; Chistyakov, I V

    2015-01-01

    An analysis of the scientific data was made. It was used the literature devoted to the intraoperative visualization of the sentinel lymph nodes in patients with lung cancer. Correct detection of such lymph nodes with following pathologic investigation allowed limiting the volume of lympho-dissection in a number of patients. There is the possibility of maximal in-depth study of the sentinel lymph nodes by purposeful application of most sensible pathologic and molecular methods for detection their micrometastatic lesions. At the same time the treatment strategy and prognosis could be determined. The authors present the results of an application of dye techniques, radioactive preparation and fluorescence imaging for sentinel lymph node detection. Advantages and disadvantages of the methods are shown in the article. There are validated the prospects of technical development, study of information value of new applications and the most perspective method of fluorescence indocyanine green visualization by lymph outflow. PMID:25962306

  3. State of the art: Intraoperative neuromonitoring in spinal deformity surgery.

    PubMed

    Takata, Yoichiro; Sakai, Toshinori; Higashino, Kosaku; Matsuura, Tetsuya; Suzue, Naoto; Hamada, Daisuke; Goto, Tomohiro; Nishisho, Toshihiko; Tsutsui, Takahiko; Goda, Yuichiro; Morimoto, Masatoshi; Abe, Mitsunobu; Mineta, Kazuaki; Kimura, Tetsuya; Nitta, Akihiro; Hama, Shingo; Higuchi, Tadahiro; C Jha, Subash; Takahashi, Rui; Fukuta, Shoji; Sairyo, Koichi

    2015-01-01

    Application of deformity correction spinal surgery has increased substantially over the past three decades in parallel with improvements in surgical techniques. Intraoperative neuromonitoring (IOM) techniques,including somatosensory evoked potentials (SEPs), muscle evoked potentials (MEPs), and spontaneous electromyography (free-run EMG), have also improved surgical outcome by reducing the risk of iatrogenic neural injury. In this article, we review IOM techniques and their applications in spinal deformity surgery. We also summarize results of selected studies including hundreds of spinal correction surgeries. These studies indicate that multimodal IOM of both motor and sensory responses is superior to either modality alone for reducing the incidence of neural injury during surgery. J. Med. Invest. 62: 103-108, August, 2015. PMID:26399330

  4. Intra-operative radiation therapy for osteosarcoma in the extremities.

    PubMed

    Tsuboyama, T; Toguchida, J; Kotoura, Y; Kasahara, K; Hiraoka, M; Nakamura, T

    2000-01-01

    The outcome following intra-operative radiation therapy in the treatment of osteosarcoma in the extremity in 33 patients was evaluated for oncological and functional results. Local recurrence occurred in seven cases, six of which were in a non-irradiated region, indicating inappropriate planning of the radiation field. Twenty-one patients underwent either prosthetic replacement (14) or amputation (7). Irradiated tumours were left in situ in the remaining 12 patients. In this latter group no degenerative joint changes were observed radiologically. Twenty-six patients experienced local complications, of which fracture of the irradiated bone was the most significant. Associated intramedullary nailing showed encouraging results in preventing fracture. Although IORT is effective for the local control of osteosarcoma in extremities, critical patient selection and improvements of treatment protocol are required in order to obtain a satisfactory outcome.

  5. Neurophysiologic intraoperative monitoring of the glossopharyngeal and vagus nerves.

    PubMed

    Singh, Rajdeep; Husain, Aatif M

    2011-12-01

    Neurophysiologic intraoperative monitoring (NIOM) of the glossopharyngeal and vagus nerves (CN IX and X) is often used during surgeries involving the lower brain stem. Although both of these nerves contain sensory, autonomic, and motor fibers, it is the motor fibers that are most amenable to NIOM. CN IX supplies the stylopharyngeus muscle, and CN X supplies striated muscles in the soft palate, pharynx, and larynx. Monitoring of these CN can be performed by monitoring free running and stimulated electromyography (EMG) from the stylopharyngeus muscle (CN IX) and the vocal cords (CN X). Various surface and needle electrodes can be used to monitor these muscle groups. When CN IX is monitored, CN X should also be monitored, as it is often needed to differentiate when CN IX is selectively activated. Data are accumulating noting the use of monitoring these CN in tumor surgeries involving the lower brain stem. PMID:22146360

  6. Interactive intraoperative localization using an infrared-based system.

    PubMed

    Zamorano, L J; Nolte, L; Kadi, A M; Jiang, Z

    1993-10-01

    We discuss new methods of localizing and treating brain lesions for both the conventional method of a base-ring fixed to the patient's skull (referred to as frame-based procedures) and the new method of frameless procedures (no base ring). Frame-based procedures are used for finding a precise instrument position during neurosurgical procedures, such as stereotactic biopsy of deep-seated lesions, placing electrodes for functional stereotaxis or catheters with radioactive seeds for brachytherapy, or even the placement of a stereotactic retractor or endoscope for removal or internal decompression of lesions. In such procedures, the intraoperative image localization of instruments becomes useful as it tracks instruments as they travel through the preplanned trajectory. Additional intraoperative digitization of surgical instruments, e.g., bipolar suction, biopsy forceps, microscope, ultrasound probe, etc, can be achieved during the stereotactic resection of eloquent areas or deep intracranial lesions by adding an infrared-based system. Frameless procedures broaden the range of surgical approaches, image guidance planning, and operative procedures, since no ring is attached to the patient's head which might interfere with the surgical approach, and offers logistic advantages in scheduling diagnostic studies. Frameless diagnostic studies employ anatomical markers and/or surface matching techniques for data registration in the computer software surgical preplanning program. This simplifies scheduling of the procedures since the image study does not need to be acquired the same day as surgery. Frameless diagnostic studies allow for the use of more than one type of imaging data for planning and optimization of surgical procedures, and greatly improve patient tolerance and comfort during these procedures and during surgery, as compared with frame-based procedures.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7905601

  7. Positron detection for the intraoperative localisation of cancer deposits

    PubMed Central

    Burian, Maria; Meisetschläger, Günther; Stein, Hubert J.; Ziegler, Sibylle; Nährig, Jörg; Picchio, Maria; Buck, Andreas; Siewert, Joerg R.; Schwaiger, Markus

    2007-01-01

    Purpose The study investigated the feasibility of a positron-sensitive hand-held detector system for the intraoperative localisation of tumour deposits resulting from intravenous [18F]FDG administration. Methods A total of 17 patients (12 receiving preoperative [18F]FDG PET imaging) with various histologically proven malignancies were included. Radioactivity from tumours and surrounding normal tissue was measured on average 3 h after administration of 36–110 MBq [18F]FDG and the tumour-to-background (T/B) ratio was calculated. In addition, phantom studies were performed to evaluate the spatial resolution and sensitivity of the probe. Results All known targeted tumour sites were identified by the positron probe. T/B ratios were generally high, with a mean T/B ratio of 6.6, allowing easy identification of most tumour sites. In one case of a hepatic metastasis, the T/B ratio of 1.34 was below expectations, since the preoperative [18F]FDG PET scan was positive. The probe was instrumental in the localisation of three additional tumour lesions (two lymph nodes, one anastomotic ring) that were not immediately apparent at surgery. Phantom studies revealed that [18F]FDG-containing gel (simulating tumour tissue), having 10 times more [18F]FDG than surrounding “normal” background gel, was clearly detectable in quantities as low as 15 mg. As measured in two cases, the absorbed radiation doses ranged from 2.5 to 8.6 μSv/h for the surgical team to 0.8 μSv/h for the aesthetician. Conclusion [18F]FDG-accumulating tumour tissues can be localised with positron probes intraoperatively with a low radiation burden to the patient and medical personnel. The methodology holds promise for further clinical testing. PMID:17431612

  8. [The role of intraoperative flowmetry in surgery of cerebral aneurysms].

    PubMed

    Shekhtman, O D; Éliava, Sh Sh; Shakhnovich, V A; Pilipenko, Iu V

    2011-01-01

    Aim of the study was to assess the capabilities of intraoperative ultrasonic flowmetry in cerebral aneurysm surgery for prevention and immediate correction of cerebral ischemia. Ultrasonic flowmeter (Model HT313/323, "ransonic Systems Inc.", USA) was used during surgery in patients with complicated, large and giant aneurysms for evaluation of cerebral blood flow in main arteries (internal carotid, anterior and middle cerebral) and their branches (branches of M2-M3 and A2 segments). The series included 20 adult patients (13 male and 7 female) operated in Burdenko Moscow Neurosurgery Institute during 2008-2011 years. Mean age was 47.4 +/- 8.6 years. Giant aneurysms (> 2.5 cm) were present in 12 (60%) patients, large (1.5-2.5 cm)--in 5 (25%). Aneurysms of internal carotid artery were found in 8 cases. 1 female patient was operated on giant aneurysm of anterior cerebral--anterior communicating artery. In 4 (20%) cases significant alterations of blood flow were registered after clipping (> 25% according to initial), the changes were not visible. This allowed to correct the position of clips. In 2 surgeries ('low' paraclinoid aneurysms) the collateral flow was sufficient during temporary clipping, this allowed trapping of aneurysms with good neurological outcome. In 3 cases flowmeter was used to evaluate blood flow after extracranial-intracranial bypass. Ultrasonic flowmetry is a simple, reproducible and safe technique for intraoperative assessment of blood flow. Despite visual sufficiency of arteries flowmetry allows detection of surgically significant alterations of blood flow after clipping. PMID:22066255

  9. Tolerance of canine anastomoses to intraoperative radiation therapy

    SciTech Connect

    Tepper, J.E.; Sindelar, W.; Travis, E.L.; Terrill, R.; Padikal, T.

    1983-07-01

    Radiation has been given intraoperatively to various abdominal structures in dogs, using a fixed horizontal 11 MeV electron beam at the Armed Forces Radiobiologic Research Institute. Animals were irradiated with single doses of 2000, 3000 and 4500 rad to a field which extended from the bifurcation of the aorta to the rib cage. All animals were irradiated during laparotomy under general anesthesia. Because the clinical use of intraoperative radiotherapy in cancer treatment will occasionally require irradiation of anastomosed large vessels and blind loops of bowel, the tolerance of aortic anastomoses and the suture lines of blind loops of jejunum to irradiation were studied. Responses in these experiments were scored at times up to one year after irradiation. In separate experiments both aortic and intestinal anastomoses were performed on each animal for evaluation of short term response. The dogs with aortic anastomoses showed adequate healing at all doses with no evidence of suture line weakening. On long-term follow-up one animal (2000 rad) had stenosis at the anastomosis and one animal (4500 rad) developed an arteriovenous fistula. Three of the animals that had an intestinal blind loop irradiated subsequently developed intussusception, with the irradiated loop acting as the lead point. One week after irradiation, bursting pressure of an intestinal blind loop was normal at 3000 rad, but markedly decreased at 4500 rad. No late complications were noted after the irradiation of the intestinal anastomosis. No late complicatons were observed after irradiation of intestinal anastomoses, but one needs to be cautious with regards to possible late stenosis at the site of an irradiated vascular anastomosis.

  10. Treatment of symptomatic intraosseous pneumatocyst using intraoperative navigation.

    PubMed

    Formby, Peter M; Kang, Daniel G; Potter, Benjamin K; Forsberg, Jonathan A

    2015-03-01

    Intraosseous pneumatocysts are benign air-containing lesions that are most often found in the spine and pelvis and are nearly always treated nonoperatively. Although rarely clinically symptomatic, studies have shown pneumatocysts to be present in up to 10% of computed tomography (CT) scans of the pelvis and spine. Radiographic characteristics of these lesions include a localized collection of gas with a thin sclerotic rim, no bony destruction, no soft tissue masses, and no medullary abnormalities. Computed tomography is the diagnostic study of choice, with Hounsfield units ranging from -580 to -950, showing a gas-containing lesion. Few studies have described the management of symptomatic pneumatocysts, and all reported cases concern underwater divers, presumably because of greater pressure cycling and barotrauma encountered while underwater diving. The goal of this report is to describe the intraoperative CT-guided navigation and percutaneous injection of calcium sulfate-calcium phosphate composite bone graft substitute material for the treatment of a symptomatic pneumatocyst in the ilium of a Navy dive instructor. The patient reported a 1-year history of increasing buttock pain with increased depth of diving, consistently reproduced by diving past a depth of 20 to 30 feet. To the authors' knowledge, this is the first description in the English literature of the operative treatment of an intraosseous pneumatocyst of the ilium. The use of intraoperative CT guidance permitted accurate percutaneous localization, decompression, and filling of the lesion with synthetic bone graft substitute, with complete early relief of symptoms. At 6-month follow up, the patient had reached diving depths of 170 feet without pain. PMID:25760515

  11. Single-trial detection for intraoperative somatosensory evoked potentials monitoring.

    PubMed

    Hu, L; Zhang, Z G; Liu, H T; Luk, K D K; Hu, Y

    2015-12-01

    Abnormalities of somatosensory evoked potentials (SEPs) provide effective evidence for impairment of the somatosensory system, so that SEPs have been widely used in both clinical diagnosis and intraoperative neurophysiological monitoring. However, due to their low signal-to-noise ratio (SNR), SEPs are generally measured using ensemble averaging across hundreds of trials, thus unavoidably producing a tardiness of SEPs to the potential damages caused by surgical maneuvers and a loss of dynamical information of cortical processing related to somatosensory inputs. Here, we aimed to enhance the SNR of single-trial SEPs using Kalman filtering and time-frequency multiple linear regression (TF-MLR) and measure their single-trial parameters, both in the time domain and in the time-frequency domain. We first showed that, Kalman filtering and TF-MLR can effectively capture the single-trial SEP responses and provide accurate estimates of single-trial SEP parameters in the time domain and time-frequency domain, respectively. Furthermore, we identified significant correlations between the stimulus intensity and a set of indicative single-trial SEP parameters, including the correlation coefficient (between each single-trial SEPs and their average), P37 amplitude, N45 amplitude, P37-N45 amplitude, and phase value (at the zero-crossing points between P37 and N45). Finally, based on each indicative single-trial SEP parameter, we investigated the minimum number of trials required on a single-trial basis to suggest the existence of SEP responses, thus providing important information for fast SEP extraction in intraoperative monitoring. PMID:26557929

  12. Single-trial detection for intraoperative somatosensory evoked potentials monitoring.

    PubMed

    Hu, L; Zhang, Z G; Liu, H T; Luk, K D K; Hu, Y

    2015-12-01

    Abnormalities of somatosensory evoked potentials (SEPs) provide effective evidence for impairment of the somatosensory system, so that SEPs have been widely used in both clinical diagnosis and intraoperative neurophysiological monitoring. However, due to their low signal-to-noise ratio (SNR), SEPs are generally measured using ensemble averaging across hundreds of trials, thus unavoidably producing a tardiness of SEPs to the potential damages caused by surgical maneuvers and a loss of dynamical information of cortical processing related to somatosensory inputs. Here, we aimed to enhance the SNR of single-trial SEPs using Kalman filtering and time-frequency multiple linear regression (TF-MLR) and measure their single-trial parameters, both in the time domain and in the time-frequency domain. We first showed that, Kalman filtering and TF-MLR can effectively capture the single-trial SEP responses and provide accurate estimates of single-trial SEP parameters in the time domain and time-frequency domain, respectively. Furthermore, we identified significant correlations between the stimulus intensity and a set of indicative single-trial SEP parameters, including the correlation coefficient (between each single-trial SEPs and their average), P37 amplitude, N45 amplitude, P37-N45 amplitude, and phase value (at the zero-crossing points between P37 and N45). Finally, based on each indicative single-trial SEP parameter, we investigated the minimum number of trials required on a single-trial basis to suggest the existence of SEP responses, thus providing important information for fast SEP extraction in intraoperative monitoring.

  13. Intraoperative Radiation Exposure During Revision Total Ankle Replacement.

    PubMed

    Roukis, Thomas S; Iceman, Kelli; Elliott, Andrew D

    2016-01-01

    Intraoperative C-arm image intensification is required for primary total ankle replacement implantation. Significant radiation exposure has been linked to these procedures; however, the radiation exposure during revision total ankle replacement remains unknown. Therefore, we sought to evaluate the radiation exposure encountered during revision total ankle replacement. The data from 41 patients were retrospectively analyzed from a prospective database: 19 Agility(™) to Agility(™); 4 Agility(™) to Custom Agility(™); 9 Agility(™) to INBONE(®) II; 5 Agility(™) to Salto Talaris(®) XT; 2 Scandinavian Total Ankle Replacement Prosthesis to Salto Talaris(®) XT; and 2 INBONE(®) I to INBONE(®) II revision total ankle replacements were performed. Two broad categories were identified: partial revision (Agility(™) to Agility(™), Agility(™) to Custom Agility(™), INBONE(®) I to INBONE(®) II) and complete conversion (Agility(™) to INBONE(®) II, Agility(™) to Salto Talaris(®) XT, Scandinavian Total Ankle Replacement Prosthesis to Salto Talaris(®) XT). The mean radiation exposure per case was significant at 3.49 ± 2.21 mGy. Complete conversions, specifically Agility(™) to INBONE(®) II, exhibited the greatest radiation exposure and C-arm time. Revision implant selection and revision type (complete or partial) directly contributed to radiation exposure. Accordingly, revision systems requiring less radiation exposure are preferable. Surgeons should strive to minimize intraoperative complications and limit additional procedures to those necessary, because both lead to additional radiation exposure.

  14. Computer assistance for intraoperative navigation in ENT surgery.

    PubMed

    Caversaccio; Freysinger

    2003-03-01

    The intraoperative need for exact orientation during interventions in the paranasal sinuses and the augmented need for navigational aids in lateral skull base surgery have lead to the development of computer-aided tools during the last fifteen years. These tools, which provide the position of a tool or a pointer in the patient's preoperative radiologic imaging, have quickly gained a wide acceptance for revision surgeries and the surgical treatment of complex pathologies in Ear-, Nose- and Throat (ENT-) surgery. Currently, the use of such systems is spreading from academic centers to smaller hospitals and will become a standard tool in the near future. We review the present state of computer-aided surgery (CAS) systems, based on our experience as clinical and research centers with a long experience in the field, provide some technological background information and, based on selected cases, show the merits of this technology. The systems we have been working with cover a wide variety of intraoperative navigational systems in ENT surgery (Easy Guide, MedScan II, MKM, SNN, STN, SurgiGATE ORL, Treon, VectorVision, Viewing Wand, [without claiming completeness]), and virtually the whole area of ENT surgeries: macroscopic, (video-)endoscopic and microscopic procedures. The 3D tracking technologies involved cover mechanical, optical (active and passive), magnetic and robotic principles. The visualization tools used are computer monitors, video monitors, head-up-displays and the microscope's oculars, thus spanning the area from pointer-systems to real navigators and a surgical telepresence demonstrator, implementing the majority of available patient-to-image referencing strategies. Clinically, the systems can be operated with an acceptable accuracy of around 1 mm, whereas in laboratory settings and in cadaver studies application accuracy may be pushed to its limits: the physical resolution of the radiologic imaging used for navigation.

  15. Intraoperative squash cytology of central nervous system lesions: a single center study of 326 cases.

    PubMed

    Jaiswal, Sushila; Vij, Mukul; Jaiswal, Awadhesh Kumar; Behari, Sanjay

    2012-02-01

    Cytology has been shown to be of great value in intraoperative consultations of central nervous system (CNS) pathology. Intraoperative smear cytology provides a rapid and reliable intraoperative diagnosis and guidance to the neurosurgeon during surgical resection and lesion targeting. It also helps the surgeon to monitor and modify the approach at surgery. The current study was undertaken to assess the accuracy and utility of intraoperative consultations for cytomorphological diagnosis by smear technique and correlate with histopathological diagnosis. A retrospective study of 326 cases of CNS intraoperative consultations was performed. Smears were prepared from the biopsy samples sent in isotonic saline for immediate processing and stained by the Haematoxylin and Eosin method. The cytomorphological features were noted and correlated with final histopathological diagnosis. Concordance between the intraoperative diagnosis and the final diagnosis was seen in 83.7% of cases. We demonstrated >95% accuracy for glioblastomas and >89% accuracy for meningiomas and schwannomas. A reduction of diagnostic accuracy was seen in oligodendrogliomas (60%) and anaplastic oligodendrogliomas (57.2%). Smear technique is a fairly accurate, relatively safe, rapid, simple, easily reproducible, and cost effective tool to diagnose brain tumors. Smear cytology is of great value in intraoperative consultation of CNS pathology.

  16. How well do cochlear implant intraoperative impedance measures predict postoperative electrode function?

    PubMed Central

    Goehring, Jenny L.; Hughes, Michelle L.; Baudhuin, Jacquelyn L.; Lusk, Rodney P.

    2012-01-01

    Objective Objectives were to: 1) evaluate the incidence of abnormal cochlear implant electrode impedance intraoperatively and at the initial activation, 2) identify the percentage of abnormalities that resolve by the initial activation, and 3) determine the incidence of normal intraoperative impedances that present as abnormal at the initial activation. Study Design Retrospective records review of intraoperative and postoperative cochlear implant electrode impedances. Setting Tertiary referral center. Patients Records were examined for 194 devices implanted in 165 pediatric and adult patients. Results Results indicate at least 1 open (OC) or short circuit (SC) in 12.4% (24/194) of devices intraoperatively, decreasing to 8.2% (16/194) postoperatively. OCs were more prevalent than SCs for intraoperative (92% vs. 8%) and postoperative (94% vs. 6%) intervals. Of the 3430 total electrodes, 78 had abnormal impedance intraoperatively. Sixty-four of those (82%) resolved by the postoperative interval (62 OC, 2 SC) while 14/78 (18%) remained abnormal postoperatively (12 OC, 2 SC). Six of 3430 (0.17%) electrodes had normal impedance intraoperatively but were abnormal postoperatively. Conclusions The incidence of SCs in the present study is likely underestimated due to poor sensitivity of monopolar coupling for detecting SCs. Intraoperative OCs have a high probability of resolving by the initial activation, particularly when contiguous electrodes are affected, and suggests limited need for the use of a backup device in these cases. Surgical technique and/or complications such as explant/reimplant or perilymphatic gushers may result in increased incidence of bubbles in the cochlea, and may play a role in abnormal intraoperative impedance results. PMID:23295726

  17. Intraoperative platelet-rich plasma does not improve outcomes of total knee arthroplasty.

    PubMed

    Morishita, Masayuki; Ishida, Kazunari; Matsumoto, Tomoyuki; Kuroda, Ryosuke; Kurosaka, Masahiro; Tsumura, Nobuhiro

    2014-12-01

    This randomized controlled study was conducted to assess the effects of platelet-rich plasma (PRP) on outcomes of total knee arthroplasty (TKA). Forty patients who underwent unilateral TKA were evaluated prospectively; 20 received intraoperative PRP and 20 served as control subjects. The results showed no significant differences in reduction of bleeding, range of motion, swelling around the knee joint, muscle power recovery, pain, Knee Society Scores, and Knee Injury and Osteoarthritis Outcome Score between the 2 groups. Additionally, no distinct clinical characteristics were found in patients who received intraoperative PRP. Therefore, we conclude that intraoperative PRP does not improve outcomes of TKA.

  18. How perioperative nurses define, attribute causes of, and react to intraoperative nursing errors.

    PubMed

    Chard, Robin

    2010-01-01

    Errors in nursing practice pose a continuing threat to patient safety. A descriptive, correlational study was conducted to examine the definitions, circumstances, and perceived causes of intraoperative nursing errors; reactions of perioperative nurses to intraoperative nursing errors; and the relationships among coping with intraoperative nursing errors, emotional distress, and changes in practice made as a result of error. The results indicate that strategies of accepting responsibility and using self-control are significant predictors of emotional distress. Seeking social support and planful problem solving emerged as significant predictors of constructive changes in practice. Most predictive of defensive changes was the strategy of escape/avoidance.

  19. Multiplane transesophageal echocardiography performed according to the guidelines of the American Society of Echocardiography in patients with mitral valve prolapse, flail, and endocarditis: diagnostic accuracy in the identification of mitral regurgitant defects by correlation with surgical findings.

    PubMed

    Agricola, Eustachio; Oppizzi, Michele; De Bonis, Michele; Maisano, Francesco; Toracca, Lucia; Bove, Tiziana; Alfieri, Ottavio

    2003-01-01

    Multiplane transesophageal echocardiography is a useful tool to study mitral regurgitation. We evaluated the diagnostic accuracy of multiplane transesophageal echocardiography performed according to the guidelines of the American Society of Echocardiography. We used 4 midesophageal and 2 transgastric views in 313 patients with degenerative lesions, endocarditic lesions, or both to identify regurgitant defects, comparing transesophageal echocardiography results with surgical findings. The overall diagnostic accuracy using individual scallops was 97.2% (P <.00001) with a sensitivity of 96.6% and a specificity of 97.6%. Considering the single sections of the mitral valve, an accuracy of 98%, 97.1%, and 98%, was found, respectively, for the lateral, middle, and medial third of the anterior leaflet. For the posterior leaflet, the accuracy was 98% for the lateral scallop, 98.4% for the middle, and 96.1% for the medial. This strategy provides good accuracy in diagnosing both simple and challenging mitral-valve lesions and its widespread use should be recommended.

  20. Is there a Role for Preoperative Infusion or Intraoperative Cholangiography?

    PubMed Central

    Lau, W. Y.; Li, Arthur K. C.

    1997-01-01

    Background: There has been a resurgence of interest in recent years in preoperative infusion cholangiography (PIC). The role of routine PIC compared to routine intraoperative cholangiography (IOC) has not been clearly defined. Study design: In our department between 1985 and 1991, 1,042 of 1,576 consecutive patients with biliary calculous disease had elective cholecystectomy: 694 patients were prospectively scheduled for PIC, and 348 patients were randomly allocated to IOC. The patients in the PIC and IOC groups were similar with regard to age, history of biliopancreatic complications, and laboratory findings. The cost of PIC in Sweden is nearly five times greater than the cost of IOC. Results: Satisfactory opacification of the biliary system was obtained in 90.1 and 96.8 percent of patients who underwent PIC and IOC, respectively. Preoperative infusion cholangiography required support by IOC in 19.5 percent of patients. There were no statistically significant differences between the PIC and IOC groups with regard to the incidence (7 percent in both groups) of or positive predictive value (68 and 80 percent, respectively) for bile duct stones, rate of retained stones (6 and 20 percent, respectively), intraoperative (5.6 and 6.3 percent, respectively) or postoperative (13.3 and 15.9 percent, respectively) morbidity, or incidence of bile duct anomalies (0.9 and 0.3 percent, respectively). Median operative time was longer in .patients with (95 minutes) compared to those without (75 minutes) IOC (p<0.001). More postoperative complications occurred after bile duct exploration (26 of 75 patients) compared to cholecystectomy alone (114 of 917 patients, p<0.001). The 30-day mortality was zero. Minor bile duct injuries occurred in two patients (0.2 percent) at cholecystectomy, (one with and one without bile duct exploration). In no patient was the cholangiographic finding of a biliary anomaly crucial for the safe execution of cholecystectomy. Conclusions: In our study, PIC

  1. Results of intraoperative mitomycin C application in dacryocystorhinostomy

    PubMed Central

    Liao, S.; Kao, S.; Tseng, J.; Chen, M.; Hou, P.

    2000-01-01

    AIMS—To evaluate the long term results of intraoperative mitomycin C application in dacryocystorhinostomy (DCR) surgery compared with results of the conventional procedure.
METHODS—In this prospective randomised controlled study, a total of 88 eyes diagnosed with acquired nasolacrimal duct obstruction were randomly divided into a conventional DCR group and a mitomycin C group in which mitomycin C was used during DCR surgery. The surgical procedures in both groups were exactly the same, except that in the patients in the mitomycin C group, a piece of neurosurgical cottonoid soaked with 0.2 mg/ml mitomycin C was applied to the osteotomy site for 30 minutes. The results of the DCR surgeries were evaluated by objective findings such as irrigation and the height of tear meniscus and subjective symptoms by asking patients the condition of tearing improvement.
RESULTS—Among the 44 eyes in the mitomycin C group, 95.5% of patients remained totally symptom free after 10 months of follow up; while in the conventional group, 70.5% of patients were reported to be symptom free and 18% of patients to have an improvement in their symptoms. There was a significant difference between these two groups. As far as objective findings were concerned, there were 41 eyes in the mitomycin C group classified as having a normal and one eye with moderate tear meniscus level, compared with 32 eyes and seven eyes, respectively, in the conventional group. There was also a significant difference between these two groups. The non-patency rate in the mitomycin C group is 4.5% compared with 11.4% in the conventional group. There were no complications such as abnormal nasal bleeding, mucosal necrosis, or infection except one patient with delayed wound healing.
CONCLUSIONS—Intraoperative mitomycin C application is effective in increasing the success rate of DCR surgery in standard nasolacrimal duct obstruction, and no significant complications resulted from its use.

 PMID

  2. See the brain at work: intraoperative laser Doppler functional brain imaging

    NASA Astrophysics Data System (ADS)

    Martin-Williams, E. J.; Raabe, A.; Van De Ville, D.; Leutenegger, M.; Szelényi, A.; Hattingen, E.; Gerlach, R.; Seifert, V.; Hauger, C.; Lopez, A.; Leitgeb, R.; Unser, M.; Lasser, T.

    2009-07-01

    During open brain surgery we acquire perfusion images non-invasively using laser Doppler imaging. The regions of brain activity show a distinct signal in response to stimulation providing intraoperative functional brain maps of remarkably strong contrast.

  3. Intraoperative ERCP: What role does it have in the era of laparoscopic cholecystectomy?

    PubMed

    Rábago, Luis R; Ortega, Alejandro; Chico, Inmaculada; Collado, David; Olivares, Ana; Castro, Jose Luis; Quintanilla, Elvira

    2011-12-16

    In the treatment of patients with symptomatic cholelithiasis and choledocholithiasis (CBDS) detected during intraoperative cholangiography (IOC), or when the preoperative study of a patient at intermediate risk for CBDS cannot be completed due to the lack of imaging techniques required for confirmation, or if they are available and yield contradictory radiological and clinical results, patients can be treated using intraoperative endoscopic retrograde cholangiopancreatography (ERCP) during the laparoscopic treatment or postoperative ERCP if the IOC finds CBDS. The choice of treatment depends on the level of experience and availability of each option at each hospital. Intraoperative ERCP has the advantage of being a single-stage treatment and has a significant success rate, an easy learning curve, low morbidity involving a shorter hospital stay and lower costs than the two-stage treatments (postoperative and preoperative ERCP). Intraoperative ERCP is also a good salvage treatment when preoperative ERCP fails or when total laparoscopic management also fails.

  4. The Dutch Linguistic Intraoperative Protocol: a valid linguistic approach to awake brain surgery.

    PubMed

    De Witte, E; Satoer, D; Robert, E; Colle, H; Verheyen, S; Visch-Brink, E; Mariën, P

    2015-01-01

    Intraoperative direct electrical stimulation (DES) is increasingly used in patients operated on for tumours in eloquent areas. Although a positive impact of DES on postoperative linguistic outcome is generally advocated, information about the neurolinguistic methods applied in awake surgery is scarce. We developed for the first time a standardised Dutch linguistic test battery (measuring phonology, semantics, syntax) to reliably identify the critical language zones in detail. A normative study was carried out in a control group of 250 native Dutch-speaking healthy adults. In addition, the clinical application of the Dutch Linguistic Intraoperative Protocol (DuLIP) was demonstrated by means of anatomo-functional models and five case studies. A set of DuLIP tests was selected for each patient depending on the tumour location and degree of linguistic impairment. DuLIP is a valid test battery for pre-, intraoperative and postoperative language testing and facilitates intraoperative mapping of eloquent language regions that are variably located.

  5. The Dutch Linguistic Intraoperative Protocol: a valid linguistic approach to awake brain surgery.

    PubMed

    De Witte, E; Satoer, D; Robert, E; Colle, H; Verheyen, S; Visch-Brink, E; Mariën, P

    2015-01-01

    Intraoperative direct electrical stimulation (DES) is increasingly used in patients operated on for tumours in eloquent areas. Although a positive impact of DES on postoperative linguistic outcome is generally advocated, information about the neurolinguistic methods applied in awake surgery is scarce. We developed for the first time a standardised Dutch linguistic test battery (measuring phonology, semantics, syntax) to reliably identify the critical language zones in detail. A normative study was carried out in a control group of 250 native Dutch-speaking healthy adults. In addition, the clinical application of the Dutch Linguistic Intraoperative Protocol (DuLIP) was demonstrated by means of anatomo-functional models and five case studies. A set of DuLIP tests was selected for each patient depending on the tumour location and degree of linguistic impairment. DuLIP is a valid test battery for pre-, intraoperative and postoperative language testing and facilitates intraoperative mapping of eloquent language regions that are variably located. PMID:25526520

  6. Intraoperative ERCP: What role does it have in the era of laparoscopic cholecystectomy?

    PubMed Central

    Rábago, Luis R; Ortega, Alejandro; Chico, Inmaculada; Collado, David; Olivares, Ana; Castro, Jose Luis; Quintanilla, Elvira

    2011-01-01

    In the treatment of patients with symptomatic cholelithiasis and choledocholithiasis (CBDS) detected during intraoperative cholangiography (IOC), or when the preoperative study of a patient at intermediate risk for CBDS cannot be completed due to the lack of imaging techniques required for confirmation, or if they are available and yield contradictory radiological and clinical results, patients can be treated using intraoperative endoscopic retrograde cholangiopancreatography (ERCP) during the laparoscopic treatment or postoperative ERCP if the IOC finds CBDS. The choice of treatment depends on the level of experience and availability of each option at each hospital. Intraoperative ERCP has the advantage of being a single-stage treatment and has a significant success rate, an easy learning curve, low morbidity involving a shorter hospital stay and lower costs than the two-stage treatments (postoperative and preoperative ERCP). Intraoperative ERCP is also a good salvage treatment when preoperative ERCP fails or when total laparoscopic management also fails. PMID:22195234

  7. Use of BIS VISTA bilateral monitor for diagnosis of intraoperative seizures, a case report.

    PubMed

    Iturri Clavero, F; Tamayo Medel, G; de Orte Sancho, K; González Uriarte, A; Iglesias Martínez, A; Martínez Ruíz, A

    2015-12-01

    Changes in BIS (bispectral index) VISTA bilateral monitoring system associated with intraoperative episodes of generalized and focal seizures, during total intravenous anesthesia for resection of a left frontal parasagittal meningioma, are herein described.

  8. [Intraoperative complications of surgical treatment of cervical cancer stages I and II in FIGO].

    PubMed

    Kornovski, Y; Iamail, E; Ivanov, S; Kovachev, E

    2013-01-01

    With this study are presented the types of intraoperative complications and their frequency in radical hysterectomy and lymph node dissection (pelvic and paraaortic) as surgical treatment of 294 patients with invasive cervical cancer FIGO stages I and II.

  9. Single high dose intraoperative electrons for advanced stage pancreatic cancer: Phase I pilot study

    SciTech Connect

    Goldson, A.L.; Ashaveri, E.; Espinoza, M.C.

    1981-07-01

    Phase I toxicity studies with intraoperative radiotherapy proved to be a feasible adjunct to surgery for unresectable malignancies of the pancreas at Howard University Hospital. There have been minimal side effects or complications related to the combination of limited surgical decompression and intraoperative radiotherapy alone. The toxic effects of intraoperative radiotherapy on normal tissues is being assessed on a dose volume basis. Doses of 2000 to 2500 rad in a single exposure to include the pancreas, regional nodes and duodenum are acceptable if the total treatment volume is less than or equal to 100 cm. The tumoricidal effects on the cancer are demonstratable when one reviews the pathological specimens that illustrate massive tumor necrosis and fibros replacement, but in all cases reviewed, viable cancer was noted. Intraoperative radiotherapy, therefore, represents a significant boost dose for resectable, partially resectable or non-resectable tumors when added to conventional external beam irradiation and/or chemotherapy. Preliminary clinical data and minimal toxicity justifies further investigation.

  10. Incremental Value of Live/Real Time Three-Dimensional over Two-Dimensional Transesophageal Echocardiography in the Assessment of Atrial Septal Pouch.

    PubMed

    Elsayed, Mahmoud; Hsiung, Ming C; Meggo-Quiroz, L David; Elguindy, Mostafa; Uygur, Begum; Tandon, Rohit; Guvenc, Tolga; Keser, Nurgul; Vural, Mustafa G; Bulur, Serkan; Chahwala, Jugal R; Abtahi, Firoozeh; Nanda, Navin C

    2015-12-01

    An atrial septal pouch (ASP) results from partial fusion of the septum primum and the septum secundum, and depending on the site of fusion, the pouch can be left-sided (LASP) or right-sided (RASP). LASPs have been described in association with thrombi found in patients admitted with acute strokes, raising awareness of its potential cardioembolic role, especially in those with no other clearly identifiable embolic source. We retrospectively studied 39 patients in whom the presence of an ASP had been identified by three-dimensional transesophageal echocardiography (3DTEE) and who had a two-dimensional transesophageal echocardiogram (2DTEE) performed during the same clinical encounter. The incremental value provided by 3DTEE over 2DTEE included the detection of six ASPs not found by 2DTEE; the detection of two ASPs in the same subject (in four patients) not identified by 2DTEE; larger ASP measurements of length and height in over 80% of the cases; and measurement of the ASP width (elevational axis) for the calculation of the area of the ASP opening, because of its unique capability to view the pouch en face. In addition, the volume of ASP and of the echogenic masses contained in the ASP (four of 39 patients) could be calculated by 3DTEE, which is a superior parameter of size characterization when compared to individual dimensions. One of these patients who presented with ischemic stroke diagnosed by magnetic resonance imaging had a large (>2 cm) mass in a LASP, with echolucencies similar to those seen in thrombi and associated with clot lysis and resolution. This mass completely disappeared on anticoagulant therapy lending credence that it was most likely a thrombus. There was no history of stroke or any other type of embolic event in the other three patients with masses in ASP. In conclusion, this retrospective study highlights the incremental value of 3DTEE over 2DTEE in the comprehensive assessment and characterization of ASPs, which can aid in the clarification of

  11. Foundations for evidence-based intraoperative neurophysiological monitoring.

    PubMed

    Howick, Jeremy; Cohen, Bernard Allan; McCulloch, Peter; Thompson, Matthew; Skinner, Stanley A

    2016-01-01

    In this review, we recommend means to enhance the evidence-base for intraoperative neurophysiological monitoring (IONM). We address two preliminary issues: (1) whether IONM should be evaluated as a diagnostic test or an intervention, and (2) the state of the evidence for IONM (as presented in systematic reviews, for example). Three reasons may be suggested to evaluate at least some IONM applications as interventions (or as part of an "interventional cascade"). First, practical barriers limit our ability to measure IONM diagnostic accuracy. Second, IONM results are designed to be correlated with interventions during surgery. Third, IONM should improve patient outcomes when IONM-directed intervention alters the course of surgery. Observational evidence for IONM is growing yet more is required to understand the conditions under which IONM, in its variety of settings, can benefit patients. A multi-center observational cohort study would represent an important initial compromise between the pragmatic difficulties with conducting controlled trials in IONM and the Evidence-Based Medicine (EBM) view that large scale randomized trials are required. Such a cohort study would improve the evidence base and (if justified) provide the rationale for controlled trials.

  12. Intraoperative management of patients with heparin-induced thrombocytopenia.

    PubMed

    Kappa, J R; Fisher, C A; Todd, B; Stenach, N; Bell, P; Campbell, F; Ellison, N; Addonizio, V P

    1990-05-01

    For 11 patients with confirmed heparin-induced thrombocytopenia, we used reversible platelet inhibition with iloprost, a stable prostacyclin analogue, to permit safe heparin administration for cardiac (n = 9) or vascular (n = 2) operations. In vitro, iloprost (0.01 mumol/L) prevented both heparin-induced platelet aggregation and 14C-serotonin release in all patients. Therefore, intraoperatively, a continuous infusion of iloprost was started before administration of heparin and was continued until 15 minutes after administration of protamine. For cardiac patients, after heparin administration, the whole blood platelet count did not change (171,000 +/- 29,000/microL versus 174,000 +/- 29,000/microL, mean +/- standard error of the mean); no spontaneous platelet aggregation was observed, and plasma levels of the alpha-granule constituents platelet factor 4 and beta-thromboglobulin increased from 38 +/- 14 and 140 +/- 18 ng/mL to 591 +/- 135 and 235 +/- 48 ng/mL, respectively. Fibrinopeptide A levels actually decreased from 287 +/- 150 to 27 +/- 6 ng/mL. Furthermore, adenosine diphosphate-induced platelet activation was preserved, postoperative bleeding times were unchanged, and no heparin-related deaths occurred. Similar results were obtained in both vascular patients. We conclude that temporary platelet inhibition with iloprost now permits safe heparin administration in all patients with heparin-induced thrombocytopenia who require a cardiac or vascular operation. PMID:1692679

  13. Intraoperative magnetic resonance imaging for neurosurgical procedures: anesthetic implications.

    PubMed

    Henrichs, Bernadette; Walsh, Robert P

    2011-02-01

    Intraoperative magnetic resonance imaging (IMRI) for tumor resection allows a neurosurgeon to pinpoint the exact location of the tumor before resection and to navigate to the tumor after the incision is made. Although the anesthetic management is not substantially different from that for other neurosurgical procedures, strategies to keep the patient and operating room personnel safe can be challenging. Because of the risk of injury by the strong force of the magnet, safety precautions with respect to anesthetic delivery must be taken. Ferrous objects must be removed and kept outside the operating room. Only MRI-compatible equipment is allowed in the MRI operating room. This includes the anesthesia machine, anesthesia cart, intubating equipment, monitors, stethoscopes, poles for intravenous solutions, and body warmers. Surgical equipment and instruments must be MRI-compatible. Absolute contraindications to entering the MRI suite include pacemakers, cochlear implants, certain cranial aneurysm clips, and metal joints or implants. Goals of anesthesia delivery during IMRI procedures include the following: (1) promoting the safety of patients and staff, (2) preventing MRI-associated accidents, (3) identifying potential equipment-related hazards, (4) recognizing limitations of physiologic monitoring, and (5) acknowledging other potential hazards such as noise. PMID:21473229

  14. Robust nonrigid registration to capture brain shift from intraoperative MRI.

    PubMed

    Clatz, Olivier; Delingette, Hervé; Talos, Ion-Florin; Golby, Alexandra J; Kikinis, Ron; Jolesz, Ferenc A; Ayache, Nicholas; Warfield, Simon K

    2005-11-01

    We present a new algorithm to register 3-D preoperative magnetic resonance (MR) images to intraoperative MR images of the brain which have undergone brain shift. This algorithm relies on a robust estimation of the deformation from a sparse noisy set of measured displacements. We propose a new framework to compute the displacement field in an iterative process, allowing the solution to gradually move from an approximation formulation (minimizing the sum of a regularization term and a data error term) to an interpolation formulation (least square minimization of the data error term). An outlier rejection step is introduced in this gradual registration process using a weighted least trimmed squares approach, aiming at improving the robustness of the algorithm. We use a patient-specific model discretized with the finite element method in order to ensure a realistic mechanical behavior of the brain tissue. To meet the clinical time constraint, we parallelized the slowest step of the algorithm so that we can perform a full 3-D image registration in 35 s (including the image update time) on a heterogeneous cluster of 15 personal computers. The algorithm has been tested on six cases of brain tumor resection, presenting a brain shift of up to 14 mm. The results show a good ability to recover large displacements, and a limited decrease of accuracy near the tumor resection cavity.

  15. An orthopedic tissue adhesive for targeted delivery of intraoperative biologics.

    PubMed

    Simson, Jacob; Crist, Joshua; Strehin, Iossif; Lu, Qiaozhi; Elisseeff, Jennifer H

    2013-03-01

    Tissue adhesives can bind together damaged tissues and serve as tools to deliver and localize therapeutics to facilitate regeneration. One emerging therapeutic trend in orthopedics is the use of intraoperative biologics (IOB), such as bone marrow (BM) and platelet-rich plasma (PRP), to stimulate healing. Here, we introduce the application of the biomaterial chondroitin sulfate succinimidyl succinate (CS-NHS) to deliver IOB in a hydrogel adhesive. We demonstrate the biomaterial's ability to bind various tissue types and its cellular biocompatibility with encapsulated human mesenchymal stem cells (hMSCs). Further, we examine in detail the CS-NHS adhesive combined with BM aspirate for use in bone applications. hMSCs were encapsulated in CS-BM and cultured for 5 weeks in osteogenic medium. Quantitative RT-PCR demonstrated osteogenesis via upregulation of the osteogenic transcription factor Runx2 and bone markers alkaline phosphatase and osteocalcin. Significant deposition of calcium and osteocalcin was detected using biochemical, histological, and immunohistochemical techniques. Shear testing demonstrated that the CS-BM adhesive exhibited an adhesive strength approximately an order of magnitude stronger than fibrin glue and approaching that of a cyanoacrylate adhesive. These results indicate that CS-NHS is a promising delivery tool for IOB in orthopedic applications requiring a strong, degradable, and biocompatible adhesive that supports bone growth. PMID:23097279

  16. Response of canine esophagus to intraoperative electron beam radiotherapy

    SciTech Connect

    Sindelar, W.F.; Hoekstra, H.J.; Kinsella, T.J.; Barnes, M.; DeLuca, A.M.; Tochner, Z.; Pass, H.I.; Kranda, K.C.; Terrill, R.E.

    1988-09-01

    Tolerance of esophagus to intraoperative radiotherapy (IORT) was investigated in dogs. Thirteen adult foxhounds were subjected to right thoractomy, mobilization of the intrathoracic esophagus, and IORT to a 6 cm full-thickness esophageal segment using 9 MeV electrons at doses of 0, 2,000, or 3,000 cGy. Dogs were followed clinically and were evaluated at regular intervals after treatment with fiberoptic esophagoscopy, barium swallows, and postmortem histologic evaluations. One sham-irradiated control dog showed no abnormalities during follow-up of 24 months. Seven dogs receiving 2,000 cGy IORT showed transient mild dysphagia and mild esophagitis, but no clinically or pathologically significant complications. Five dogs receiving 3,000 cGy demonstrated severe ulcerative esophagitis within 6 weeks of treatment which progressed to chronic ulcerative esophagitis with stricture formation by 9 months following IORT. One 3,000 cGy dog died at 13 months from an esophageal perforation. On the basis of a pilot experience using 13 experimental animals, it was concluded that intact canine esophagus tolerates IORT well to doses of 2,000 cGy, but doses of 3,000 cGy pose serious and potentially lethal risks. The clinical application of IORT to the treatment of human intrathoracic neoplasms requiring esophageal irradiation should be approached with caution, particularly at doses exceeding 2,000 cGy.

  17. Multimodal correlation and intraoperative matching of virtual models in neurosurgery

    NASA Technical Reports Server (NTRS)

    Ceresole, Enrico; Dalsasso, Michele; Rossi, Aldo

    1994-01-01

    The multimodal correlation between different diagnostic exams, the intraoperative calibration of pointing tools and the correlation of the patient's virtual models with the patient himself, are some examples, taken from the biomedical field, of a unique problem: determine the relationship linking representation of the same object in different reference frames. Several methods have been developed in order to determine this relationship, among them, the surface matching method is one that gives the patient minimum discomfort and the errors occurring are compatible with the required precision. The surface matching method has been successfully applied to the multimodal correlation of diagnostic exams such as CT, MR, PET and SPECT. Algorithms for automatic segmentation of diagnostic images have been developed to extract the reference surfaces from the diagnostic exams, whereas the surface of the patient's skull has been monitored, in our approach, by means of a laser sensor mounted on the end effector of an industrial robot. An integrated system for virtual planning and real time execution of surgical procedures has been realized.

  18. Intraoperative and external beam irradiation for locally advanced colorectal cancer.

    PubMed Central

    Gunderson, L L; Martin, J K; Bèart, R W; Nagorney, D M; Fieck, J M; Wieand, H S; Martinez, A; O'Connell, M J; Martenson, J A; McIlrath, D C

    1988-01-01

    In view of poor local control rates obtained with standard treatment, intraoperative radiation (IORT) using electrons was combined with external beam irradiation and surgical resection, with or without 5-fluorouracil (5FU), in 51 patients with locally advanced colorectal cancer (recurrent, 36 patients; primary, 15 patients). Patients received 4500-5500 cGy (rad) of fractionated, multiple field external beam irradiation and an IORT dose of 1000-2000 cGy. Thirty of 51 patients (59%) are alive and 22 patients (43%) are free of disease. In 44 patients at risk greater than or equal to 1 year, local progression within the IORT field has occurred in 1 of 44 (2%) and within the external beam field in 8 of 44 (18%). All local failures have occurred in patients with recurrence or with gross residual after partial resection, and the risk was less in patients who received 5FU during external irradiation (1 of 11, 9% vs. 6 of 31, 19%). The incidence of distant metastases is high in patients with recurrence, but subsequent peritoneal failures are infrequent. Acute and chronic tolerance have been acceptable, but peripheral nerve appears to be a dose-limiting structure. Randomized trials are needed to determine whether potential gains with IORT are real. PMID:3337561

  19. Intraoperative Squash Cytologic Features of Subependymal Giant Cell Astrocytoma.

    PubMed

    Nasit, Jitendra; Vaghsiya, Viren; Hiryur, Srilaxmi; Patel, Smita

    2016-01-01

    Subependymal giant cell astrocytoma (SEGA) is a low grade (WHO Grade I) tumor, usually seen in patients with tuberous sclerosis complex and commonly occurs at a lateral ventricular location. Intraoperative squash cytologic features can help in differentiating SEGA from gemistocytic astrocytoma (GA), giant cell glioblastoma and ependymoma, in proper clinical context and radiological findings, which may alter the surgical management. Here, we present a case of SEGA with squash cytologic findings and a review of cytology findings of SEGA presently available in the literature. Loose cohesive clusters of large polygonal cells containing an eccentric nucleus, evenly distributed granular chromatin, distinct to prominent nucleoli, and moderate to the abundant eosinophilic cytoplasm in a hair-like fibrillar background are the key cytologic features of SEGA. Other important features are moderate anisonucleosis and frequent binucleation and multinucleation. The absence of mitoses, necrosis, and vascular endothelial proliferation are important negative features. Other consistent features are cellular smears, few dispersed cells, few spindly strap-like cells, rare intranuclear cytoplasmic inclusion, and perivascular pseudorosettes. PMID:27013816

  20. Intraoperative Squash Cytologic Features of Subependymal Giant Cell Astrocytoma

    PubMed Central

    Nasit, Jitendra; Vaghsiya, Viren; Hiryur, Srilaxmi; Patel, Smita

    2016-01-01

    Subependymal giant cell astrocytoma (SEGA) is a low grade (WHO Grade I) tumor, usually seen in patients with tuberous sclerosis complex and commonly occurs at a lateral ventricular location. Intraoperative squash cytologic features can help in differentiating SEGA from gemistocytic astrocytoma (GA), giant cell glioblastoma and ependymoma, in proper clinical context and radiological findings, which may alter the surgical management. Here, we present a case of SEGA with squash cytologic findings and a review of cytology findings of SEGA presently available in the literature. Loose cohesive clusters of large polygonal cells containing an eccentric nucleus, evenly distributed granular chromatin, distinct to prominent nucleoli, and moderate to the abundant eosinophilic cytoplasm in a hair-like fibrillar background are the key cytologic features of SEGA. Other important features are moderate anisonucleosis and frequent binucleation and multinucleation. The absence of mitoses, necrosis, and vascular endothelial proliferation are important negative features. Other consistent features are cellular smears, few dispersed cells, few spindly strap-like cells, rare intranuclear cytoplasmic inclusion, and perivascular pseudorosettes. PMID:27013816

  1. Incorporation of surface-based deformations for updating images intraoperatively

    NASA Astrophysics Data System (ADS)

    Miga, Michael I.; Fitzpatrick, J. Michael; Galloway, Robert L., Jr.; Paulsen, Keith D.

    2001-05-01

    Patient-to-image misalignment becomes exacerbated by common surgical events such as brain sag, drug interactions, retraction, and resection. One strategy to remedy this mis- registration is to employ computational models in conjunction with low-cost intraoperatively-acquired data (e.g. surface tracking, and co-registered ultrasound) to deform preoperative imaging data to account for OR actions. In this paper, we present preliminary data from a cortical surface scanning system and study the impact of surface- based information on model-updates. Preliminary data is presented using a 3D laser scanning technology in conjunction with an iterative closest point (ICP) algorithm to register and track phantom and ex vivo data. Simulations are presented to analyze the direct use of displacement data versus modeling the underlying physical load in a clinical example of gravity-induced deformation. Results demonstrate dramatic differences in subsurface deformation fields highlighting that the nature of the surgical load (i.e. surface or body force) must be thoughtfully discriminated to accurately update images. Furthermore, the results suggest that the application of surface displacements to update image volumes must be consistent with the physical origin of deformation rather than applied in a direct interpolative sense.

  2. Dosimetry characteristics of metallic cones for intraoperative radiotherapy.

    PubMed

    Nyerick, C E; Ochran, T G; Boyer, A L; Hogstrom, K R

    1991-07-01

    Dosimetry data were obtained on the first dedicated linear accelerator of its type designed for electron intraoperative radiotherapy (IORT) within an operating room. The linear accelerator uses a high dose rate, 9 Gy.min-1, to reduce the treatment time. Its chrome-plated brass treatment cones, designed with straight ends and 22.5 degrees beveled ends, are not mechanically attached to the collimator head, but are aligned using a laser projection system. Dosimetry measurements were made for each combination of energy (6, 9, 12, 15, and 16 MeV), cone size (diameters range from 5 to 12 cm), and cone type (22.5 degrees beveled or straight). From these data, depth-dose curves, cone output, and air-gap correction factors were generated that allow the calculation of the monitor setting for delivering a prescribed dose at any depth for any irradiation condition (energy, cone, air gap). Isodose data were measured for every cone using film in a solid water phantom. Scatter off the inside wall of the cone resulted in peripheral dose horns near the surface that were energy and cone dependent, being as large as 120%.

  3. Dosimetry characteristics of metallic cones for intraoperative radiotherapy

    SciTech Connect

    Nyerick, C.E.; Ochran, T.G.; Boyer, A.L.; Hogstrom, K.R. )

    1991-07-01

    Dosimetry data were obtained on the first dedicated linear accelerator of its type designed for electron intraoperative radiotherapy (IORT) within an operating room. The linear accelerator uses a high dose rate, 9 Gy.min-1, to reduce the treatment time. Its chrome-plated brass treatment cones, designed with straight ends and 22.5 degrees beveled ends, are not mechanically attached to the collimator head, but are aligned using a laser projection system. Dosimetry measurements were made for each combination of energy (6, 9, 12, 15, and 16 MeV), cone size (diameters range from 5 to 12 cm), and cone type (22.5 degrees beveled or straight). From these data, depth-dose curves, cone output, and air-gap correction factors were generated that allow the calculation of the monitor setting for delivering a prescribed dose at any depth for any irradiation condition (energy, cone, air gap). Isodose data were measured for every cone using film in a solid water phantom. Scatter off the inside wall of the cone resulted in peripheral dose horns near the surface that were energy and cone dependent, being as large as 120%.

  4. Revision stapedectomy: intraoperative findings, results, and review of the literature.

    PubMed

    Han, W W; Incesulu, A; McKenna, M J; Rauch, S D; Nadol, J B; Glynn, R J

    1997-09-01

    Seventy-four revision stapedectomies performed consecutively over 10 years (1986 to 1995) were reviewed retrospectively. The most common intraoperative findings were incus erosion, prosthesis displacement, and oval window closure. Incus erosion was more frequently associated with multiple revisions. The postoperative results were reported using the conventional method (postoperative air minus preoperative bone) as well as the guidelines recently published by the American Academy of Otolaryngology--Head and Neck Surgery (postoperative air minus postoperative bone), with success rates of postoperative air-bone gap closure to within 10 dB after revision surgery of 51.6% and 45.6%, respectively. Patients with persistent conductive hearing loss (large residual air-bone gaps) after primary stapedectomy had poorer postrevision hearing results. Sensorineural hearing loss (defined as a drop in bone pure-tone average of more than 10 dB) occurred in four cases (5.4%). The number of revision surgeries, variations in operative techniques using laser or drill, and the ossicle to which the prosthesis was attached did not statistically affect the postoperative air-bone gaps. These results were compared with previously published data. PMID:9292601

  5. Evaluating the Safety of Intraoperative Antiarrhythmics in Pediatric Cardiac Surgery Patients.

    PubMed

    Beaty, Rachel S; Moffett, Brady S; Hall, Stuart; Kim, Jeffrey

    2015-10-01

    Cardiac arrhythmias occurring during the intraoperative period for cardiac surgery have been associated with excess morbidity and mortality. Several antiarrhythmics have been utilized for the management of intraoperative arrhythmias. These antiarrhythmic medications can cause undesirable adverse outcomes in the intensive care setting. The incidence and treatment of adult intraoperative arrhythmias have been studied. In addition, the prevalence, risk factors, and optimal treatment of pediatric postoperative arrhythmias have also been studied. However, the literature has not been published on intraoperative antiarrhythmia treatment during pediatric cardiac surgery. The purpose of this study was to determine the safety of intraoperative antiarrhythmic medications utilized in pediatric cardiac surgery patients. This was a retrospective review of all patients who received an intraoperative antiarrhythmic in the cardiovascular operating room at Texas Children's Hospital. Patients were included if they underwent cardiovascular surgery from November 2008 to July 2013 and were excluded if antiarrhythmics were given intraoperatively for other indications (i.e., esmolol for hypertension) or if patients were older than 18 years of age. Safety of antiarrhythmic treatment was determined by the absence or presence of adverse events. Control or recurrence of the arrhythmia was analyzed as a secondary measure to help determine antiarrhythmic efficacy. A total of 45 patients were identified (53.3 % male). Patients were a median of 0.52 years at the time of surgery. Primary surgery types were tetralogy of Fallot repair (n = 6; 13.3 %) and ventricular septal defect closure (n = 5, 11.1 %). Thirty-one patients (68.9 %) had documented adverse events after the administration of antiarrhythmics. Most of these adverse events occurred after the administration of amiodarone (n = 16; 51.6 %) followed by esmolol (n = 15; 48.4 %). Fifty-one percent of the arrhythmias resolved in the operating

  6. Intraoperative radiotherapy in early stage breast cancer: potential indications and evidence to date

    PubMed Central

    Kirby, A M

    2015-01-01

    Following early results of recent studies of intraoperative radiotherapy (IORT) in the adjuvant treatment of patients with early breast cancer, the clinical utility of IORT is a subject of much recent debate within the breast oncology community. This review describes the intraoperative techniques available, the potential indications and the evidence to date pertaining to local control and toxicity. We also discuss any implications for current practice and future research. PMID:25734489

  7. Risk factors for intraoperative calcar fracture in cementless total hip arthroplasty

    PubMed Central

    Miettinen, Simo S A; Mäkinen, Tatu J; Kostensalo, Inari; Mäkelä, Keijo; Huhtala, Heini; Kettunen, Jukka S; Remes, Ville

    2016-01-01

    Background and purpose — Intraoperative periprosthetic femoral fracture is a known complication of cementless total hip arthroplasty (THA). We determined the incidence of—and risk factors for—intraoperative calcar fracture, and assessed its influence on the risk of revision. Patients and methods — This retrospective analysis included 3,207 cementless THAs (in 2,913 patients). 118 intraoperative calcar fractures were observed in these hips (3.7%). A control group of 118 patients/hips without calcar fractures was randomly selected. The mean follow-up was 4.2 (1.8–8.0) years. Demographic data, surgical data, type of implant, and proximal femur morphology were evaluated to determine risk factors for intraoperative calcar fracture. Results — The revision rates in the calcar fracture group and the control group were 10% (95% CI: 5.9–17) and 3.4% (CI: 1.3–8.4), respectively. The revision rate directly related to intraoperative calcar fracture was 7.6%. The Hardinge approach and lower age were risk factors for calcar fracture. In the fracture group, 55 of 118 patients (47%) had at least one risk factor, while only 23 of118 patients in the control group (20%) had a risk factor (p = 0.001). Radiological analysis showed that in the calcar fracture group, there were more deviated femoral anatomies and proximal femur bone cortices were thinner. Interpretation — Intraoperative calcar fracture increased the risk of revision. The Hardinge approach and lower age were risk factors for intraoperative calcar fracture. To avoid intraoperative fractures, special attention should be paid when cementless stems are used with deviant-shaped proximal femurs and with thin cortices. PMID:26541230

  8. Visual evoked potentials for intraoperative neurophysiologic monitoring using total intravenous anesthesia.

    PubMed

    Wiedemayer, Helmut; Fauser, Barbara; Armbruster, W; Gasser, Thomas; Stolke, Dietmar

    2003-01-01

    Conflicting reports on the usefulness of intraoperative monitoring of visual function by means of visual evoked potentials (VEPs) initiated this study. In 32 patients without visual problems, VEPs were recorded to evaluate the reliability for intraoperative monitoring with total intravenous anesthesia. All patients underwent noncranial surgery. Using a standard technique, VEPs were recorded preoperatively in the awake patients and after induction of anesthesia during surgery. A total of 1436 intraoperative traces were recorded and analyzed. A minor prolongation of the P100 latency of 8% and a more pronounced attenuation of the P100-N145 amplitude of 60% were observed in the anesthetized patients. In most of the anesthetized patients, a stable recording of VEPs was not obtainable. In 4 patients (12.5%), clearly identifiable VEP peaks were detected in more than 90% of the traces recorded intraoperatively. In 88% of the patients, reproducible VEPs were obtained in less than 75% of the intraoperative traces only. We concluded that with standard recording techniques and total intravenous anesthesia, intraoperative VEP monitoring in surgically anesthetized patients is not reliable.

  9. Digital Photographic Measurement in Hypospadias: Validation and Comparison to Intraoperative Measurement

    PubMed Central

    Akhavan, Ardavan; Merguerian, Paul A; Grady, Richard W; DiSandro, Michael; Shnorhavorian, Margarett

    2013-01-01

    Background We propose a standardized method of photographing the hypospadias penis to capture penile dimensions that may be relevant for surgery. We also validate the use of digital imaging software for calculating penile dimensions as a substitute for intraoperative caliper-based measurements. Methods Photographs were taken of hypospadias penises in four different views after placement of a traction stitch and retraction of the preputial hood. Intraoperative measurements were obtained with a caliper. Digital measurements were taken of the same parameters postoperatively. All measurements were obtained in triplicate by multiple participants, and averages were tested for equivalency by determining the correlation coefficient for each parameter. Inter-observer correlation was also calculated for each parameter. Results 180 intraoperative and 180 digital measurements were taken from 60 dimensions on 10 hypospadiac penises. Strong correlation existed between most digital and intraoperative measurements. Average inter-observer correlations ranged from 0.91 to 0.99 for each of the intraoperative measurements, and 0.90 to 1.00 for each of the digital measurements. Conclusions Standardized imaging is effective in capturing penile dimensions and measurements during hypospadias surgery. When compared with intraoperative measurements, digital measurements are reliable and precise; digital photography has the potential to both aid in surgical planning and improve documentation. PMID:24291248

  10. Combined use of intraoperative indocyanine green and dynamic angiography in rotational vertebral artery occlusion.

    PubMed

    Chaudhry, Nauman S; Ambekar, Sudheer; Elhammady, Mohamed Samy; Riley, Jonathan P; Pradilla, Gustavo; Nogueira, Raul G; Ahmad, Faiz U

    2016-08-01

    Rotational vertebral artery occlusion, also known as bow hunter's syndrome, is a well-documented surgically amenable cause of vertebrobasilar insufficiency. Traditionally, patients have been imaged using dynamic rotational angiography. The authors sought to determine whether intraoperative indocyanine green (ICG) angiography could reliably assess the adequacy of surgical decompression of the vertebral artery (VA). The authors report two patients who presented with multiple transient episodes of syncope provoked by turning their head to the right. Rotational dynamic angiography revealed a dominant VA that became occluded with head rotation to the right side. The patients underwent successful surgical decompression of the VA via an anterior cervical approach. Intraoperative ICG angiography demonstrated patency of the VA with head rotation. This was further confirmed by intraoperative dynamic catheter angiography. To our knowledge, we present the first two cases of the use of ICG combined with intraoperative dynamic rotational angiography to document the adequacy of surgical decompression of the VA in a patient with rotational vertebral artery occlusion. Intraoperative ICG angiography is a useful adjunct and may potentially supplant the need for intraoperative catheter angiography. PMID:27041076

  11. Predictive roles of intraoperative blood glucose for post-transplant outcomes in liver transplantation.

    PubMed

    Park, Chul Soo

    2015-06-14

    Diabetogenic traits in patients undergoing liver transplantation (LT) are exacerbated intraoperatively by exogenous causes, such as surgical stress, steroids, blood transfusions, and catecholamines, which lead to intraoperative hyperglycemia. In contrast to the strict glucose control performed in the intensive care unit, no systematic protocol has been developed for glucose management during LT. Intraoperative blood glucose concentrations typically exceed 200 mg/dL in LT, and extreme hyperglycemia (> 300 mg/dL) is common during the neohepatic phase. Only a few retrospective studies have examined the relationship between intraoperative hyperglycemia and post-transplant complications, with reports of infectious complications or mortality. However, no prospective studies have been conducted regarding the influence of intraoperative hyperglycemia in LT on post-transplant outcome. In addition to absolute blood glucose values, the temporal patterns in blood glucose levels during LT may serve as prognostic features. Persistent neohepatic hyperglycemia (without a decline) throughout LT is a useful indicator of early graft dysfunction. Moreover, intraoperative variability in glucose levels may predict the need for reoperation for hemorrhage after LT. Thus, there is an urgent need for guidelines for glucose control in these patients, as well as prospective studies on the impact of glucose control on various post-transplant complications. This report highlights some of the recent studies related to perioperative blood glucose management focused on LT and liver disease. PMID:26078559

  12. Comparison of transesophageal echocardiographic and scintigraphic estimates of left ventricular end-diastolic volume index and ejection fraction in patients following coronary artery bypass grafting

    SciTech Connect

    Urbanowicz, J.H.; Shaaban, M.J.; Cohen, N.H.; Cahalan, M.K.; Botvinick, E.H.; Chatterjee, K.; Schiller, N.B.; Dae, M.W.; Matthay, M.A. )

    1990-04-01

    Transesophageal echocardiography (TEE) has become a commonly used monitor of left ventricular (LV) function and filling during cardiac surgery. Its use is based on the assumption that changes in LV short-axis ID reflect changes in LV volume. To study the ability of TEE to estimate LV volume and ejection immediately following CABG, 10 patients were studied using blood pool scintigraphy, TEE, and thermodilution cardiac output (CO). A single TEE short-axis cross-sectional image of the LV at the midpapillary muscle level was used for area analysis. Between 1 and 5 h postoperatively, simultaneous data sets (scintigraphy, TEE, and CO) were obtained three to five times in each patient. End-diastolic (EDa) and end-systolic (ESa) areas were measured by light pen. Ejection fraction area (EFa) was calculated (EFa = (EDa - ESa)/EDa). When EFa was compared with EF by scintigraphy, correlation was good (r = 0.82 SEE = 0.07). EDa was taken as an indicator of LV volume and compared with LVEDVI which was derived from EF by scintigraphy and CO. Correlation between EDa and LVEDVI was fair (r = 0.74 SEE = 3.75). The authors conclude that immediately following CABG, a single cross-sectional TEE image provides a reasonable estimate of EF but not LVEDVI.

  13. Ultrasound-Guided Transesophageal High-Intensity Focused Ultrasound Cardiac Ablation in a Beating Heart: A Pilot Feasibility Study in Pigs.

    PubMed

    Bessiere, Francis; N'djin, W Apoutou; Colas, Elodie Constanciel; Chavrier, Françoise; Greillier, Paul; Chapelon, Jean Yves; Chevalier, Philippe; Lafon, Cyril

    2016-08-01

    Catheter ablation for the treatment of arrhythmia is associated with significant complications and often-repeated procedures. Consequently, a less invasive and more efficient technique is required. Because high-intensity focused ultrasound (HIFU) enables the generation of precise thermal ablations in deep-seated tissues without harming the tissues in the propagation path, it has the potential to be used as a new ablation technique. A system capable of delivering HIFU into the heart by a transesophageal route using ultrasound (US) imaging guidance was developed and tested in vivo in six male pigs. HIFU exposures were performed on atria and ventricles. At the time of autopsy, visual inspection identified thermal lesions in the targeted areas in three of the animals. These lesions were confirmed by histologic analysis (mean size: 5.5 mm(2) × 11 mm(2)). No esophageal thermal injury was observed. One animal presented with bradycardia due to an atrio-ventricular block, which provides real-time confirmation of an interaction between HIFU and the electrical circuits of the heart. Thus, US-guided HIFU has the potential to minimally invasively create myocardial lesions without an intra-cardiac device.

  14. Intraoperative electrophysiological evaluations of macular function during peripheral scleral indentation

    PubMed Central

    Akiyama, Goichi; Matsumoto, Celso Soiti; Shinoda, Kei; Terauchi, Gaku; Matsumoto, Harue; Watanabe, Emiko; Iwata, Takeshi; Mizota, Atsushi; Miyake, Yozo

    2016-01-01

    Scleral indentation is widely used to examine the peripheral fundus, however it can increase the intraocular pressure (IOP) to high levels which can then affect retinal function. We evaluated the effects of scleral indentation on the macular function electrophysiologically. Intraoperative focal macular electroretinograms (iFMERGs) were recorded with and without controlling the IOP in 7 eyes. Without IOP control, the IOP increased from 21.7 ± 4.9 to 92.7 ± 20.2 mmHg significantly (P = 0.020) and the amplitudes of the b-wave (from 6.29 ± 1.160 to 3.71 ± 1.98 uV, P = 0.007), on-photopic negative response (from 2.29 ± 0.99 to 0.72 ± 0.47 uV, on-PhNR, P = 0.005), and d-wave (from 2.57 ± 0.41 to 1.64 ± 0.69 uV, P = 0.007) decreased significantly soon after beginning the indentation. All values returned to the baseline levels after releasing the indentation. In the eyes with IOP controlled, the IOP and the amplitude of all components did not change significantly during and after the indentation except the on-PhNR amplitude which was significantly reduced during the indentation. The changes in the iFMERGs and macular function caused by scleral indentation were transient and reversible. The changes can be minimized by controlling the IOP. PMID:27762313

  15. Intraoperative Radiotherapy for Parotid Cancer: A Single-Institution Experience

    SciTech Connect

    Zeidan, Youssef H.; Shiue, Kevin; Weed, Daniel; Johnstone, Peter A.; Terry, Colin; Freeman, Stephen; Krowiak, Edward; Borrowdale, Robert; Huntley, Tod; Yeh, Alex

    2012-04-01

    Purpose: Our practice policy has been to provide intraoperative radiotherapy (IORT) at resection to patients with head-and-neck malignancies considered to be at high risk of recurrence. The purpose of the present study was to review our experience with the use of IORT for primary or recurrent cancer of the parotid gland. Methods and Materials: Between 1982 and 2007, 96 patients were treated with gross total resection and IORT for primary or recurrent cancer of the parotid gland. The median age was 62.9 years (range, 14.3-88.1). Of the 96 patients, 33 had previously undergone external beam radiotherapy as a component of definitive therapy. Also, 34 patients had positive margins after surgery, and 40 had perineural invasion. IORT was administered as a single fraction of 15 or 20 Gy with 4-6-MeV electrons. The median follow-up period was 5.6 years. Results: Only 1 patient experienced local recurrence, 19 developed regional recurrence, and 12 distant recurrence. The recurrence-free survival rate at 1, 3, and 5 years was 82.0%, 68.5%, and 65.2%, respectively. The 1-, 3-, and 5-year overall survival rate after surgery and IORT was 88.4%, 66.1%, and 56.2%, respectively. No perioperative fatalities occurred. Complications developed in 26 patients and included vascular complications in 7, trismus in 6, fistulas in 4, radiation osteonecrosis in 4, flap necrosis in 2, wound dehiscence in 2, and neuropathy in 1. Of these 26 patients, 12 had recurrent disease, and 8 had undergone external beam radiotherapy before IORT. Conclusions: IORT results in effective local disease control at acceptable levels of toxicity and should be considered for patients with primary or recurrent cancer of the parotid gland.

  16. Quantification of tumor fluorescence during intraoperative optical cancer imaging.

    PubMed

    Judy, Ryan P; Keating, Jane J; DeJesus, Elizabeth M; Jiang, Jack X; Okusanya, Olugbenga T; Nie, Shuming; Holt, David E; Arlauckas, Sean P; Low, Phillip S; Delikatny, E James; Singhal, Sunil

    2015-11-13

    Intraoperative optical cancer imaging is an emerging technology in which surgeons employ fluorophores to visualize tumors, identify tumor-positive margins and lymph nodes containing metastases. This study compares instrumentation to measure tumor fluorescence. Three imaging systems (Spectropen, Glomax, Flocam) measured and quantified fluorescent signal-to-background ratios (SBR) in vitro, murine xenografts, tissue phantoms and clinically. Evaluation criteria included the detection of small changes in fluorescence, sensitivity of signal detection at increasing depths and practicality of use. In vitro, spectroscopy was superior in detecting incremental differences in fluorescence than luminescence and digital imaging (Ln[SBR] = 6.8 ± 0.6, 2.4 ± 0.3, 2.6 ± 0.1, p = 0.0001). In fluorescent tumor cells, digital imaging measured higher SBRs than luminescence (6.1 ± 0.2 vs. 4.3 ± 0.4, p = 0.001). Spectroscopy was more sensitive than luminometry and digital imaging in identifying murine tumor fluorescence (SBR = 41.7 ± 11.5, 5.1 ± 1.8, 4.1 ± 0.9, p = 0.0001), and more sensitive than digital imaging at detecting fluorescence at increasing depths (SBR = 7.0 ± 3.4 vs. 2.4 ± 0.5, p = 0.03). Lastly, digital imaging was the most practical and least time-consuming. All methods detected incremental differences in fluorescence. Spectroscopy was the most sensitive for small changes in fluorescence. Digital imaging was the most practical considering its wide field of view, background noise filtering capability, and sensitivity to increasing depth.

  17. Intraoperative Near-Infrared Imaging Can Identify Pulmonary Nodules

    PubMed Central

    Okusanya, Olugbenga T.; Holt, David; Heitjan, Daniel; Deshpande, Charuhas; Venegas, Ollin; Jiang, Jack; Judy, Ryan; DeJesus, Elizabeth; Madajewski, Brian; Oh, Kenny; Albelda, Steven M.; Nie, Shuming; Singhal, Sunil

    2014-01-01

    Background Over 80,000 people undergo pulmonary resection for a lung nodule in the United States each year. Small nodules are frequently missed or difficult to find despite preoperative imaging. We hypothesized that near-infrared (NIR) imaging technology could be used to identify and locate lung nodules during surgery. Methods We enrolled 18 patients who were diagnosed with a pulmonary nodule that required resection. All patients had a fine-cut 1mm computed tomography scan preoperatively. The patients were given systemic 5 mg/kg indocyanine green (ICG) and then underwent an open thoracotomy 24 hours later. NIR imaging was used to identify the primary nodule and search for additional nodules that were not found by visual inspection or manual palpation of the ipsilateral lung. Results Manual palpation and visual inspection identified all 18 primary pulmonary nodules and no additional lesions. Intraoperative NIR imaging detected 16 out of the 18 primary nodules. NIR imaging also identified 5 additional subcentimeter nodules: 3 metastatic adenocarcinomas and 2 metastatic sarcomas. This technology could identify nodules as small as 0.2 cm and as deep as 1.3 cm from the pleural surface. This approach discovered 3 nodules that were in different lobes than the primary tumor. Nodule fluorescence was independent of size, metabolic activity, histology, tumor grade and vascularity. Conclusions This is the first-in-human demonstration of identifying pulmonary nodules during Thoracic surgery with NIR imaging without a priori knowledge of their location or existence. NIR imaging can detect pulmonary nodules during lung resections that are poorly visualized on computed tomography and difficult to discriminate on finger palpation. PMID:25106680

  18. Quantification of tumor fluorescence during intraoperative optical cancer imaging

    PubMed Central

    Judy, Ryan P.; Keating, Jane J.; DeJesus, Elizabeth M.; Jiang, Jack X.; Okusanya, Olugbenga T.; Nie, Shuming; Holt, David E.; Arlauckas, Sean P.; Low, Phillip S.; Delikatny, E. James; Singhal, Sunil

    2015-01-01

    Intraoperative optical cancer imaging is an emerging technology in which surgeons employ fluorophores to visualize tumors, identify tumor-positive margins and lymph nodes containing metastases. This study compares instrumentation to measure tumor fluorescence. Three imaging systems (Spectropen, Glomax, Flocam) measured and quantified fluorescent signal-to-background ratios (SBR) in vitro, murine xenografts, tissue phantoms and clinically. Evaluation criteria included the detection of small changes in fluorescence, sensitivity of signal detection at increasing depths and practicality of use. In vitro, spectroscopy was superior in detecting incremental differences in fluorescence than luminescence and digital imaging (Ln[SBR] = 6.8 ± 0.6, 2.4 ± 0.3, 2.6 ± 0.1, p = 0.0001). In fluorescent tumor cells, digital imaging measured higher SBRs than luminescence (6.1 ± 0.2 vs. 4.3 ± 0.4, p = 0.001). Spectroscopy was more sensitive than luminometry and digital imaging in identifying murine tumor fluorescence (SBR = 41.7 ± 11.5, 5.1 ± 1.8, 4.1 ± 0.9, p = 0.0001), and more sensitive than digital imaging at detecting fluorescence at increasing depths (SBR = 7.0 ± 3.4 vs. 2.4 ± 0.5, p = 0.03). Lastly, digital imaging was the most practical and least time-consuming. All methods detected incremental differences in fluorescence. Spectroscopy was the most sensitive for small changes in fluorescence. Digital imaging was the most practical considering its wide field of view, background noise filtering capability, and sensitivity to increasing depth. PMID:26563091

  19. Intraoperative Sac Pressure Measurement During Endovascular Abdominal Aortic Aneurysm Repair

    SciTech Connect

    Ishibashi, Hiroyuki; Ishiguchi, Tsuneo; Ohta, Takashi; Sugimoto, Ikuo; Iwata, Hirohide; Yamada, Tetsuya; Tadakoshi, Masao; Hida, Noriyuki; Orimoto, Yuki; Kamei, Seiji

    2010-10-15

    PurposeIntraoperative sac pressure was measured during endovascular abdominal aortic aneurysm repair (EVAR) to evaluate the clinical significance of sac pressure measurement.MethodsA microcatheter was placed in an aneurysm sac from the contralateral femoral artery, and sac pressure was measured during EVAR procedures in 47 patients. Aortic blood pressure was measured as a control by a catheter from the left brachial artery.ResultsThe systolic sac pressure index (SPI) was 0.87 {+-} 0.10 after main-body deployment, 0.63 {+-} 0.12 after leg deployment (P < 0.01), and 0.56 {+-} 0.12 after completion of the procedure (P < 0.01). Pulse pressure was 55 {+-} 21 mmHg, 23 {+-} 15 mmHg (P < 0.01), and 16 {+-} 12 mmHg (P < 0.01), respectively. SPI showed no significant differences between the Zenith and Excluder stent grafts (0.56 {+-} 0.13 vs. 0.54 {+-} 0.10, NS). Type I endoleak was found in seven patients (15%), and the SPI decreased from 0.62 {+-} 0.10 to 0.55 {+-} 0.10 (P = 0.10) after fixing procedures. Type II endoleak was found in 12 patients (26%) by completion angiography. The SPI showed no difference between type II endoleak positive and negative (0.58 {+-} 0.12 vs. 0.55 {+-} 0.12, NS). There were no significant differences between the final SPI of abdominal aortic aneurysms in which the diameter decreased in the follow-up and that of abdominal aortic aneurysms in which the diameter did not change (0.53 {+-} 0.12 vs. 0.57 {+-} 0.12, NS).ConclusionsSac pressure measurement was useful for instant hemodynamic evaluation of the EVAR procedure, especially in type I endoleaks. However, on the basis of this small study, the SPI cannot be used to reliably predict sac growth or regression.

  20. Intraoperative positioning of mobile C-arms using artificial fluoroscopy

    NASA Astrophysics Data System (ADS)

    Dressel, Philipp; Wang, Lejing; Kutter, Oliver; Traub, Joerg; Heining, Sandro-Michael; Navab, Nassir

    2010-02-01

    In trauma and orthopedic surgery, imaging through X-ray fluoroscopy with C-arms is ubiquitous. This leads to an increase in ionizing radiation applied to patient and clinical staff. Placing these devices in the desired position to visualize a region of interest is a challenging task, requiring both skill of the operator and numerous X-rays for guidance. We propose an extension to C-arms for which position data is available that provides the surgeon with so called artificial fluoroscopy. This is achieved by computing digitally reconstructed radiographs (DRRs) from pre- or intraoperative CT data. The approach is based on C-arm motion estimation, for which we employ a Camera Augmented Mobile C-arm (CAMC) system, and a rigid registration of the patient to the CT data. Using this information we are able to generate DRRs and simulate fluoroscopic images. For positioning tasks, this system appears almost exactly like conventional fluoroscopy, however simulating the images from the CT data in realtime as the C-arm is moved without the application of ionizing radiation. Furthermore, preoperative planning can be done on the CT data and then visualized during positioning, e.g. defining drilling axes for pedicle approach techniques. Since our method does not require external tracking it is suitable for deployment in clinical environments and day-to-day routine. An experiment with six drillings into a lumbar spine phantom showed reproducible accuracy in positioning the C-arm, ranging from 1.1 mm to 4.1 mm deviation of marker points on the phantom compared in real and virtual images.

  1. Intraoperative Flap Complications in LASIK Surgery Performed by Ophthalmology Residents

    PubMed Central

    Romero-Diaz-de-Leon, Lorena; Serna-Ojeda, Juan Carlos; Navas, Alejandro; Graue-Hernández, Enrique O.; Ramirez-Miranda, Arturo

    2016-01-01

    Purpose: To report the rate of flap-related complications in LASIK surgery performed by in-training ophthalmology residents and to analyze the risk factors for these complications. Methods: We analyzed 273 flap dissections in 145 patients from March 2013 to February 2014. We included all LASIK surgeries performed by 32 ophthalmology residents using a Moria M2 microkeratome. All the flap-related complications were noted. Comparison between both groups with and without complications was performed with an independent Student's t-test and relative risks were calculated. Results: There were 19 flap-related complications out of the 273 flap dissections (6.95%). The most common complication was incomplete flap dissection (n = 10; 3.66%), followed by free-cap (n = 5; 1.83%), and flap-buttonhole (n = 2; 0.73%). There was no significant difference between the complicated and uncomplicated cases in terms of the right versus the left eye, pachymetry results, white-to-white diameter, and spherical equivalent. But this difference was significant for mean keratometry (P = 0.008), K-min (P = 0.01), and K-max (P = 0.03) between these groups. Final visual acuity after rescheduling laser treatment was similar in both groups. Relative risks for flap-related complications were 2.03 for the first LASIK surgery (CI 95% 0.64 to 6.48; P = 0.22) and 1.26 (CI 95% 0.43 to 3.69; P = 0.66) for the surgeon's flap-related complications. Female gender presented an odds ratio of 2.48 (CI 95% 0.68 to 9.00; P = 0.16) for complications. Conclusion: Flap-related complications are common intraoperative event during LASIK surgery performed by in-training ophthalmologists. Keratometries and surgeon's first procedure represent a higher probability for flap related complications than some other biometric parameters of patient's eye. PMID:27621782

  2. Noninvasive Electrocardiographic Imaging (ECGI): Comparison to intraoperative mapping in patients

    PubMed Central

    Ghanem, Raja N.; Jia, Ping; Ramanathan, Charulatha; Ryu, Kyungmoo; Markowitz, Alan; Rudy, Yoram

    2007-01-01

    OBJECTIVES/BACKGROUND Cardiac arrhythmias are a leading cause of death and disability. Electrocardiographic imaging (ECGI) is a noninvasive imaging modality that reconstructs potentials, electrograms, and isochrones on the epicardial surface from body surface measurements. We previously demonstrated in animal experiments through comparison with simultaneously measured epicardial data the high accuracy of ECGI in imaging cardiac electrical events. Here, images obtained by noninvasive ECGI are compared to invasive direct epicardial mapping in open heart surgery patients. METHODS Three patients were studied during sinus rhythm and right ventricular endocardial and epicardial pacing (total of five datasets). Body surface potentials were acquired preoperatively or postoperatively using a 224-electrode vest. Heart-torso geometry was determined preoperatively using computed tomography. Intraoperative mapping was performed with two 100-electrode epicardial patches. RESULTS Noninvasive potential maps captured epicardial breakthrough sites and reflected general activation and repolarization patterns, localized pacing sites to ∼1 cm and distinguished between epicardial and endocardial origin of activation. Noninvasively reconstructed electrogram morphologies correlated moderately with their invasive counterparts (cross correlation = 0.72 ± 0.25 [sinus rhythm], 0.67 ± 0.23 [endocardial pacing], 0.71 ± 0.21 [epicardial pacing]). Noninvasive isochrones captured the sites of earliest activation, areas of slow conduction, and the general excitation pattern. CONCLUSIONS Despite limitations due to nonsimultaneous acquisition of the surgical and noninvasive data under different conditions, the study demonstrates that ECGI can capture important features of cardiac electrical excitation in humans noninvasively during a single beat. It also shows that general excitation patterns and electrogram morphologies are largely preserved in open chest conditions. PMID:15851333

  3. Intraoperative Electron Radiotherapy for the Management of Aggressive Fibromatosis

    SciTech Connect

    Roeder, Falk; Timke, Carmen; Oertel, Susanne; Hensley, Frank W.; Bischof, Marc; Muenter, Marc W.; Weitz, Juergen; Buchler, Markus W.; Lehner, Burkhard; Debus, Juergen; Krempien, Robert

    2010-03-15

    Purpose: We analyzed our experience with intraoperative electron radiotherapy (IOERT) followed by moderate doses of external beam radiotherapy (EBRT) after organ-sparing surgery in patients with primary or recurrent aggressive fibromatosis. Methods and Materials: Indication for IOERT and postoperative EBRT as an individual treatment approach to avoid mutilating surgical procedures was seen when complete surgical removal seemed to be unlikely or impossible. A total of 31 lesions in 30 patients were treated by surgery and IOERT with a median dose of 12 Gy. Median age was 31 years (range, 13-59 years). Resection status was close margin in six lesions, microscopically positive in 13, and macroscopically positive in 12. Median tumor size was 9 cm. In all, 25 patients received additional EBRT, with a median dose of 45 Gy (range, 36-54 Gy). Results: After a median follow-up of 32 months (range, 3-139 months), no disease-related deaths occurred. A total of five local recurrences were seen, resulting in actuarial 3-year local control rates of 82% overall and 91% inside the IOERT areas. Trends to improved local control were seen for older age (>31 years) and negative margins, but none of these factors reached significance. Perioperative complications were found in six patients, in particular as wound healing disturbances in five patients and venous thrombosis in one patient. Late toxicity was seen in five patients. Conclusion: Introduction of IOERT into a multimodal treatment approach in patients with aggressive fibromatosis is feasible with low toxicity and yielded good local control rates even in patients with microscopical or gross residual disease.

  4. Intraoperative Flap Complications in LASIK Surgery Performed by Ophthalmology Residents

    PubMed Central

    Romero-Diaz-de-Leon, Lorena; Serna-Ojeda, Juan Carlos; Navas, Alejandro; Graue-Hernández, Enrique O.; Ramirez-Miranda, Arturo

    2016-01-01

    Purpose: To report the rate of flap-related complications in LASIK surgery performed by in-training ophthalmology residents and to analyze the risk factors for these complications. Methods: We analyzed 273 flap dissections in 145 patients from March 2013 to February 2014. We included all LASIK surgeries performed by 32 ophthalmology residents using a Moria M2 microkeratome. All the flap-related complications were noted. Comparison between both groups with and without complications was performed with an independent Student's t-test and relative risks were calculated. Results: There were 19 flap-related complications out of the 273 flap dissections (6.95%). The most common complication was incomplete flap dissection (n = 10; 3.66%), followed by free-cap (n = 5; 1.83%), and flap-buttonhole (n = 2; 0.73%). There was no significant difference between the complicated and uncomplicated cases in terms of the right versus the left eye, pachymetry results, white-to-white diameter, and spherical equivalent. But this difference was significant for mean keratometry (P = 0.008), K-min (P = 0.01), and K-max (P = 0.03) between these groups. Final visual acuity after rescheduling laser treatment was similar in both groups. Relative risks for flap-related complications were 2.03 for the first LASIK surgery (CI 95% 0.64 to 6.48; P = 0.22) and 1.26 (CI 95% 0.43 to 3.69; P = 0.66) for the surgeon's flap-related complications. Female gender presented an odds ratio of 2.48 (CI 95% 0.68 to 9.00; P = 0.16) for complications. Conclusion: Flap-related complications are common intraoperative event during LASIK surgery performed by in-training ophthalmologists. Keratometries and surgeon's first procedure represent a higher probability for flap related complications than some other biometric parameters of patient's eye.

  5. Comparison of Intraoperatively Built Custom Linked Seeds Versus Loose Seed Gun Applicator Technique Using Real-Time Intraoperative Planning for Permanent Prostate Brachytherapy

    SciTech Connect

    Zauls, A. Jason; Ashenafi, Michael S.; Onicescu, Georgiana; Clarke, Harry S.; Marshall, David T.

    2011-11-15

    Purpose: To report our dosimetric results using a novel push-button seed delivery system that constructs custom links of seeds intraoperatively. Methods and Materials: From 2005 to 2007, 43 patients underwent implantation using a gun applicator (GA), and from 2007 to 2008, 48 patientsunderwent implantation with a novel technique allowing creation of intraoperatively built custom links of seeds (IBCL). Specific endpoint analyses were prostate D90% (pD90%), rV100% > 1.3 cc, and overall time under anesthesia. Results: Final analyses included 91 patients, 43 GA and 48 IBCL. Absolute change in pD90% ({Delta}pD90%) between intraoperative and postoperative plans was evaluated. Using GA method, the {Delta}pD90% was -8.1Gy and -12.8Gy for I-125 and Pd-103 implants, respectively. Similarly, the IBCL technique resulted in a {Delta}pD90% of -8.7Gy and -9.8Gy for I-125 and Pd-103 implants, respectively. No statistically significant difference in {Delta}pD90% was found comparing methods. The GA method had two intraoperative and 10 postoperative rV100% >1.3 cc. For IBCL, five intraoperative and eight postoperative plans had rV100% >1.3 cc. For GA, the mean time under anesthesia was 75 min and 87 min for Pd-103 and I-125 implants, respectively. For IBCL, the mean time was 86 and 98 min for Pd-103 and I-125. There was a statistical difference between the methods when comparing mean time under anesthesia. Conclusions: Dosimetrically relevant endpoints were equivalent between the two methods. Currently, time under anesthesia is longer using the IBCL technique but has decreased over time. IBCL is a straightforward brachytherapy technique that can be implemented into clinical practice as an alternative to gun applicators.

  6. Intraoperative Optical Coherence Tomography-Assisted Descemet Membrane Endothelial Keratoplasty in the DISCOVER Study

    PubMed Central

    Cost, Brian; Goshe, Jeffrey M.; Srivastava, Sunil; Ehlers, Justis P.

    2015-01-01

    Purpose To investigate the utility of intraoperative optical coherence tomography (OCT) for Descemet Membrane Endothelial Keratoplasty (DMEK) surgery. Design Prospective consecutive interventional case series. Methods DISCOVER (NCT02423213) is a prospective consecutive interventional case series examining the feasibility and utility microscope-integrated intraoperative OCT in ophthalmic surgery. This report focuses on those eyes in the DISCOVER study undergoing DMEK surgery. The eight cases were the first DMEK cases performed by the primary surgeon (J.M.G.) with microscope integrated intraoperative OCT feedback (Rescan 700, Carl Zeiss Meditec). Qualitative OCT analysis was performed at multiple surgeon-defined time points, including host and donor tissue preparation, graft orientation, graft apposition, and tissue interface fluid dynamics. Results Correct graft orientation was confirmed by intraoperative OCT prior to unscrolling in 100% of cases. Seven of eight grafts were fully attached at the conclusion of surgery and on postoperative day one. One graft had a linear paracentral fixed area of interface separation corresponding to posterior stromal irregularities which was visible during surgery and unchanged on postoperative day one. Two eyes developed significant peripheral graft dehiscence visible by the first postoperative week. Both grafts were successfully re-attached with repeat gas injection. All eyes demonstrated improvement in best corrected visual acuity and there was a 100% graft survival rate at last follow-up (minimum = 4 months). Surgeon feedback indicated that intraoperative OCT provided valuable information in all eight cases. Conclusions Real-time intraoperative OCT can provide useful information, which may directly impact surgical decision-making during DMEK surgery. Intraoperative OCT may facilitate the transition for novice DMEK surgeons by increasing surgeon confidence and reducing the risk of iatrogenic graft failure. PMID:26026264

  7. Intraoperative monitoring of torsion to prevent vertical deviations during augmented vertical rectus transposition surgery

    PubMed Central

    Holmes, Jonathan M.; Hatt, Sarah R.; Leske, David A.

    2012-01-01

    Background Total transposition of the superior and inferior rectus muscle laterally, with augmentation sutures, may be complicated by induction of an undesirable vertical deviation. Induced vertical misalignment may be associated with changes in torsion. We have developed a simple method to monitor intraoperative torsion that may reduce the incidence of vertical deviations. Methods We reviewed consecutive cases of total abducens palsy or esotropic Duane syndrome treated with augmented lateral transposition of the superior and inferior rectus muscles, where the 12 o’clock and 6 o’clock intraoperative positions were initially marked with a dot at the limbus using a surgical pen. The location of the marks was monitored during tying of the augmentation sutures; changes in torsion were monitored intraoperatively. Results Records of 9 cases of augmented vertical rectus transposition were reviewed. Based on intraoperative assessment of torsion by observing the position of the preplaced limbal dots, the inferior rectus augmentation suture was tied less tightly than the superior rectus suture, leaving a gap of 1–3 mm between the inferior and lateral rectus muscles in 8 of 9 cases. The augmentation suture was totally removed in 1 case. Following these intraoperative adjustments, there was no induced intraoperative torsion, whereas further tightening of the inferior suture induced extorsion. Six weeks postoperatively, 8 of 9 patients did not experience a symptomatic vertical deviation. Conclusions When performing augmented transposition procedures, intraoperative monitoring of torsion may reduce the incidence of inadvertent vertical deviations and torsion. This technique may also be useful in other cases where correction or avoidance of torsion is needed. PMID:22525168

  8. Predisposing Factors for Intraoperative Endplate Injury of Extreme Lateral Interbody Fusion

    PubMed Central

    Kanemura, Tokumi; Yamaguchi, Hidetoshi; Segi, Naoki; Ouchida, Jun

    2016-01-01

    Study Design Retrospective study. Purpose To compare intraoperative endplate injury cases and no injury cases in consecutive series and to identify predisposing factors for intraoperative endplate injury. Overview of Literature Unintended endplate violation and subsequent cage subsidence is an intraoperative complication of extreme lateral interbody fusion (XLIF). It is still unknown whether it is derived from inexperienced surgical technique or patients' inherent problems. Methods Consecutive patients (n=102; mean age, 69.0±0.8 years) underwent XLIF at 201 levels at a single institute. Preoperative and immediately postoperative radiographs were compared and cases with intraoperative endplate injury were identified. Various parameters were reviewed in each patient and compared between the injury and no injury groups. Results Twenty one levels (10.4%) had signs of intraoperative endplate injury. The injury group had a significantly higher rate of females (p=0.002), lower bone mineral density (BMD) (p=0.02), higher rate of polyetheretherketone as cage material (p=0.04), and taller cage height (p=0.03) compared with the no injury group. Multivariate analysis indicated that a T-score of BMD as a negative (odds ratio, 0.52; 95% confidence interval, 0.27–0.93; p=0.03) and cage height as a positive (odds ratio, 1.84; 95% confidence interval, 1.01–3.17; p=0.03) were predisposing factors for intraoperative endplate injury. Conclusions Intraoperative endplate injury is correlated significantly with reduced BMD and taller cage height. Precise evaluation of bone quality and treatment for osteoporosis might be important and care should be taken not to choose excessively taller cage. PMID:27790319

  9. Intraoperative augmented reality for laparoscopic colorectal surgery by intraoperative near-infrared fluorescence imaging and optical coherence tomography.

    PubMed

    Cahill, R A; Mortensen, N J

    2010-08-01

    Advances in imaging quality and capability have been the major driver of the laparoscopic revolution that has dramatically impacted upon operative strategies and surgical patient care in recent years. Increasingly now the technological capacity is becoming available to supraselect or extend the useful clinical range of the electromagnetic spectrum beyond visible or white light. This has markedly broadened the intraprocedural optical information available at intraluminal endoscopy and there is likely to be considerable similar benefit for laparoscopy. Rather than narrow band or ultraviolet imaging however, it is the near infrared (NIR) spectrum that seems of most potential to exploit during intra-abdominal endoscopy in particular as this energy range is capable of penetrating relatively deeply into tissues such as the mesentery and bowel wall without inducing thermal damage due to heat dissipation or indeed the intracellular effects associated with higher energy, shorter wavelength energies. By incorporating the NIR spectrum alongside more conventional laparoscopic imaging, a greater appreciation of tissue architecture, character and quality is possible in particular with respect to lymphatic and vascular channel anatomy and flow dynamics and also real-time optical histology (by NIR optical coherence tomography). Such a facility may significantly aid critical intraoperative decision making during colorectal operations by informing the surgeon regarding the most biologically relevant lymphatic basin and lymph nodes for any target area of interest (especially important if considering tailored operative extent for colorectal neoplasia), the sufficiency and quality of arterial supply (and hence inform re the perfusion of stapled intestinal ends prior to reanastomosis) and perhaps even in situ pathological assessment. This article provides a state of art overview of the fascinating potential of this emergent technological capability. PMID:20802433

  10. Use of intraoperative computed tomography in complex craniofacial trauma: an example of on-table change in management.

    PubMed

    Morrison, Clinton S; Taylor, Helena O; Collins, Scott; Oyelese, Adetokunbo; Sullivan, Stephen R

    2014-12-01

    The primary goals in repairing complex craniofacial fractures are restoration of occlusion and mastication, and anatomic reconstruction of a symmetric facial skeleton. Failure to accomplish these goals may result in the need for secondary operations. Recognition of malreduction may not be appreciated until review of a postoperative computed tomographic (CT) scan. Intraoperative CT scanning enables immediate on-table assessment of reduction and fixation, allowing alteration of the surgical plan as needed. We report using intraoperative CT scanning while repairing a panfacial injury in which malreduction was appreciated intraoperatively and corrected. Intraoperative CT can be used to improve outcomes and quality of complex facial fracture repair. PMID:25383151

  11. Excimer versus Femtosecond Laser Assisted Penetrating Keratoplasty in Keratoconus and Fuchs Dystrophy: Intraoperative Pitfalls

    PubMed Central

    El-Husseiny, Moatasem; Seitz, Berthold; Langenbucher, Achim; Akhmedova, Elena; Szentmary, Nora; Hager, Tobias; Tsintarakis, Themistoklis; Janunts, Edgar

    2015-01-01

    Purpose. To assess the intraoperative results comparing two non-mechanical laser assisted penetrating keratoplasty approaches in keratoconus and Fuchs dystrophy. Patients and Methods. 68 patients (age 18 to 87 years) with keratoconus or Fuchs dystrophy were randomly distributed to 4 groups. 35 eyes with keratoconus and 33 eyes with Fuchs dystrophy were treated with either excimer laser ([Exc] groups I and II) or femtosecond laser-assisted ([FLAK] groups III and IV) penetrating keratoplasty. Main intraoperative outcome measures included intraoperative decentration, need for additional interrupted sutures, alignment of orientation markers, and intraocular positive pressure (vis a tergo). Results. Intraoperative recipient decentration occurred in 4 eyes of groups III/IV but in none of groups I/II. Additional interrupted sutures were not necessary in groups I/II but in 5 eyes of groups III/IV. Orientation markers were all aligned in groups I/II but were partly misaligned in 8 eyes of groups III/IV. Intraocular positive pressure grade was recognized in 12 eyes of groups I/II and in 19 eyes of groups III/IV. In particular, in group III, severe vis a tergo occurred in 8 eyes. Conclusions. Intraoperative decentration, misalignment of the donor in the recipient bed, and need for additional interrupted sutures as well as high percentage of severe intraocular positive pressure were predominantly present in the femtosecond laser in keratoconus eyes. PMID:26483974

  12. Intraoperative portal vein insulin assay combined with occlusion of the pancreas for complex pancreatogenous hypoglycemia

    PubMed Central

    Yang, Zhiying; Tan, Haidong; Sun, Yongliang; Si, Shuang; Xu, Li; Liu, Xiaolei; Liu, Liguo; Zhou, Wenying; Huang, Jia

    2016-01-01

    Abstract Intraoperative localization and confirmation of complete resection of the hypersecreting tissue are the 2 main challenges in the management of pancreatogenous hypoglycemia. Here, we report our experience with intraoperative portal vein insulin assay combined with occlusion of the pancreas in the management of pancreatogenous hypoglycemia. Clinical courses of 2 patients with biochemical evidence of a pancreatogenous hypoglycemia were studied. The preoperative diagnosis was multiple endocrine neoplasia 1 (MEN-1) and nesidioblastosis, respectively. Rapid intraoperative portal vein insulin assay combined with occlusion of the pancreas was used to localize and confirm complete excision of the hypersecreting tissue. Hypoglycemia was successfully treated in both the patients. In the MEN-1 patient, 2 small tumors in the head of pancreas were not resected, as they were deemed noninsulin secreting by intraoperative portal vein insulin assay, thus avoiding a total pancreatectomy. In the patient with nesidioblastosis, using intraoperative portal vein insulin assay combined with occlusion of the pancreas, an appropriate amount of pancreatic tissue was resected thereby avoiding recurrence and diabetes. This technique may be of particular value in patients with complex conditions such as MEN-1 and nesidioblastosis, to localize and achieve complete resection of hypersecreting pancreatic tissue. PMID:27367988

  13. Intraoperative microvascular Doppler ultrasonography in cerebral aneurysm surgery

    PubMed Central

    Stendel, R.; Pietila, T.; Al, H; Schilling, A.; Brock, M.

    2000-01-01

    OBJECTIVES—Outcome of surgical treatment of cerebral aneurysms may be severely compromised by local cerebral ischaemia or infarction resulting from the inadvertent occlusion of an adjacent vessel by the aneurysm clip, or by incomplete aneurysm closure. It is therefore mandatory to optimise clip placement in situ to reduce the complication rate. The present study was performed to investigate the reliability of intraoperative microvascular Doppler ultrasonography (MDU) in cerebral aneurysm surgery, and to assess the impact of this method on the surgical procedure itself.
METHODS—Seventy five patients (19 men, 56 women, mean age 54.8 years, range 22-84 years) with 90 saccular cerebral aneurysms were evaluated. Blood flow velocities in the aneurysmal sac and in the adjacent vessels were determined by MDU before and after aneurysm clipping. The findings of MDU were analysed and compared with those of visual inspection of the surgical site and of postoperative angiography. Analysis was also made of the cases in which the clip was repositioned due to MDU findings.
RESULTS—A relevant stenosis of an adjacent vessel induced by clip positioning that had escaped detection by visual inspection was identified by Doppler ultrasonography in 17 out of 90 (18.9%) aneurysms. In addition, Doppler ultrasound demonstrated a primarily unoccluded aneurysm in 11 out of 90 (12.2%) patients. The aneurysm clip was repositioned on the basis of the MDU findings in 26 out of 90 (28.8%) cases. In middle cerebral artery (MCA) aneurysms, the MDU results were relevant to the surgical procedure in 17out of 44 (38.6%) cases. Whereas with aneurysms of the anterior cerebral artery significant findings occurred in only five of 32cases (15.6%; p<0.05). The clip was repositioned on the basis of the MDU results in 18 out of 50 (36%) aneurysms in patients with subarachnoid haemorrhage (SAH) grade I-V compared with only eight out of 40 (20%) aneurysms in patients without SAH (p<0.05).

  14. A novel silicon array designed for intraoperative charged particle imaging.

    PubMed

    Tornai, Martin P; Patt, Bradley E; Iwanczyk, Jan S; Tull, Carolyn R; MacDonald, Lawrence R; Hoffman, Edward J

    2002-11-01

    A novel Si-PIN imaging array is under investigation for a charged particle (beta, positron, or alpha) sensitive intraoperative camera to be used for (residual) tumor identification during surgery. This class of collimator-less nuclear imaging device has a higher signal response for direct interactions than its scintillator-optical detector-based counterparts. Monte Carlo simulations with 635 keV betas were performed, yielding maximum and projected ranges of 1.64 and 0.55 mm in Si. Up to 90% of these betas were completely absorbed in the first 0.30 mm. Based on these results, 300 microm thick prototype Si detector arrays were designed in a 16 x 16 crossed-grid arrangement with 0.8 mm wide orthogonal strips on 1.0 mm pitch. A NIM- and CAMAC-based high-density data acquisition and processing system was used to collect the list mode data. The system was calibrated by comparisons of measured spectra to energy deposition simulations or by direct measurement of various >100 keV conversion electron or beta emitters. Mean electronic noise per strip was <3.6 keV FWHM at room temperature. When detecting positrons, which have an accompanying 511 keV annihilation background, the flood irradiated beta/gamma ratio was approximately 40, indicating that beta images could be made without the use of background rejection techniques. The intrinsic spatial resolution corresponds to the 1 x 1 mm2 pixel size, and measurements of beta emitting point and line sources yielded FWHM resolutions of 1.5 (lateral) and 2.5 mm (diagonal), respectively, with the larger widths due to particle range blurting effects. Deconvolution of the finite source size yielded intrinsic resolutions that corresponded to the image pixel size. Transmission images of circle and line phantoms with various hole sizes and pitch were resolved with either pure beta or positron irradiation without a background correction. This novel semiconductor imaging device facilitates high charged particle and low gamma sensitivity

  15. Comparison of Intraoperative C-Arm Fluoroscopy to Postoperative Radiographs in Operative Fracture Fixation.

    PubMed

    Horst, Taylor A; Mooney, James F; Hooker, Jennifer A; Barfield, William R; Glaser, John A

    2015-01-01

    The purpose of this study is to evaluate the differences between intraoperative C-arm images and postoperative plain film radiographs and the utility of each in assessing fracture fixation and determining postoperative management. Intraoperative and postoperative images with varying fracture types and locations were analyzed. C-arm images were compared to postoperative plain film radiographs for each treated fracture and reviewed by two orthopaedic surgeons. Image adequacy and quality for each radiograph were analyzed. The quality of reduction and fixation was also analyzed. Information was apparent on the postoperative radiographs, such that a reviewer felt that the postoperative treatment plan should change in 8.2% of cases. In the cases where treatment change was recommended, fracture gap, rotation, and angulation were found to be the strongest predictors. The ability of intraoperative and postoperative images to reflect fracture gap, rotation, and angulation may vary between images.

  16. Usefulness of Intraoperative Computer Tomography-Assisted Thoracoscopic Segmentectomy for Small-Sized Lung Cancer

    PubMed Central

    Nakano, Takayuki; Okamoto, Taku

    2015-01-01

    We report the case of a patient who had synchronous primary lung cancers in the left upper lobe (S1+2a, S1+2c), and underwent S1+2 segmentectomy. The lesion in S1+2c was non-palpable, and the location was confirmed using intraoperative computed tomography (CT) scan. After A1+2 and B1+2 had been cut, the intersegmental border was marked with clips and intraoperative CT was performed. After confirming the correct anatomical intersegmental border and the resection margin was sufficient, we cut the intersegmental border. The two lesions were both adenocarcinomas. Intraoperative CT was useful for confirming the locations of non-palpable lesions and anatomical intersegmental borders. PMID:26499906

  17. Intraoperative C-arm CT imaging in angular stable plate osteosynthesis of distal radius fractures.

    PubMed

    Mehling, I; Rittstieg, P; Mehling, A P; Küchle, R; Müller, L P; Rommens, P M

    2013-09-01

    The purpose of this study was to analyze the practicability and benefit of intraoperative C-arm computed tomography (CT) imaging in volar plate osteosynthesis of unstable distal radius fractures. During a 1 year period, intraoperative three dimensional (3D) imaging with the ARCADIS Orbic 3D was performed in addition to standard fluoroscopy in 51 cases. The volar angular stable plate oesteosyntheses were analyzed intraoperatively and, if necessary, improved immediately. The duration of the scan and radiation exposure dose were measured. On average, performance of the scan and analysis of the CT dataset took 6.7 minutes. In 31.3% of the surgeries a misplacement of screws was detected and correction was done immediately. C-arm CT imaging can easily be integrated in the normal course of surgery. As a complement to the standard 2D-fluoroscopy, the C-arm CT is a useful tool to evaluate the quality of osteosynthesis.

  18. Intraoperative Optical Coherence Tomography Imaging and Assessment of the Macula During Cataract Surgery: A Novel Technique.

    PubMed

    Tripathy, Koushik; Chawla, Rohan; Kumawat, Babulal; Sharma, Yog Raj

    2016-09-01

    The authors describe a technique to qualitatively analyze the posterior segment during cataract surgery using intraoperative optical coherence tomography (iOCT). Macular iOCT can be done before and after intraocular lens implantation after the media is rendered clear following phacoemulsification. A handheld irrigating planoconcave contact lens is placed over the cornea with the operating microscope in retroillumination mode. After focusing the microscope and upon getting a clear view of the posterior segment, iOCT is switched on, centered at the macula, and focused. This technique enables the surgeon to intraoperatively analyze and document the macular morphology and vitreoretinal interface. Potential uses of this technique include intraoperative decision-making regarding concurrent use of anti-vascular endothelial growth factor agents or steroids in cases with dense cataracts where preoperative OCT is difficult. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:846-847.]. PMID:27631481

  19. Intraoperative assessment of margins in breast conserving therapy: a systematic review.

    PubMed

    Butler-Henderson, Kerryn; Lee, Andy H; Price, Roger I; Waring, Kaylene

    2014-04-01

    Approximately one quarter of patients undergoing breast conserving therapy for breast cancer will require a second operation to achieve adequate clearance of the margins. A number of techniques to assess margins intraoperatively have been reported. This systematic review examines current intraoperative methods for assessing margin status. The final pathology status, statistical measures including accuracy of tumour margin assessment, average time impact on the procedure and second operation rate, were used as criteria for comparison between studies. Although pathological methods, such as frozen section and imprint cytology performed well, they added on average 20-30 min to operation times. An ultrasound probe allows accurate examination of the margins and delivers results in a timely manner, yet it has a limited role with DCIS where calcification is present and in multifocal cancer. Further research is required in other intraoperative margin assessment techniques, such as mammography, radiofrequency spectroscopy and optical coherence tomography.

  20. Quantitative Wavelength Analysis and Image Classification for Intraoperative Cancer Diagnosis with Hyperspectral Imaging

    PubMed Central

    Lu, Guolan; Qin, Xulei; Wang, Dongsheng; Chen, Zhuo Georgia; Fei, Baowei

    2015-01-01

    Complete surgical removal of tumor tissue is essential for postoperative prognosis after surgery. Intraoperative tumor imaging and visualization are an important step in aiding surgeons to evaluate and resect tumor tissue in real time, thus enabling more complete resection of diseased tissue and better conservation of healthy tissue. As an emerging modality, hyperspectral imaging (HSI) holds great potential for comprehensive and objective intraoperative cancer assessment. In this paper, we explored the possibility of intraoperative tumor detection and visualization during surgery using HSI in the wavelength range of 450 nm - 900 nm in an animal experiment. We proposed a new algorithm for glare removal and cancer detection on surgical hyperspectral images, and detected the tumor margins in five mice with an average sensitivity and specificity of 94.4% and 98.3%, respectively. The hyperspectral imaging and quantification method have the potential to provide an innovative tool for image-guided surgery. PMID:26523083

  1. Quantitative wavelength analysis and image classification for intraoperative cancer diagnosis with hyperspectral imaging

    NASA Astrophysics Data System (ADS)

    Lu, Guolan; Qin, Xulei; Wang, Dongsheng; Chen, Zhuo Georgia; Fei, Baowei

    2015-03-01

    Complete surgical removal of tumor tissue is essential for postoperative prognosis after surgery. Intraoperative tumor imaging and visualization are an important step in aiding surgeons to evaluate and resect tumor tissue in real time, thus enabling more complete resection of diseased tissue and better conservation of healthy tissue. As an emerging modality, hyperspectral imaging (HSI) holds great potential for comprehensive and objective intraoperative cancer assessment. In this paper, we explored the possibility of intraoperative tumor detection and visualization during surgery using HSI in the wavelength range of 450 nm - 900 nm in an animal experiment. We proposed a new algorithm for glare removal and cancer detection on surgical hyperspectral images, and detected the tumor margins in five mice with an average sensitivity and specificity of 94.4% and 98.3%, respectively. The hyperspectral imaging and quantification method have the potential to provide an innovative tool for image-guided surgery.

  2. Comparison of tissue Doppler dynamics with Doppler flow in evaluating left atrial appendage function by transesophageal echocardiography in prehypertensive and hypertensive patients.

    PubMed

    Tenekecioğlu, Erhan; Karabulut, Aziz; Yilmaz, Mustafa

    2010-07-01

    Increased blood pressure (BP) is associated with an increase in cardiovascular mortality and morbidity. We aimed to analyze the effect of increased BP onto the function of left atrial appendage (LAA) in early stages of hypertension. Transesophageal echocardiography (TEE) was prospectively performed to assess LAA functions in 120 patients with increased BP, and in 58 normotensive subjects without cardiovascular disease. Patients with increased BP were divided according to Joint National Committee VII (JNC VII) report: prehypertensive, stage-1 hypertensive and stage-2 hypertensive patients. During TEE, LAA late-emptying velocities (LAAEV) were significantly reduced only in stage-2 hypertensives as compared with control group (P < 0.001). In contrast, LAA late-contracting velocity (LAA TDI-D2) was significantly reduced in prehypertensive,stage-1 hypertensive and stage-2 hypertensive patients, when compared with control group (P < 0.05, P < 0.001, and P < 0.001, respectively). The LAA maximal areas were increased significantly only in stage-2 hypertensive patients when compared with control group (P < 0.05). During TEE, left atrial spontaneous echocardiographic contrast was found in 2 of 36 patients in prehypertension group, in 7 of 40 patients in stage-1 hypertension group, and in 10 of 44 patients in stage-2 hypertension group. Left atrial thrombi were observed in 3 (6.8%) patients of stage-2 hypertension group. In conclusion, in patients with untreated prehypertension and hypertension, elevation of afterload imposed on left atrium involved both left atrium and LAA, resulting in impairment of the LAA function. Tissue Doppler imaging (TDI) enables the detection of this functional impairment in early stages of hypertension, even in prehypertensive phase, when compared with conventional Doppler flow measurement of the LAA. Even in prehypertensive phase, BP should be decreased to normal levels to prevent the LAA dysfunction. PMID:20345441

  3. Intraoperative detection of radiolabeled compounds using a hand held gamma probe

    NASA Astrophysics Data System (ADS)

    Ricard, Marcel

    2001-02-01

    Scintillation cameras in Nuclear Medicine allow external detection of cancerous lesions after administration of a specific radiopharmaceutical to the patient. In some particular cases the affinity of the tracer is sufficient to consider the use of an intraoperative probe which enables the surgeon to identify radioactive tissues. A radiopharmaceutical consists of a radioisotope bound to a carrier molecule. The radioactive emissions must represent certain criteria in terms of half-life and energy to be detected during an operation. In the field of intraoperative detection radionuclides like 99mTc, 111In, 125I and 131I fall into this category. Their energy, which ranges from some 10 to 364 keV, cannot be properly detected by a single type of detector. Two technologies have been developed to yield detectors which are handy and sufficiently sensitive: semiconductor CdTe or CdZnTe to detect low energies and scintillator CsI(Tl) for higher energies. Today the intraoperative detection has been evaluated in the case of several pathologies such as osteoid osteoma, colorectal cancer, neuroblastoma, reoperation of differentiated thyroid carcinoma and localization of sentinel node in breast cancer and cutaneous melanoma. Obviously, the results obtained are not comparable from one indication to the other. Nevertheless, the surgeons have noted a considerable advantage in using the intraoperative probe in the case of neuroblastoma and thyroid surgery, especially when the reoperation is difficult or the localizations are ectopic or unusual. As regards the sentinel node, this concept represents a major new opportunity in the field of intraoperative detection and the results actually reported in the literature demonstrate that, when it is detected, elective node excision renders the staging of the disease more accurate. In conclusion, intraoperative detection supplies the surgeon with additional knowledge to be used in correlation with the patient's medical history.

  4. The impact of use of an intraoperative margin assessment device on re-excision rates.

    PubMed

    Sebastian, Molly; Akbari, Stephanie; Anglin, Beth; Lin, Erin H; Police, Alice M

    2015-01-01

    Historically there has been a high rate of surgical interventions to obtain clear margins for breast cancer patients undergoing breast conserving local therapy. An intraoperative margin assessment tool (MarginProbe) has been approved for use in the US since 2013. This study is the first compilation of data from routine use of the device, to assess the impact of device utilization on re-excision rates. We present a retrospective, observational, review from groups of consecutive patients, before and after the implementation of intraoperative use of the device during lumpectomy procedures. Lesions were localized by standard methods. The intraoperative margin assessment device was used on all circumferential margins of the main specimen, but not on any additional shavings. A positive reading by the device led to an additional shaving of the corresponding cavity location. Specimens were also, when feasible, imaged intra-operatively by X-ray, and additional shavings were taken if needed based on clinical assessment. For each surgeon, historical re-excision rates were established based on a consecutive set of patients from a time period proximal to initiation of use of the device. From March 2013 to April 2014 the device was routinely used by 4 surgeons in 3 centers. In total, 165 cases lumpectomy cases were performed. Positive margins resulted in additional re-excision procedures in 9.7% (16/165) of the cases. The corresponding historical set from 2012 and 2013 consisted of 186 Lumpectomy cases, in which additional re-excision procedures were performed in 25.8% (48/186) of the cases. The reduction in the rate of re-excision procedures was significant 62% (P < 0.0001). Use of an intraoperative margin assessment device contributes to achieving clear margins and reducing re-excision procedures. As in some cases positive margins were found on shavings, future studies of interest may include an analysis of the effect of using the device on the shavings intra-operatively

  5. Clinical Utility and Limitations of Intraoperative Monitoring of Visual Evoked Potentials

    PubMed Central

    Luo, Yeda; Regli, Luca; Bozinov, Oliver; Sarnthein, Johannes

    2015-01-01

    Objectives During surgeries that put the visual pathway at risk of injury, continuous monitoring of the visual function is desirable. However, the intraoperative monitoring of the visual evoked potential (VEP) is not yet widely used. We evaluate here the clinical utility of intraoperative VEP monitoring. Methods We analyzed retrospectively 46 consecutive surgeries in 2011-2013. High luminance stimulating devices delivered flash stimuli on the closed eyelid during intravenous anesthesia. We monitored VEP features N75 and P100 and took patients' preoperative and postoperative visual function from patient charts. Postoperative ophthalmologic workup was performed in 25 (54%) patients and preoperatively in 28 (61%) patients. Results VEP recordings were feasible in 62 of 85 eyes (73%) in 46 patients. All 23 eyes without VEP had impaired vision. During surgery, VEPs remained stable throughout surgery in 50 eyes. In 44 of these, visual function did not deteriorate and three patients (6 eyes) developed hemianopia. VEP decreased transiently in 10 eyes and visual function of all was preserved. VEPs were lost permanently in 2 eyes in two patients without new postoperative visual impairment. Conclusions Satisfactory intraoperative VEP monitoring was feasible in all patients except in those with severe visual impairment. Preservation of VEPs predicted preserved visual function. During resection of lesions in the visual cortex, VEP monitoring could not detect new major visual field defects due to injury in the posterior visual pathway. Intraoperative VEPs were sensitive enough to detect vascular damage during aneurysm clipping and mechanical manipulation of the anterior visual pathway in an early reversible stage. Intraoperative VEP monitoring influenced surgical decisions in selected patients and proved to be a useful supplement to the toolbox of intraoperative neurophysiological monitoring. PMID:25803287

  6. Visual intraoperative estimation of cup and stem position is not reliable in minimally invasive hip arthroplasty

    PubMed Central

    Woerner, Michael; Sendtner, Ernst; Springorum, Robert; Craiovan, Benjamin; Worlicek, Michael; Renkawitz, Tobias; Grifka, Joachim; Weber, Markus

    2016-01-01

    Background and purpose In hip arthroplasty, acetabular inclination and anteversion—and also femoral stem torsion—are generally assessed by eye intraoperatively. We assessed whether visual estimation of cup and stem position is reliable. Patients and methods In the course of a subgroup analysis of a prospective clinical trial, 65 patients underwent cementless hip arthroplasty using a minimally invasive anterolateral approach in lateral decubitus position. Altogether, 4 experienced surgeons assessed cup position intraoperatively according to the operative definition by Murray in the anterior pelvic plane and stem torsion in relation to the femoral condylar plane. Inclination, anteversion, and stem torsion were measured blind postoperatively on 3D-CT and compared to intraoperative results. Results The mean difference between the 3D-CT results and intraoperative estimations by eye was −4.9° (−18 to 8.7) for inclination, 9.7° (−16 to 41) for anteversion, and −7.3° (−34 to 15) for stem torsion. We found an overestimation of > 5° for cup inclination in 32 hips, an overestimation of > 5° for stem torsion in 40 hips, and an underestimation < 5° for cup anteversion in 42 hips. The level of professional experience and patient characteristics had no clinically relevant effect on the accuracy of estimation by eye. Altogether, 46 stems were located outside the native norm of 10–20° as defined by Tönnis, measured on 3D-CT. Interpretation Even an experienced surgeon’s intraoperative estimation of cup and stem position by eye is not reliable compared to 3D-CT in minimally invasive THA. The use of mechanical insertion jigs, intraoperative fluoroscopy, or imageless navigation is recommended for correct implant insertion. PMID:26848628

  7. Intra-operative awareness in children and post-traumatic stress disorder.

    PubMed

    Lopez, U; Habre, W; Van der Linden, M; Iselin-Chaves, I A

    2008-05-01

    Adults who experience intra-operative awareness can develop disturbing long-lasting after-effects, such as daytime anxiety, sleep disturbances, nightmares, flashbacks and, in the worst case, a post-traumatic stress disorder (PTSD). It is unknown whether intra-operative awareness has a similar psychological impact in children. We designed the present study in order to evaluate the incidence of psychological symptoms in children who had either confirmed or possible intra-operative awareness. Attempts were made to locate 11 children who had been identified in a previous study, approximately 1 year following their experience. A PTSD questionnaire was administered to the children and their parents in order to detect any long-term or short-term psychological symptoms (the 1-month postoperative data were evaluated retrospectively). Factors believed to be associated with PTSD, such as intra-operative perceptions, the children's temperament and cognitive strategies, and the parents' coping strategies, were also analysed. Seven children were successfully located and interviewed and no short or long-term psychological symptoms were identified. None of them offered negative appraisals of the traumatic event and none had displayed dysfunctional behaviour or cognitive strategies. Thus, none of them had developed a PTSD syndrome. In contrast with what has been reported in adults, these children claimed not to have experienced major pain, terror or helplessness during their surgery. Despite the small sample size, the results of the present study suggest that children suffer less psychological sequelae than adults following intra-operative awareness. This may be due to the fact that the children reported less frightening intra-operative sensations as compared with the adults, and had less understanding of the anaesthesia procedure, and this may have influenced their appraisal of their awareness and protected them from the full impact of this potentially traumatic experience. PMID

  8. Safety, effectiveness and economic evaluation of intra-operative radiation therapy: a systematic review

    PubMed Central

    Najafipour, Farshad; Hamouzadeh, Pejman; Arabloo, Jalal; Mobinizadeh, Mohammadreza; Norouzi, Amir

    2015-01-01

    Background: Intra-operative radiation therapy (IORT) is the transfer of a single large radiation dose to the tumor bed during surgery with the final goal of improving regional tumor control. This study aimed to investigate the safety, effectiveness and economic evaluation of intra-operative radiation therapy. Methods: The scientific literature was searched in the main biomedical databases (Centre for Reviews and Dissemination, Cochrane Library and PubMed) up to March 2014. Two independent reviewers selected the papers based on pre-established inclusion criteria, with any disagreements being resolved by consensus. Data were then extracted and summarized in a structured form. Results from studies were analyzed and discussed within a descriptive synthesis. Results: Sixteen studies met the inclusion criteria. It seems that outcomes from using intraoperative radiation therapy can be considered in various kinds of cancers like breast, pancreatic and colorectal cancers. The application of this method may provide significant survival increase only for colorectal cancer, but this increase was not significant for other types of cancer. This technology had low complications; and it is relatively safe. Using intra-operative radiation therapy could potentially be accounted as a cost-effective strategy for controlling and managing breast cancer. Conclusion: According to the existing evidences, that are the highest medical evidences for using intra-operative radiation therapy, one can generally conclude that intra-operative radiation therapy is considered as a relatively safe and cost-effective method for managing early-stage breast cancer and it can significantly increase the survival of patients with colorectal cancer. Also, the results of this study have policy implications with respect to the reimbursement of this technology. PMID:26793649

  9. Donor disc attachment assessment with intraoperative spectral optical coherence tomography during descemet stripping automated endothelial keratoplasty

    PubMed Central

    Wylegala, Edward; Nowinska, Anna K; Wroblewska-Czajka, Ewa; Janiszewska, Dominika

    2013-01-01

    Optical coherence tomography has already been proven to be useful for pre- and post-surgical anterior eye segment assessment, especially in lamellar keratoplasty procedures. There is no evidence for intraoperative usefulness of optical coherence tomography (OCT). We present a case report of the intraoperative donor disc attachment assessment with spectral-domain optical coherence tomography in case of Descemet stripping automated endothelial keratoplasty (DSAEK) surgery combined with corneal incisions. The effectiveness of the performed corneal stab incisions was visualized directly by OCT scan analysis. OCT assisted DSAEK allows the assessment of the accuracy of the Descemet stripping and donor disc attachment. PMID:24104711

  10. Modern intraoperative imaging modalities for the vascular neurosurgeon treating intracerebral hemorrhage.

    PubMed

    Goren, Oded; Monteith, Stephen J; Hadani, Moshe; Bakon, Mati; Harnof, Sagi

    2013-05-01

    This paper reviews the current intraoperative imaging tools that are available to assist neurosurgeons in the treatment of intracerebral hemorrhage (ICH). This review shares the authors' experience with each modality and discusses the advantages, potential limitations, and disadvantages of each. Surgery for ICH is directed at blood clot removal, reduction of intracranial pressure, and minimization of secondary damage associated with hematoma breakdown products. For effective occlusion and safe obliteration of vascular anomalies associated with ICH, vascular neurosurgeons today require a thorough understanding of the various intraoperative imaging modalities available for obtaining real-time information. Use of one or more of these modalities may improve the surgeon's confidence during the procedure, the patient's safety during surgery, and surgical outcome. The modern techniques discussed include 1) indocyanine green-based video angiography, which provides real-time information based on high-quality images showing the residual filling of vascular pathological entities and the patency of blood vessels of any size in the surgical field; and 2) intraoperative angiography, which remains the gold standard intraoperative diagnostic test in the surgical management of cerebral aneurysms and arteriovenous malformations. Hybrid procedures, providing multimodality image-guided surgeries and combining endovascular with microsurgical strategies within the same surgical session, have become feasible and safe. Microdoppler is a safe, noninvasive, and reliable technique for evaluation of hemodynamics of vessels in the surgical field, with the advantage of ease of use. Intraoperative MRI provides an effective navigation tool for cavernoma surgery, in addition to assessing the extent of resection during the procedure. Intraoperative CT scanning has the advantage of very high sensitivity to acute bleeding, thereby assisting in the confirmation of the extent of hematoma evacuation and

  11. Cardiopulmonary Bypass and Extracorporeal Life Support for Emergent Intraoperative Thoracic Situations.

    PubMed

    Machuca, Tiago N; Cypel, Marcelo; Keshavjee, Shaf

    2015-08-01

    Intraoperative thoracic surgical catastrophes may require extracorporeal circulation modes to support the patient while the appropriate repair is made. Teamwork is key and, given the evidence supporting better performance with the use of simulation and surgical-crisis checklists, their use should be encouraged. Anticipation is another important factor because the results of intrathoracic malignancy resection are clearly superior in the setting of planned cardiopulmonary support. In addition, familiarity with the different modes of support that are currently available can direct the decision-making process toward the best option to facilitate resolution of the intraoperative catastrophe with the least related morbidity. PMID:26210928

  12. Infratentorial benign cystic meningioma mimicking a hemangioblastoma radiologically and a pilocytic astrocytoma intraoperatively: a case report

    PubMed Central

    2013-01-01

    Introduction Cystic meningiomas are rare variants of meningiomas; they can pose a radiological diagnostic dilemma. Case presentation We present a rare case of a 30-year-old Chinese woman with a histopathological diagnosis of infratentorial cystic meningioma (World Health Organization Grade 1) in which the features in imaging modalities were suggestive of a hemangioblastoma. Intraoperatively, however, the gross macroscopic features were more in keeping with a pilocytic astrocytoma. Conclusion In benign cystic meningiomas, particularly the infratentorial variety, radiological findings utilizing the various imaging modalities and intraoperative impressions may not be reflective of or in keeping with the final histopathological diagnosis. PMID:23537099

  13. Intraoperative imaging and fluorescence image guidance in oncologic surgery using a wearable fluorescence goggle system

    NASA Astrophysics Data System (ADS)

    Mondal, Suman B.; Gao, Shengkui; Zhu, Nan; Liu, Yang; Sudlow, Gail P.; Akers, Walter J.; Liang, Rongguang; Gruev, Viktor; Achilefu, Samuel

    2014-03-01

    We have developed a wearable, fluorescence goggle based system for intraoperative imaging of tumors and image guidance in oncologic surgery. Our system can detect fluorescence from cancer selective near infra-red (NIR) contrast agent, facilitating intraoperative visualization of surgical margins and tumors otherwise not apparent to the surgeon. The fluorescence information is displayed directly to the head mounted display (HMD) of the surgeon in real time, allowing unhindered surgical procedure under image guidance. This system has the potential of improving surgical outcomes in oncologic surgery and reduce the chances of cancer recurrence.

  14. Analysis of endocardial acceleration during intraoperative optimization of cardiac resynchronization therapy

    PubMed Central

    Hernandez, Alfredo I.; Ziglio, Filippo; Amblard, Amel; Senhadji, Lotfi; Leclercq, Christophe

    2013-01-01

    Cardiac resynchronization therapy (CRT) is the therapy of choice for selected patients suffering from drug-refractory congestive heart failure and presenting an interventricular desynchronization. CRT is delivered by an implantable biventricular pacemaker, which stimulates the right atrium and both ventricles at specific timings. The optimization and personalization of this therapy requires to quantify both the electrical and the mechanical cardiac functions during the intraoperative and postoperative phases. The objective of this paper is to evaluate the feasibility of the calculation of features extracted from endocardial acceleration (EA) signals and the potential utility of these features for the intraoperative optimization of CRT. Endocardial intraoperative data from one patient are analyzed for 33 different pacing configurations, including changes in the atrio-ventricular and inter-ventricular delays and different ventricular stimulation sites. The main EA features are extracted for each pacing configuration and analyzed so as to estimate the intra-configuration and inter-configuration variability. Results show the feasibility of the proposed approach and suggest the potential utility of EA for intraoperative monitoring of the cardiac function and defining optimal, adaptive pacing configurations. PMID:24111356

  15. Clinical toxicity of peripheral nerve to intraoperative radiotherapy in a canine model

    SciTech Connect

    Johnstone, P.A.S.; DeLuca, A.M.; Terrill, R.E.

    1995-07-15

    The clinical late effects of intraoperative radiotherapy (IORT) on peripheral nerve were investigated in a foxhound model. Between 1982 and 1987, 40 animals underwent laparotomy with intraoperative radiotherapy of doses from 0-75 Gy administered to the right lumbosacral plexus. Subsequently, all animals were monitored closely and sacrificed to assess clinical effects to peripheral nerve. This analysis reports final clinical results of all animals, with follow-up to 5 years. All animals treated with {>=} 25 Gy developed ipsilateral neuropathy. An inverse relationship was noted between intraoperative radiotherapy dose and time to neuropathy, with an effective dose for 50% paralysis (ED{sub 50}) of 17.2 Gy. One of the animals treated with 15 Gy IORT developed paralysis, after a much longer latency than the other animals. Doses of 15 Gy delivered intraoperatively may be accompanied by peripheral neuropathy with long-term follow-up. This threshold is less than that reported with shorter follow-up. The value of ED{sub 50} determined here is in keeping with data from other animal trials, and from clinical trials in humans. 11 refs., 2 figs.

  16. Numerical characterization of intraoperative and chronic electrodes in deep brain stimulation

    PubMed Central

    Paffi, Alessandra; Camera, Francesca; Apollonio, Francesca; d’Inzeo, Guglielmo; Liberti, Micaela

    2015-01-01

    An intraoperative electrode (microelectrode) is used in the deep brain stimulation (DBS) technique to pinpoint the brain target and to choose the best parameters for the electrical stimulus. However, when the intraoperative electrode is replaced with the chronic one (macroelectrode), the observed effects do not always coincide with predictions. To investigate the causes of such discrepancies, a 3D model of the basal ganglia has been considered and realistic models of both intraoperative and chronic electrodes have been developed and numerically solved. Results of simulations of the electric potential (V) and the activating function (AF) along neuronal fibers show that the different geometries and sizes of the two electrodes do not change the distributions and polarities of these functions, but rather the amplitudes. This effect is similar to the one produced by the presence of different tissue layers (edema or glial tissue) in the peri-electrode space. Conversely, an inaccurate positioning of the chronic electrode with respect to the intraoperative one (electric centers not coincident) may induce a completely different electric stimulation in some groups of fibers. PMID:25745397

  17. Preoperative and Intraoperative Evaluation of the Eustachian Tube in Chronic Ear Surgery.

    PubMed

    Tarabichi, Muaaz; Kapadia, Mustafa

    2016-10-01

    This article discusses the authors' approach to the assessment of the eustachian tube using opening pressure measurement, endoscopic assessment of the protympanic segment of the eustachian tube, and Valsalva computed tomography. A possible algorithm for the evaluation of eustachian tube obstructive disorders is detailed both preoperatively and intraoperatively. PMID:27468635

  18. Comparing the dosimetric characteristics of the electron beam from dedicated intraoperative and conventional radiotherapy accelerators.

    PubMed

    Baghani, Hamid Reza; Aghamiri, Seyed Mahmoud Reza; Mahdavi, Seyed Rabi; Akbari, Mohammad Esmail; Mirzaei, Hamid Reza

    2015-01-01

    The specific design of the mobile dedicated intraoperative radiotherapy (IORT) accelerators and different electron beam collimation system can change the dosimetric characteristics of electron beam with respect to the conventional accelerators. The aim of this study is to measure and compare the dosimetric characteristics of electron beam produced by intraoperative and conventional radiotherapy accelerators. To this end, percentage depth dose along clinical axis (PDD), transverse dose profile (TDP), and output factor of LIAC IORT and Varian 2100C/D conventional radiotherapy accelerators were measured and compared. TDPs were recorded at depth of maximum dose. The results of this work showed that depths of maximum dose, R90, R50, and RP for LIAC beam are lower than those of Varian beam. Furthermore, for all energies, surface doses related to the LIAC beam are substantially higher than those of Varian beam. The symmetry and flatness of LIAC beam profiles are more desirable compared to the Varian ones. Contrary to Varian accelerator, output factor of LIAC beam substantially increases with a decrease in the size of the applicator. Dosimetric characteristics of beveled IORT applicators along clinical axis were different from those of the flat ones. From these results, it can be concluded that dosimetric characteristics of intraoperative electron beam are substantially different from those of conventional clinical electron beam. The dosimetric characteristics of the LIAC electron beam make it a useful tool for intraoperative radiotherapy purposes.

  19. [Intraoperative monitoring of motor cranial nerves in operations of the neck and cranial base].

    PubMed

    Maurer, J; Pelster, H; Mann, W

    1994-11-01

    Intraoperative monitoring of cranial nerves is performed to minimize postoperative cranial nerve dysfunction. We performed electrophysiological monitoring of motor cranial nerves with a NIM 2 unit from Xomed Treace and a patient multiplexer developed in our clinic. This multiplexer allows simultaneous monitoring of 4 cranial nerves and is additionally equipped with a bipolar stimulation mode. This intraoperative monitoring was employed during 102 skull base operations. Of these 102 operations, 44 were acoustic neuroma removals by translabyrinthine approach and 36 by a middle fossa approach. Various operations including removal of tumours of the jugular foramen and the infratemporal fossa were performed in the remaining 22 patients. The facial nerve, being the most frequently monitored nerve, was evaluated both pre- and intraoperatively. Electrophysiologic data were evaluated with respect to their predictive value for postoperative facial nerve function. The relative per cent decrease in amplitude of the EMG after resection compared to that observed before resection seems to be of some predictive value for postoperative facial nerve function. A 50-60% decrease or more is associated with an increase in the House classification. Intraoperative monitoring is a useful tool in skull base surgery allowing for safer and faster identification of motor nerves in pathologic anatomic conditions. It allows the surgeon a degree of comfort by providing immediate information regarding the status of the nerve. It may also improve post-operative nerve function and shorten operating time. Additionally, neuromonitoring provides some information about expected postoperative facial nerve function.

  20. Intraoperative measurement of graft blood flow--a necessity in liver transplantation.

    PubMed

    Rasmussen, A; Hjortrup, A; Kirkegaard, P

    1997-01-01

    Portal venous and hepatic arterial flow was measured intraoperatively in the 70 most recent patients undergoing liver transplantation in our institution. Impaired graft flow due to vascular abnormalities was detected in six patients. One patient suffered from arterial steal due to stenosis of the recipient celiac trunk with blood shunting from the hepatic to the splenic artery. Ligation of the recipient hepatic artery restored the arterial graft flow. In two patients we found reduced portal venous flow due to large portosystemic collaterals. The collaterals accountable for the impaired portal flow were identified and ligated, which restored portal venous graft flow. Excessive sensitivity of the portal venous flow to the position of the graft was found in a 6-month-old boy. Portal venous flow varied considerably, depending upon the position of the graft, and intraoperative flow measurement allowed the best position of the graft to be identified. Two patients developed arterial thrombosis in the early postoperative course. Immediate laparatomy with thrombectomy resulted in good, palpable pulsation in the graft artery in both patients. Intraoperative flow measurement demonstrated satisfactory arterial flow in one patient, whereas there was no net flow in the other patient's graft artery. Pulsation in this patient was caused by blood oscillating in and out of the liver. In conclusion, we find that causes of primary graft dysfunction due to technically flawed reperfusion of the graft can be identified and alleviated by intraoperative measurement of the flow in the graft vessels.

  1. Dissociation of Subtraction and Multiplication in the Right Parietal Cortex: Evidence from Intraoperative Cortical Electrostimulation

    ERIC Educational Resources Information Center

    Yu, Xiaodan; Chen, Chuansheng; Pu, Song; Wu, Chenxing; Li, Yongnian; Jiang, Tao; Zhou, Xinlin

    2011-01-01

    Previous research has consistently shown that the left parietal cortex is critical for numerical processing, but the role of the right parietal lobe has been much less clear. This study used the intraoperative cortical electrical stimulation approach to investigate neural dissociation in the right parietal cortex for subtraction and…

  2. A review of brain retraction and recommendations for minimizing intraoperative brain injury.

    PubMed

    Andrews, R J; Bringas, J R

    1993-12-01

    Brain retraction is required for adequate exposure during many intracranial procedures. The incidence of contusion or infarction from overzealous brain retraction is probably 10% in cranial base procedures and 5% in intracranial aneurysm procedures. The literature on brain retraction injury is reviewed, with particular attention to the use of intermittent retraction. Intraoperative monitoring techniques--brain electrical activity, cerebral blood flow, and brain retraction pressure--are evaluated. Various intraoperative interventions--anesthetic agents, positioning, cerebrospinal fluid drainage, operative approaches involving bone resection or osteotomy, hyperventilation, induced hypotension, induced hypertension, mannitol, and nimodipine--are assessed with regard to their effects on brain retraction. Because brain retraction injury, like other forms of focal cerebral ischemia, is multifactorial in its origins, a multifaceted approach probably will be most advantageous in minimizing retraction injury. Recommendations for operative management of cases involving significant brain retraction are made. These recommendations optimize the following goals: anesthesia and metabolic depression, improvement in cerebral blood flow and calcium channel blockade, intraoperative monitoring, and operative exposure and retraction efficacy. Through a combination of judicious retraction, appropriate anesthetic and pharmacological management, and aggressive intraoperative monitoring, brain retraction should become a much less common source of morbidity in the future.

  3. Excision of nasopharyngeal angiofibroma facilitated by intra-operative 3D-image guidance.

    PubMed

    Murray, A; Falconer, M; McGarry, G W

    2000-04-01

    The latest 3D-image guidance systems to assist surgeons have greatly improved over earlier models. We describe the use of an optical infra-red system to assist in the removal of a juvenile nasopharyngeal angiofibroma. The specific advantages of this system in pre-operative assessment, intra-operative evaluation and excision of the angiofibroma are discussed.

  4. Can intraoperative neurophysiologic monitoring during cervical spine decompression predict post-operative segmental C5 palsy?

    PubMed Central

    Blaskiewicz, Donald J.; Ramirez, Bertha; Zhang, Richard

    2016-01-01

    Background C5 nerve root palsy is a known complication after cervical laminectomy or laminoplasty, characterized by weakness of the deltoid and bicep brachii muscles. The efficacy of intraoperative monitoring of these muscles is currently unclear. In the current prospective study, intraoperative monitoring through somatosensory (SSEPs), motor (TcMEPs) evoked potentials and real-time electromyography activity (EMG) were analyzed for their ability to detect or prevent deltoid muscle weakness after surgery. Methods One hundred consecutive patients undergoing laminectomy/laminoplasty with or without fusion were enrolled. Intraoperative SSEPs, TcMEPs and EMGs from each patient were studied and analyzed. Results Intraoperative EMG activity of the C5 nerve root was detected in 34 cases, 10 of which demonstrated a sustained and repetitive EMG activity lasting 5 or more minutes. Paresis of the unilateral deltoid muscle developed in 5 patients, all from the group with sustained C5 EMG activity. None of the patients with weakness of deltoid muscle after surgery demonstrated any abnormal change in TcMEP or SSEP. Conclusions Real-time EMG recordings were sensitive to C5 nerve root irritation, whilst SSEPs and TcMEPs were not. Sustained EMG activity of the C5 nerve root during surgery is a possible warning sign of irritation or injury to the nerve. PMID:27757428

  5. Intraoperative MRI: the challenges of providing a safe environment for patients and personnel.

    PubMed

    Porteous, Joan

    2014-06-01

    Real-time intraoperative magnetic resonance imaging (iMRI) provides a tremendous benefit to patients undergoing brain tumour surgery. This paper will discuss the Winnipeg Health Sciences Centre's experience implementing a new iMRI program in a new neurosurgery operating room suite. It will review MRI technology and discuss related safety considerations for patients and personnel.

  6. Impact of Intraoperative Acetaminophen Administration on Postoperative Opioid Consumption in Patients Undergoing Hip or Knee Replacement

    PubMed Central

    Vaughan, Cathy; McGee, Ann

    2014-01-01

    Abstract Background: Opioid utilization for acute pain has been associated with numerous adverse events, potentially resulting in longer inpatient stays and increased costs. Objective: To examine the effect of intravenous (IV) acetaminophen administered intraoperatively on postoperative opioid consumption in adult subjects who underwent hip or knee replacement. Methods: This retrospective cohort study evaluated postoperative opioid consumption in 176 randomly selected adult subjects who underwent hip or knee replacement at Duke University Hospital (DUH). Eighty-eight subjects received a single, intraoperative, 1 g dose of IV acetaminophen. The other subjects did not receive any IV acetaminophen. This study evaluated mean opioid consumption (in oral morphine equivalents) during the 24-hour postoperative period in the 2 groups. Other endpoints included length of stay in the postanesthesia care unit (PACU), incidence of oversedation, need for acute opioid reversal, and adjunctive analgesic utilization. Results: Subjects who were given a single dose of intraoperative acetaminophen received an average of 149.3 mg of oral morphine equivalents during the 24 hours following surgery compared to 147.2 mg in participants who were not exposed to IV acetaminophen (P = .904). The difference in average length of PACU stay between the IV acetaminophen group (163 minutes) and those subjects not exposed to IV acetaminophen (169 minutes) was not statistically significant (P = .588). No subjects in the study experienced oversedation or required acute opioid reversal. Conclusion: There was not a statistically significant difference in postoperative opioid consumption between patients receiving and not receiving IV acetaminophen intraoperatively. PMID:25673891

  7. Synergistic Interactions with a High Intraoperative Expander Fill Volume Increase the Risk for Mastectomy Flap Necrosis

    PubMed Central

    Khavanin, Nima; Jordan, Sumanas; Lovecchio, Francis; Fine, Neil A.

    2013-01-01

    Purpose Prosthetic-based breast reconstruction is performed with increasing frequency in the United States. Major mastectomy skin flap necrosis is a significant complication with outcomes ranging from poor aesthetic appearance to reconstructive failure. The present study aimed to explore the interactions between intraoperative fill and other risk factors on the incidence of flap necrosis in patients undergoing mastectomy with immediate expander/implant-based reconstruction. Methods A retrospective review of 966 consecutive patients (1,409 breasts) who underwent skin or nipple sparing mastectomy with immediate tissue expander reconstruction at a single institution was conducted. Age, body mass index, hypertension, smoking status, premastectomy and postmastectomy radiation, acellular dermal matrix use, and application of the tumescent mastectomy technique were analyzed as potential predictors of flap necrosis both independently and as synergistic variables with high intraoperative fill. The following three measures of interaction were calculated: relative excess risk due to interaction, attributable proportion of risk due to interaction, and synergy index (SI). Results Intraoperative tissue expander fill volume was high (≥66.7% of the maximum volume) in 40.9% (576 of 1,409 breasts) of cases. The unadjusted flap necrosis rate was greater in the high intraoperative fill cohort than in the low fill cohort (10.4% vs. 7.1%, p=0.027). Multivariate logistic regression did not identify high intraoperative fill volume as an independent risk factor for flap necrosis (odds ratio 1.442, 95% confidence interval 0.973-2.137, p=0.068). However, four risk factors were identified that interacted significantly with intraoperative fill volume, namely tumescence, age, hypertension, and obesity. The SI, or the departure from additive risks, was largest for tumescence (SI, 25.3), followed by hypertension (SI, 2.39), obesity (SI, 2.28), and age older than 50 years (SI, 1.17). Conclusion

  8. Persistent and automatic intraoperative 3D digitization of surfaces under dynamic magnifications of an operating microscope

    PubMed Central

    Kumar, Ankur N.; Miga, Michael I.; Pheiffer, Thomas S.; Chambless, Lola B.; Thompson, Reid C.; Dawant, Benoit M.

    2014-01-01

    One of the major challenges impeding advancement in image-guided surgical (IGS) systems is the soft-tissue deformation during surgical procedures. These deformations reduce the utility of the patient’s preoperative images and may produce inaccuracies in the application of preoperative surgical plans. Solutions to compensate for the tissue deformations include the acquisition of intraoperative tomographic images of the whole organ for direct displacement measurement and techniques that combines intraoperative organ surface measurements with computational biomechanical models to predict subsurface displacements. The later solution has the advantage of being less expensive and amenable to surgical workflow. Several modalities such as textured laser scanners, conoscopic holography, and stereo-pair cameras have been proposed for the intraoperative 3D estimation of organ surfaces to drive patient-specific biomechanical models for the intraoperative update of preoperative images. Though each modality has its respective advantages and disadvantages, stereo-pair camera approaches used within a standard operating microscope is the focus of this article. A new method that permits the automatic and near real-time estimation of 3D surfaces (at 1Hz) under varying magnifications of the operating microscope is proposed. This method has been evaluated on a CAD phantom object and on full-length neurosurgery video sequences (~1 hour) acquired intraoperatively by the proposed stereovision system. To the best of our knowledge, this type of validation study on full-length brain tumor surgery videos has not been done before. The method for estimating the unknown magnification factor of the operating microscope achieves accuracy within 0.02 of the theoretical value on a CAD phantom and within 0.06 on 4 clinical videos of the entire brain tumor surgery. When compared to a laser range scanner, the proposed method for reconstructing 3D surfaces intraoperatively achieves root mean square

  9. Research on intraoperative iris behavior in rabbits treated with tamsulosin and finasteride

    PubMed Central

    Horvath, K; Vultur, F; Simon, V; Voidazan, S; Mühlfay, Gh

    2015-01-01

    Aim: The purpose of this study was to investigate intraoperative iris behavior during some phacoemulsification maneuvers in rabbits treated with tamsulosin or finasteride. Material and Method: An experimental study was conducted on 26 Metis male rabbits aged 1.5 - 2 years, body weight between 3.4 and 5.6 kg, divided into three groups: Group 1 - Control, 6 rabbits; Group 2 - tamsulosin, 10 rabbits; Group 3 - finasteride, 10 rabbits. Dose calculation was performed according to body surface area ratio man/rabbit, taking into account the median lethal dose LD50. Surgery study in rabbits was done over two days by the same specialist using an adapted protocol. He was not informed before or during surgeries which group the animal belonged to, the order being random with a quasi-uniform distribution. Valid results for a modified iris behavior were obtained from two steps of the procedure (cannula irrigation maneuver and irrigation-aspiration). The iris billowing was graded from 0 to 3, according to severity. Results: The risk of intraoperative iris billowing was higher in rabbits included in tamsulosin group [OR=8.33 (CI 95% 0.63-110.09)], but insignificant statistically compare with control group (p= 0.13). In rabbits treated with finasteride the risk of intraoperative iris billowing is increased compared with those without treatment [OR=11.6 (CI 95% 0.92-147.6)], but insignificant statistically (p= 0.11). Conclusion: In our research, we showed an increased risk of intraoperative iris billowing in rabbits treated with finasteride, almost similar with those obtained in rabbits treated with tamsulosin. Further experimental or clinical studies to confirm the role of finasteride in the etiology of intraoperative floppy iris syndrome in humans are needed. Hippokratia 2015, 19 (1): 20-24. PMID:26435641

  10. Strategy of Surgical Resection for Glioma Based on Intraoperative Functional Mapping and Monitoring

    PubMed Central

    TAMURA, Manabu; MURAGAKI, Yoshihiro; SAITO, Taiichi; MARUYAMA, Takashi; NITTA, Masayuki; TSUZUKI, Shunsuke; ISEKI, Hiroshi; OKADA, Yoshikazu

    2015-01-01

    A growing number of papers have pointed out the relationship between aggressive resection of gliomas and survival prognosis. For maximum resection, the current concept of surgical decision-making is in “information-guided surgery” using multimodal intraoperative information. With this, anatomical information from intraoperative magnetic resonance imaging (MRI) and navigation, functional information from brain mapping and monitoring, and histopathological information must all be taken into account in the new perspective for innovative minimally invasive surgical treatment of glioma. Intraoperative neurofunctional information such as neurophysiological functional monitoring takes the most important part in the process to acquire objective visual data during tumor removal and to integrate these findings as digitized data for intraoperative surgical decision-making. Moreover, the analysis of qualitative data and threshold-setting for quantitative data raise difficult issues in the interpretation and processing of each data type, such as determination of motor evoked potential (MEP) decline, underestimation in tractography, and judgments of patient response for neurofunctional mapping and monitoring during awake craniotomy. Neurofunctional diagnosis of false-positives in these situations may affect the extent of resection, while false-negatives influence intra- and postoperative complication rates. Additionally, even though the various intraoperative visualized data from multiple sources contribute significantly to the reliability of surgical decisions when the information is integrated and provided, it is not uncommon for individual pieces of information to convey opposing suggestions. Such conflicting pieces of information facilitate higher-order decision-making that is dependent on the policies of the facility and the priorities of the patient, as well as the availability of the histopathological characteristics from resected tissue. PMID:26185825

  11. Use of Non-Invasive Phase Contrast Magnetic Resonance Imaging for Estimation of Atrial Septal Defect Size and Morphology: A Comparison with Transesophageal Echo

    SciTech Connect

    Piaw, Chin Sze; Kiam, Ong Tiong; Rapaee, Annuar Khoon, Liew Chee; Bang, Liew Houng; Ling, Chan Wei; Samion, Hasri; Hian, Sim Kui

    2006-04-15

    Background: Transesophageal echocardiography (TEE) is a trusted method of sizing atrial septal defect (ASD) prior to percutaneous closure but is invasive, uncomfortable, and may carry a small risk of morbidity and mortality. Magnetic resonance imaging (MRI) may be useful non-invasive alternative in such patients who refuse or are unable to tolerate TEE and may provide additional information on the shape of the A0SD. Purpose: To validate the accuracy of ASD sizing by MRI compared with TEE.Method: Twelve patients (mean age 30 years; range 11-60 years) scheduled for ASD closure underwent TEE, cine balanced fast field echo MRI (bFFE-MRI) in four-chamber and sagittal views and phase-contrast MRI (PC-MRI) with reconstruction using the two orthogonal planes of T2-weighted images as planning. The average of the three longest measurements for all imaging modalities was calculated for each patient. Results: Mean maximum ASD length on TEE was 18.8 {+-} 4.6 mm, mean length by bFFE-MRI was 20.0 {+-} 5.0 mm, and mean length by PC-MRI was 18.3 {+-} 3.6 mm. The TEE measurement was significantly correlated with the bFFE-MRI and PC-MRI measurements (Pearson r = 0.69, p = 0.02 and r = 0.59, p = 0.04, respectively). The mean difference between TEE and bFFE-MRI measurements was -1.2mm (95% CI: -3.7, 1.3) and between TEE and PC-MRI was 0.5 mm (95% CI: -1.9, 2.9). Bland-Altman analysis also determined general agreement between both MRI methods and TEE. The ASDs were egg-shaped in two cases, circular in 1 patient and oval in the remaining patients. Conclusion: ASD sizing by MRI using bFFE and phase-contrast protocols correlated well with TEE estimations. PC-MRI provided additional information on ASD shapes and proximity to adjacent structures.

  12. TU-F-BRF-04: Registration of 3D Transesophageal Echocardiography and X-Ray Fluoroscopy Using An Inverse Geometry X-Ray System

    SciTech Connect

    Speidel, M; Hatt, C; Tomkowiak, M; Raval, A; Funk, T

    2014-06-15

    Purpose: To develop a method for the fusion of 3D echocardiography and Scanning-Beam Digital X-ray (SBDX) fluoroscopy to assist with catheter device and soft tissue visualization during interventional procedures. Methods: SBDX is a technology for low-dose inverse geometry x-ray fluoroscopy that performs digital tomosynthesis at multiple planes in real time. In this study, transesophageal echocardiography (TEE) images were fused with SBDX images by estimating the 3D position and orientation (the “pose”) of the TEE probe within the x-ray coordinate system and then spatially transforming the TEE image data to match this pose. An initial pose estimate was obtained through tomosynthesis-based 3D localization of points along the probe perimeter. Position and angle estimates were then iteratively refined by comparing simulated projections of a 3D probe model against SBDX x-ray images. Algorithm performance was quantified by imaging a TEE probe in different known orientations and locations within the x-ray field (0-30 degree tilt angle, up to 50 mm translation). Fused 3D TEE/SBDX imaging was demonstrated by imaging a tissue-mimicking polyvinyl alcohol cylindrical cavity as a catheter was navigated along the cavity axis. Results: Detected changes in probe tilt angle agreed with the known changes to within 1.2 degrees. For a 50 mm translation along the source-detector axis, the detected translation was 50.3 mm. Errors for in-plane translations ranged from 0.1 to 0.9 mm. In a fused 3D TEE/SBDX display, the catheter device was well visualized and coincident with the device shadow in the TEE images. The TEE images portrayed phantom boundaries that were not evident under x-ray. Conclusion: Registration of soft tissue anatomy derived from TEE imaging and device imaging from SBDX x-ray fluoroscopy is feasible. The simultaneous 3D visualization of these two modalities may be useful in interventional procedures involving the navigation of devices to soft tissue anatomy.

  13. Prosthesis-patient mismatch after transcatheter aortic valve implantation: impact of 2D-transthoracic echocardiography versus 3D-transesophageal echocardiography.

    PubMed

    da Silva, Cristina; Sahlen, Anders; Winter, Reidar; Bäck, Magnus; Rück, Andreas; Settergren, Magnus; Manouras, Aristomenis; Shahgaldi, Kambiz

    2014-12-01

    To investigate the role of 2D-transthoracic echocardiography (2D-TTE) and 3D-transesophageal echocardiography (3D-TEE) in the determination of aortic annulus size prior transcatheter aortic valve implantation (TAVI) and its' impact on the prevalence of patient prosthesis mismatch (PPM). Echocardiography plays an important role in measuring aortic annulus dimension in patients undergoing TAVI. This has great importance since it determines both eligibility for TAVI and selection of prosthesis type and size, and can be potentially important in preventing an inadequate ratio between the prosthetic valvular orifice and the patient's body surface area, concept known as prosthesis-patient mismatch (PPM). A total of 45 patients were studied pre-TAVI: 20 underwent 3D-TEE (men/women 12/8, age 84.8 ± 5.6) and 25 2D-TTE (men/women 9/16, age 84.4 ± 5.4) in order to measure aortic annulus diameter. The presence of PPM was assessed before hospital discharge and after a mean period of 3 months. Moderate PPM was defined as indexed aortic valve area (AVAi) ≤ 0.85 cm(2)/m(2) and severe PPM as AVAi < 0.65 cm(2)/m(2). Immediately post-TAVI, moderate PPM was present in 25 and 28 % of patients worked up using 3D-TEE and 2D-TTE respectively p value = n.s) and severe PPM occurred in 10 % of the patients who underwent 3D-TEE and in 20 % in those with 2D-TTE (p value = n.s). The echocardiographic evaluation 3 months post-TAVI showed 25 % moderate PPM in the 3D-TEE group compared with 24 % in the 2D-TTE group (p value = n.s) and no cases of severe PPM in the 3DTEE group comparing to 20 % in the 2D-TTE group (p = 0.032). Our results indicate a higher incidence of severe PPM in patients who performed 2DTTE compared to those performing 3DTEE prior TAVI. This suggests that the 3D technique should replace the 2DTTE analysis when investigating the aortic annulus diameter in patients undergoing TAVI. PMID:25102782

  14. Usefulness of phased-array intracardiac echocardiography for the assessment of left atrial mechanical "stunning" in atrial flutter and comparison with multiplane transesophageal echocardiography(*).

    PubMed

    Morton, Joseph B; Sanders, Prashanthan; Sparks, Paul B; Morgan, John; Kalman, Jonathan M

    2002-10-01

    We compared transesophageal and phased-array intracardiac echocardiography (TEE/ICE) for the 2-dimensional and spectral Doppler assessment of left atrial (LA) mechanical function. TEE is commonly used to assess LA body and LA appendage mechanical function in patients who are undergoing radiofrequency ablation of typical atrial flutter. Fifteen patients underwent TEE and ICE imaging before and after ablation of typical atrial flutter. The following parameters were measured: (1) LA appendage emptying velocity and fractional area change, (2) severity of LA spontaneous echo contrast (graded 0 to 4), (3) maximal inflow velocity of the left and right upper pulmonary veins, and (5) maximal mitral valve E- and A-wave inflow velocities in sinus rhythm. Diagnostic quality imaging was achieved in all patients with TEE and ICE. Comparing TEE and ICE, the following absolute values and linear correlation coefficient (R) were obtained: preablation LA appendage emptying velocity: 0.45 +/- 0.21 versus 0.44 +/- 0.21 m/s (r = 0.95, p = <0.001); postablation LA appendage velocity: 0.33 +/- 0.24 versus 0.34 +/- 0.24 m/s (r = 0.97, p <0.001); LA appendage fractional area change: 35.3 +/- 13.7 versus 35.9 +/- 17.1% (r = 0.81, p <0.001); left upper/right upper pulmonary vein inflow velocity: 0.50 +/- 0.17/0.49 +/- 0.18 versus 0.51 +/- 0.17/0.47 +/- 0.20 m/s (r = 0.93/0.90, p <0.001); mitral valve E/A wave: 0.66 +/- 0.14/0.31 +/- 0.14 versus 0.69 +/- 0.17/0.35 +/- 0.23 (r = 0.84/0.97, p <0.002); LA spontaneous echo contrast (pre- and postablation): 1.1 +/- 1.2/1.3 +/- 1.2 versus 1.2 +/- 1.3/1.4 +/- 1.3 (r = 0.92/0.90, p <0.001). No patients were identified with LA appendage thrombus. Thus, TEE and phased-array ICE provided equivalent imaging data with high statistical correlation. ICE may be an imaging alternative to TEE in the evaluation of a "stunned" left atrium.

  15. Atrial Septal Aneurysm and Patent Foramen Ovale as Risk Factors for Cryptogenic Stroke in Patients Less Than 55 Years of Age: A Study using Transesophageal Echocardiography

    NASA Technical Reports Server (NTRS)

    Cabanes, L.; Mas, J. L.; Cohen, A.; Amarenco, P.; Cabanes, P. A.; Oubary, P.; Chedru, F.; Guerin, F.; Bousser, M. G.; deRecondo, J.

    1993-01-01

    Background and Purpose: An association between atrial septal aneurysm and embolic events has been suggested. Atrial septal aneurysm has been shown to be associated with patent foramen ovale and,.in some reports, with mitral valve prolapse. These two latter cardiac disorder; have been identified as potential risk factors for ischemic stroke. The aim of this prospective study was to assess the role of atrial septal aneurysm as an independent risk factor for stroke, especially for cryptogenic stroke. Methods: We studied the prevalence of atrial septal aneurysm, patent foramen ovale, and mitral valve prolapse in 100 consecutive patients <55 years of age with ischemic stroke who underwent extensive etiological investigations. We compared these results with those in a control group of 50 consecutive patients. The diagnosis of atrial septal aneurysm and patent foramen ovale relied on transesophageal echocardiography with a contrast study and that of mitral valve prolapse, on two-dimensional transthoracic echocardiography. Results: Stepwise logistic regression analysis showed that atrial septal aneurysm (odds ratio, 4.3; 95% confidence interval, 1.3 to 14.6; P=.01) and patent foramen ovale (odds ratio, 3.9; 95% confidence interval, 1.5 to 10; P=.003) but not mitral valve prolapse were significantly associated with the diagnosis of cryptogenic stroke. The stroke odds of a patient with both atrial septal aneurysm and patent foramen ovale were 33.3 times (95% confidence interval, 4.1 to 270) the stroke odds of a patient with neither of these cardiac disorders. For a patient with atrial septal aneurysm of >lo-mm excursion, the stroke odds were approximately 8 times the stroke odds of a patient with atrial septal aneurysm of <10 mm. Conclusions: This study shows that atrial septal aneurysm and patent foramen ovale are both significantly associated with cryptogenic stroke and that their association has a marked synergistic effect. Atrial septal aneurysms of >lo-mm excursion are

  16. Transesophageal Doppler echocardiographic assessment of systolic and diastolic coronary blood flow velocities at baseline and during adenosine triphosphate-induced coronary vasodilation in chronic aortic regurgitation.

    PubMed

    Kisanuki, A; Matsushita, R; Murayama, T; Otsuji, Y; Miyazono, Y; Toyonaga, K; Nakao, S; Taira, A; Tanaka, H

    1997-01-01

    Few reports exist on the changes in systolic and diastolic coronary flow velocities (CFVs) at baseline and during coronary vasodilation in patients with chronic aortic regurgitation (AR). We examined the left anterior descending CFVs in 21 patients with AR (11 patients with mild AR and 10 patients with moderate to severe AR), 9 patients without AR (no AR group), and 6 patients who had undergone surgery for moderate to severe AR (postoperation group) with transesophageal Doppler echocardiography. Adenosine triphosphate (ATP) was infused into a peripheral right arm vein at four different doses (35, 70, 100, and 140 micrograms/kg/min). Coronary flow velocity response in systole and diastole was calculated as the ratio of systolic peak and mean and diastolic peak and mean CFVs during maximal ATP infusion to those at baseline. The systolic peak and mean CFVs and the diastolic peak and mean CFVs at baseline were significantly increased in the moderate to severe group compared with those in the other groups (p < 0.05, respectively). Systolic and diastolic CFVs were significantly increased during ATP infusions in the four groups. No significant differences of systolic and diastolic CFVs were observed among the four groups during maximal ATP infusion. The coronary flow velocity response calculated from the peak and mean diastolic CFVs were significantly decreased in the moderate to severe group (1.6 +/- 0.3 and 1.7 +/- 0.4) compared with those in the other three groups (3.6 +/- 0.7 and 3.2 +/- 1.1 in the no AR group, 2.6 +/- 0.6 and 2.5 +/- 0.4 in the mild group, and 2.5 +/- 0.7 and 2.4 +/- 0.6 in the postoperation group) (p < 0.05, respectively). In conclusion, the systolic and diastolic left CFVs at baseline appeared to be significantly increased in patients with moderate to severe chronic AR. However, the velocities during coronary vasodilation by ATP were equal to those in other groups, resulting in a decrease of coronary flow velocity response in systole and diastole

  17. Comparison of intraoperative and postoperative complications based on ASA risks in patients who underwent percutaneous nephrolithotomy

    PubMed Central

    Karakaş, Hüseyin Buğra; Çiçekbilek, İzzet; Tok, Adem; Alışkan, Tamer; Akduman, Bülent

    2016-01-01

    Objective In this study we aimed to evaluate intraoperative and postoperative complications which developed according to pre-operative American Society of Anesthesiologists (ASA) risk criteria in patients who had undergone percutaneous nephrolithotomy (PNL). Material and methods Five hundred and sixty patients who had undergone PNL between 2002 and 2014 were included in the study. Patients operated on the ipsilateral kidney, those with solitary kidney or the cases who had previously undergone more than one access were excluded from this study. Preoperative anesthesia risks were determined according to preoperative classification developed by ASA. Postoperative complications were evaluated using Clavien Complication Grading Scale. Results The mean age of the cases was 47±14 years. The 57% (n=319) of the cases were male, 241 (43%) of them were female. The average indwell time of nephrostomy catheter was 2.88±1.00 (1–8), and length of hospital stay was 4.91±1.54 (2–17) days. When the cases were assessed according to ASA risk groups, intraoperative complications were observed in 9 (5.5%) ASA I, 27 (8.6%) ASA II, and 18 (22%) ASA III patients and and distribution of the patients was statistically significant (p<0.001). When intraoperative complications were evaluated one by one, intraoperative hypotension developed in ASA I (n=3; 1.8%), ASA II (n=20; 6.4%) and ASA III (n=11; 13.4%) risk groups and this distribution (p=0.002) of patients was statistically significant. When assessed according to Clavien Postoperative Scale, postoperative complications developed (p=0.053) in ASAI (n=24; 14.7%), ASA II (n=27, 8.6%) and ASA III (n=13; 15.9%) risk groups, and this distribution of the patients was not statistically significant. In postoperative complications, Grade 3a complications developed in ASA I (n=12; 7.4%), ASA II (n=19; 6%) and ASA III (n=8; 9.8%) risk groups and this distribution was not seen to be statistically significant (p=0.485). Conclusion A statistically

  18. Comparison of intraoperative and postoperative complications based on ASA risks in patients who underwent percutaneous nephrolithotomy

    PubMed Central

    Karakaş, Hüseyin Buğra; Çiçekbilek, İzzet; Tok, Adem; Alışkan, Tamer; Akduman, Bülent

    2016-01-01

    Objective In this study we aimed to evaluate intraoperative and postoperative complications which developed according to pre-operative American Society of Anesthesiologists (ASA) risk criteria in patients who had undergone percutaneous nephrolithotomy (PNL). Material and methods Five hundred and sixty patients who had undergone PNL between 2002 and 2014 were included in the study. Patients operated on the ipsilateral kidney, those with solitary kidney or the cases who had previously undergone more than one access were excluded from this study. Preoperative anesthesia risks were determined according to preoperative classification developed by ASA. Postoperative complications were evaluated using Clavien Complication Grading Scale. Results The mean age of the cases was 47±14 years. The 57% (n=319) of the cases were male, 241 (43%) of them were female. The average indwell time of nephrostomy catheter was 2.88±1.00 (1–8), and length of hospital stay was 4.91±1.54 (2–17) days. When the cases were assessed according to ASA risk groups, intraoperative complications were observed in 9 (5.5%) ASA I, 27 (8.6%) ASA II, and 18 (22%) ASA III patients and and distribution of the patients was statistically significant (p<0.001). When intraoperative complications were evaluated one by one, intraoperative hypotension developed in ASA I (n=3; 1.8%), ASA II (n=20; 6.4%) and ASA III (n=11; 13.4%) risk groups and this distribution (p=0.002) of patients was statistically significant. When assessed according to Clavien Postoperative Scale, postoperative complications developed (p=0.053) in ASAI (n=24; 14.7%), ASA II (n=27, 8.6%) and ASA III (n=13; 15.9%) risk groups, and this distribution of the patients was not statistically significant. In postoperative complications, Grade 3a complications developed in ASA I (n=12; 7.4%), ASA II (n=19; 6%) and ASA III (n=8; 9.8%) risk groups and this distribution was not seen to be statistically significant (p=0.485). Conclusion A statistically

  19. Self-inflicted nail-gun injury with cranial penetration and use of intraoperative computed tomography

    PubMed Central

    Carnevale, Joseph A.; Morrison, John F.; Choi, David B.; Klinge, Petra M.; Cosgrove, G. Rees; Oyelese, Adetokunbo A.

    2016-01-01

    Background: Management of penetrating cranial trauma remains a high acuity and imaging intense neurosurgical disorder. Imaging of vital structures, including angiography, is typically conducted to understand the proximity of vital structures in comparison to a foreign body and prepare for intraoperative complications such as hemorrhage. Preservation of function following initial injury in cases where minimal neurological deficit exists is essential. Case Description: Here, we present a case using intraoperative computed tomography to assist in early detection and resolution of hemorrhage in the surgical management of an intact patient with self-inflicted penetrating cranial trauma. Conclusions: This method may aid in early detection of hemorrhage and prevention of consequential neurological deterioration or emergent need for secondary surgery. PMID:27213112

  20. A Narrative of Intraoperative Staple Line Leaks and Bleeds During Bariatric Surgery.

    PubMed

    Ghosh, Sudip K; Roy, Sanjoy; Chekan, Ed; Fegelman, Elliott J

    2016-07-01

    The primary objective of this review was to assess the incidence of intraoperative staple line leaks and bleeds during laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). A literature search of MEDLINE®, EMBASE™, and Biosis from January 2010 to November 2014, plus secondary citations extending to 2008, identified 16 relevant articles. For LSG, the incidence of intraoperative leaks and bleeds was as high as 3.93 and 4.07 %, respectively. For LRYGB, leaks occurred in up to 8.26 % and bleeds in 3.45 % of cases. Stapler misfire was commonly cited as a cause. Widespread, precautionary use of staple line reinforcement (SLR), lack of standardized testing, and underreporting suggest the incidence may be underestimated. Published studies were insufficient to address the economic impact of bleeds and leaks or interventions, but development of improved stapler designs that obviate the need for SLR may reduce costs and improve outcomes.

  1. A Case Report of Preoperative, Intraoperative, and Postoperative Anterior Chamber Shallowing Resulting from Different Mechanisms.

    PubMed

    Mori, Yujiro; Ikeda, Yoshifumi; Sano, Ichiya; Fujihara, Etsuko; Tanito, Masaki

    2016-01-01

    A 54-year-old woman with an epiretinal membrane in her left eye accompanied by a shallow anterior chamber due to primary angle closure glaucoma underwent vitrectomy and cataract surgery. During the cataract surgery, immediately after the ultrasonic tip had been removed from the anterior chamber, anterior chamber flattening occurred. An intraoperative fundus examination showed the development of acute intraoperative choroidal effusion. Postoperatively, the anterior chamber remained shallow even after the choroidal detachment had subsided; capsular bag distension seen by ultrasound biomicroscopy suggested the development of early postoperative capsular block syndrome. After neodymium:yttrium-aluminium-garnet laser capsulotomy, the anterior chamber deepened. Depending on the perioperative period, the mechanism of a flat anterior chamber can change, and understanding the underlying mechanisms is required for appropriate treatment. PMID:27293412

  2. [Non-invasive mechanical ventilation in the pre- and intraoperative period and difficult airway].

    PubMed

    Esquinas, A M; Jover, J L; Úbeda, A; Belda, F J

    2015-11-01

    Non-invasive mechanical ventilation is a method of ventilatory assistance aimed at increasing alveolar ventilation, thus achieving, in selected subjects, the avoidance of endotracheal intubation and invasive mechanical ventilation, with the consequent improvement in survival. There has been a systematic review and study of the technical, clinical experiences, and recommendations concerning the application of non-invasive mechanical ventilation in the pre- and intraoperative period. The use of prophylactic non-invasive mechanical ventilation before surgery that involves significant alterations in the ventilatory function may decrease the incidence of postoperative respiratory complications. Its intraoperative use will mainly depend on the type of surgery, type of anaesthetic technique, and the clinical status of the patient. Its use allows greater anaesthetic depth without deterioration of oxygenation and ventilation of patients.

  3. Intraoperative 16-Channel Electroencephalography and Bilateral Near Infrared Spectroscopy Monitorization in Aortic Surgery.

    PubMed

    Demir, Aslı; Aydınlı, Bahar; Ünal, Ertekin Utku; Bindal, Mustafa; Koçulu, Rabia; Sarıtaş, Ahmet; Karadeniz, Ümit

    2015-08-01

    Transient neurologic dysfunction is common after aortic surgery. Major causes of postoperative complications followed by cardiac surgery are due to hypoperfusion states such as selective cerebral perfusion, embolic debris during cardiopulmonary bypass and ulcerated plaque emboli originated from carotid arteries. Neurologic complications prolong periods of intensive care unit and hospital stay, worsens quality of life and unfortunately they are an important cause of morbidity. Anaesthesia during a carotid and aortic surgery constitutes of providing adequate brain perfusion pressure, attenuating cerebral metabolism by anaesthetic agents and monitoring the cerebral metabolic supply and demand relationship during the intraoperative period. We present a monitoring approach with an intraoperative 16-channel electroencephalography and bilateral near infrared spectroscopy during redo aneurysm of the sinus of Valsalva surgery. PMID:27366510

  4. Analysis of intra-operative bleeding and recurrence of juvenile nasopharyngeal angiofibromas.

    PubMed

    Liu, L; Wang, R; Huang, D; Han, D; Ferguson, E J; Shi, H; Yang, W

    2002-12-01

    The purpose of this study is to present our experience with 34 patients diagnosed with juvenile nasopharyngeal angiofibromas and treated in the Chinese PLA General Hospital between 1986 and 1999, and to examine the factors influencing intra-operative bleeding and tumour recurrence. The age of the patient, the duration of symptoms and tumour stage were related to the amount of intra-operative bleeding. The tumours were totally resected in 30 patients and recurred in five patients (16.7%), with a mean follow-up time of 77 months. The mean time to tumour recurrence after operation was 3.2 months (1-6 months). The incidence of recurrence had no correlation with the age of the patient, duration of symptoms, peri-operative treatment or surgical approaches (P > 0.05); but strongly correlated with tumour stage (P < 0.05).

  5. Intraoperative Management of Hypercapnia With an Extracorporeal Carbon Dioxide Removal Device During Giant Bullectomy.

    PubMed

    Dell'Amore, Andrea; D'Andrea, Rocco; Caroli, Guido; Mazzoli, Carlo Alberto; Rocca, Alberto; Stella, Franco; Bini, Alessandro; Melotti, Rita

    2016-01-01

    Extracorporeal CO2-removal devices have been introduced in clinical practice to provide protective and ultraprotective ventilation strategies in different settings to avoid retention of carbon dioxide. The need to facilitate lung-protective ventilation is required not only for the treatment of acute respiratory distress syndrome but also in thoracic surgery during complex operations, especially in respiratory compromised patients. This report describes a case of giant bullectomy for vanishing lung syndrome in which intraoperative hypercapnia secondary to protective ventilation was managed with a CO2-removal device (Decap-Hemodec s.r.l., Salerno, Italy). To the best of our knowledge, this is the first report in the literature of the intraoperative use of the Decap system for giant bullectomy.

  6. [INVASIVE TECHNIQUES AND INTRAOPERATIVE ECHOGRAPHY IN THE LOCALIZATION OF INSULINOMAS; A CASE REPORT].

    PubMed

    Herrera-Martínez, Aura D; Padillo-Cuenca, José C; Calañas Continente, Alfonso; Bahamondes-Opazo, Rodrigo; Muñoz-Jiménez, Concepción; Gálvez Moreno, María A

    2015-07-01

    The insulinoma is the most common pancreatic neuroendocrine tumor. Surgery is curative in most cases, an appropriate preoperative localization allows a minimal invasive surgical technique for keeping the exo and endocrine function of the pancreas. Some authors suggest the use of invasive localization techniques just in cases with non-identified tumor lesion, others recommend their routinely use. We describe a case with clinical and biochemical diagnosis of insulinoma, conventional image studies revealed a tumor image in the pancreas which corresponded to a lipoma, the intraoperative ultrasound allowed the localization of the real tumor, but body-tail pancreatectomy was performed due to pancreatic necrosis in relation with the duration of the surgery. The systematic use of invasive localization techniques as the intra-arterial calcium stimulation and the pancreatic intraoperative ultrasound would allow a better localization of insulinoma for avoiding complications and associated morbidity.

  7. Intraoperative measurement of parathyroid hormone: A Copernican revolution in the surgical treatment of hyperparathyroidism.

    PubMed

    Gioviale, Maria Concetta; Damiano, Giuseppe; Altomare, Roberta; Maione, Carolina; Buscemi, Salvatore; Buscemi, Giuseppe; Lo Monte, Attilio Ignazio

    2016-04-01

    Intraoperative parathyroid hormone (PTH) monitoring in the setting of the operating room represents a valuable example of the rationale use of the laboratory diagnostic in a patient-oriented approach. Rapid intraoperative PTH (ioPTH) assay is a valid tool for an accurate evaluation of the success of parathyroid surgery. The reliability of the user-friendly portable systems as well as the collaboration between operators and surgical staff allow the one-site monitoring of the ioPTH decrements on the course of the surgical management of hyperparathyroidism. The rapid answer provided by an effective decrement of PTH during parathyroidectomy contributes dramatically to the efficacy of parathyroid surgery and the reduction of the number of re-operations. Therefore the dose of ioPTH is a valid and reliable support for the success of the intervention of parathyroidectomy at controlled costs. PMID:26708859

  8. [Non-invasive mechanical ventilation in the pre- and intraoperative period and difficult airway].

    PubMed

    Esquinas, A M; Jover, J L; Úbeda, A; Belda, F J

    2015-11-01

    Non-invasive mechanical ventilation is a method of ventilatory assistance aimed at increasing alveolar ventilation, thus achieving, in selected subjects, the avoidance of endotracheal intubation and invasive mechanical ventilation, with the consequent improvement in survival. There has been a systematic review and study of the technical, clinical experiences, and recommendations concerning the application of non-invasive mechanical ventilation in the pre- and intraoperative period. The use of prophylactic non-invasive mechanical ventilation before surgery that involves significant alterations in the ventilatory function may decrease the incidence of postoperative respiratory complications. Its intraoperative use will mainly depend on the type of surgery, type of anaesthetic technique, and the clinical status of the patient. Its use allows greater anaesthetic depth without deterioration of oxygenation and ventilation of patients. PMID:25702198

  9. Survival of patients with glioblastoma multiforme treated by intraoperative high-activity cobalt 60 endocurietherapy

    SciTech Connect

    Kumar, P.P.; Good, R.R.; Jones, E.O.; Patil, A.A.; Leibrock, L.G.; McComb, R.D. )

    1989-10-01

    The authors report their initial treatment results in 49 patients with glioblastoma multiforme (GM) who received intraoperative endocurietherapy (ECT) with high-activity cobalt 60 ({sup 60}Co) probe. Thirty poor prognosis (unresectable tumor) patients (Group I) with newly diagnosed GM were treated by either biopsy or subtotal excision, followed by 20.00-Gy single-fraction {sup 60}Co probe ECT, and 60.00-Gy external-beam radiation therapy (EXRT) (80.00 Gy total tumor dose). Nineteen patients (Group II) with recurrent, previously resected and externally irradiated GM were retreated with 20.00-Gy single-fraction {sup 60}Co probe ECT alone. The authors' initial experience with intraoperative ECT of GM is discussed.

  10. Intraoperative smile in a multiple sclerosis patient with medication-refractory tremor.

    PubMed

    Thompson, Amanda J; Peng-Chen, Zhongxing; Pastrana, Marlon; Foote, Kelly D; Haq, Ihtsham; Okun, Michael S

    2014-01-01

    Deep brain stimulation has been utilized to improve disease symptoms in patients with Parkinson's disease, dystonia, essential tremor, and other neuropsychiatric syndromes such as depression and obsessive compulsive disorder. Deep brain stimulation has also been observed to improve tremor for select patients with multiple sclerosis. During intraoperative stimulation in these multiple sclerosis patients, researchers have observed a wide spectrum of motor and sensory phenomena, but no stimulation-induced emotional responses have been reported. We detailed intraoperative smiling associated with stimulation of the ventralis oralis anterior/ventralis oralis posterior border region of the left thalamus.  A single patient with medication-resistant multiple sclerosis tremor experienced smiling, laughing, and subjective euphoria during intraoperative stimulation of the left thalamus. Specifically, during intraoperative stimulation of the left thalamic ventralis oralis anterior border, the patient developed a contralateral smile which progressed to a bilateral smile and was accompanied by a feeling of subjective happiness. The smile habituated in approximately 60 seconds and it was reproducible on a repeat stimulation. The patient could subjectively feel the facial movement, and, at higher voltages, the movement was described as a pulling sensation. Stimulation of the anterior ventralis oralis anterior border of the left thalamus in an multiple sclerosis patient produced a unilateral smile that rapidly developed into a bilateral smile accompanied by euphoria. There were presumed capsular side effects at higher voltages. The exact mechanism by which stimulation of the thalamus produced a smile and mood elevation is unknown, but we speculate that the smile could be induced by stimulation of corticobulbar fibers arising from the caudal cingulate motor area connecting the contralateral facial nerve nucleus.

  11. Television system for verification and documentation of treatment fields during intraoperative radiation therapy.

    PubMed

    Fraass, B A; Harrington, F S; Kinsella, T J; Sindelar, W F

    1983-09-01

    Intraoperative radiation therapy (IORT) involves direct treatment of tumors or tumor beds with large single doses of radiation. The verification of the area to be treated before irradiation and the documentation of the treated area are critical for IORT, just as for other types of radiation therapy. A television system which allows the target area to be directly imaged immediately before irradiation has been developed. Verification and documentation of treatment fields has made the IORT television system indispensable.

  12. Experience of Intraoperative Cell Salvage in Surgical Correction of Spinal Deformity

    PubMed Central

    Yang, Changsheng; Wang, Jianru; Zheng, Zhaomin; Zhang, Zhongmin; Liu, Hui; Wang, Hua; Li, Zemin

    2016-01-01

    Abstract The effect of intraoperative cell salvage (ICS) in surgical correction of spinal deformity remained controversial. This study was to quantitatively demonstrate its effect. In all, 124 patients having ICS in surgical correction of spinal deformity were included. These patients would be divided into 3 groups. Group 1—blood loss less than 15 mL/kg; group 2—between 15 and 37.5 mL/kg; and group 3—more than 37.5 mL/kg. The mean blood loss was 37.2 mL/kg and patients received 872.2 mL salvaged blood on average. The prevalence of intraoperative transfusion of allogenic RBC was 62.9% and the amount averaged 3.4 U. In groups 1 to 3, the prevalence of intraoperative allogenic transfusion was 23.5%, 66.7%, and 100%, respectively. Logistic analysis showed blood loss minus autotransfusion was of significance in predicting intraoperative transfusion, whereas the blood loss or autotransfusion alone was not, implicating an important role of ICS in saving allogenic RBC. The maximum decrease of hemoglobin after operation occurred in the third day, and the magnitude was 45.7 g/L. No severe complications related to ICS were observed. In summary, ICS could decrease the amount of allogenic transfusion in surgical correction of spinal deformity. However, in terms of reducing prevalence of allogenic transfusion, it had a protective effect only in patients with small blood loss. PMID:27227909

  13. Delphi Consensus Recommendations: Intraoperative Technique and Postoperative Management of Patients with Natrelle 410 Implants

    PubMed Central

    Brown, Mitchell H.; Hedén, Per; Luan, Jie; Munhoz, Alexandre Mendonça; Carter, Mollie

    2015-01-01

    Background: Anatomically shaped, form-stable Natrelle 410 breast implants were approved in Europe in 1993 and in the United States in 2013. Although general guidelines for breast augmentation are available, the distinctive characteristics of Natrelle 410 warrant specific guidelines for this device. The goal of this study was to generate consensus recommendations for intraoperative technique and postoperative management with Natrelle 410 in primary breast augmentation. Methods: Surgeons were invited to participate in the study, which used a modified Delphi method. Participants completed 2 rounds of online surveys; the second survey (Recommendations Survey) was generated based on first survey results. Respondents also listed top priorities for use of Natrelle 410. Results: Participants (n = 22) reached consensus on 15 of 18 perioperative and surgical techniques; dual-plane placement, tight pockets, and limiting the boundaries of dissection were among intraoperative techniques considered most important for Natrelle 410. Consensus was reached for 18 of 32 items regarding postoperative management and 6 of 9 open-ended postoperative activity restrictions. Consensus on activity restrictions with specified time limits were similar to consensus recommendations on general restrictions. Top participant-identified intraoperative and postoperative management practices for Natrelle 410 were dual-plane placement of the implant and wearing a bra postoperatively, respectively. Conclusions: The Delphi method identified consensus recommendations on a broad range of intraoperative techniques and postoperative management practices for primary breast augmentation with Natrelle 410. These recommendations and priorities provide surgeons with a framework that, together with the surgeon’s experience, will contribute to optimal clinical outcomes with Natrelle 410. PMID:26893982

  14. A case of diffused malignant pleural mesothelioma forming small multiple disseminations with intraoperatively suspicious carcinoid tumors.

    PubMed

    Suemitsu, Ryuichi; Takeo, Sadanori; Hamatake, Motoharu; Furuya, Kiyomi; Uesugi, Noriko

    2011-01-01

    A 65-year-old male, having symptoms suggestive of pulmonary malignant tumor, underwent video-assisted thoracic surgery (VATS). Surgery revealed a solid tumor originating from the thoracic wall, with many small solid tumors in the thoracic wall and diaphragm near the tumor. The intraoperative observation of a frozen section typed the tumor as carcinoid; however, hematoxylin-eosin staining and immunohistological findings provided the definitive diagnosis of diffused, malignant pleural mesothelioma (MPM).

  15. Intraoperative C-arm fluoroscopy-based 3D navigation for intraventricular endoscopic intervention.

    PubMed

    Herbowski, L; Sagan, L; Szyłak, R; Sałapa, P; Harat, A

    2013-08-01

    The authors present the technique of retained ventricular catheter removal by means of fluoroscopy-guided neuronavigation. A disconnected free-floating intraventricular catheter is an unusual shunt complication, and in case of shunt infection it should be removed immediately. The operative procedure described here is the first such imaging technique and original approach to retained ventricular catheter endoscopic surgery. The real-time fluoroscopy-guided neuroendoscopy seems to make 3D intraoperative navigation possible.

  16. Thermal burn associated with intraoperative convective forced-air warming blanket (bair paws™ flex gown system).

    PubMed

    Hansen, Elizabeth K; Apostolidou, Ioanna; Layton, Heather; Prielipp, Richard

    2014-10-01

    A 44-year-old man undergoing ambulatory surgery sustained a 5% total body surface first-degree burn on his lower and lateral torso and upper thigh during routine use of a new forced-air warming Bair Paws™ flex gown system. We describe the likely mechanism of injury, intraoperative events suggesting special variation in the warming process, and a brief review of adverse events associated with forced-air warming systems. PMID:25611618

  17. Temporary intra-operative reduction techniques for tibial fracture fixation: A review of the literature.

    PubMed

    Beazley, J C; Hull, P

    2010-12-01

    Accurate intra-operative reduction and maintenance of reduction is essential for successful fixation of tibial fractures. Although many tibial fractures can be reduced with minimal manipulation, numerous techniques have been described to facilitate fixation of more difficult fractures. These include use of a traction table, manual traction techniques, temporary distracters, reduction clamps and temporary unicortical plating. This article reviews the literature and assesses the options available for the temporary reduction and maintenance of reduction of tibial fractures prior to definitive fixation.

  18. Computed tomography, endoscopic, laparoscopic, and intra-operative sonography for assessing resectability of pancreatic cancer.

    PubMed

    Long, Eliza E; Van Dam, Jacques; Weinstein, Stefanie; Jeffrey, Brooke; Desser, Terry; Norton, Jeffrey A

    2005-08-01

    Pancreas cancer is the fourth leading cancer killer in adults. Cure of pancreas cancer is dependent on the complete surgical removal of localized tumor. A complete surgical resection is dependent on accurate preoperative and intra-operative imaging of tumor and its relationship to vital structures. Imaging of pancreatic tumors preoperatively and intra-operatively is achieved by pancreatic protocol computed tomography (CT), endoscopic ultrasound (EUS), laparoscopic ultrasound (LUS), and intra-operative ultrasound (IOUS). Multi-detector CT with three-dimensional (3-D) reconstruction of images is the most useful preoperative modality to assess resectability. It has a sensitivity and specificity of 90 and 99%, respectively. It is not observer dependent. The images predict operative findings. EUS and LUS have sensitivities of 77 and 78%, respectively. They both have a very high specificity. Further, EUS has the ability to biopsy tumor and obtain a definitive tissue diagnosis. IOUS is a very sensitive (93%) method to assess tumor resectability during surgery. It adds little time and no morbidity to the operation. It greatly facilitates the intra-operative decision-making. In reality, each of these methods adds some information to help in determining the extent of tumor and the surgeon's ability to remove it. We rely on pancreatic protocol CT with 3-D reconstruction and either EUS or IOUS depending on the tumor location and operability of the tumor and patient. With these modern imaging modalities, it is now possible to avoid major operations that only determine an inoperable tumor. With proper preoperative selection, surgery is able to remove tumor in the majority of patients.

  19. Surgery for traumatic facial nerve paralysis: does intraoperative monitoring have a role?

    PubMed

    Ashram, Yasmine A; Badr-El-Dine, Mohamed M K

    2014-09-01

    The use of intraoperative facial nerve (FN) monitoring during surgical decompression of the FN is underscored because surgery is indicated when the FN shows more than 90 % axonal degeneration. The present study proposes including intraoperative monitoring to facilitate decision taking and provide prognostication with more accuracy. This prospective study was conducted on ten patients presenting with complete FN paralysis due to temporal bone fracture. They were referred after variable time intervals for FN exploration and decompression. Intraoperative supramaximal electric stimulation (2-3 mA) of the FN was attempted in all patients both proximal and distal to the site of injury. Postoperative FN function was assessed using House-Brackmann (HB) scale. All patients had follow-up period ranging from 7 to 42 months. Three different patterns of neurophysiological responses were characterized. Responses were recorded proximal and distal to the lesion in five patients (pattern 1); only distal to the lesion in two patients (pattern 2); and neither proximal nor distal to the lesion in three patients (pattern 3). Sporadic, mechanically elicited EMG activity was recorded in eight out of ten patients. Patients with pattern 1 had favorable prognosis with postoperative function ranging between grade I and III. Pattern 3 patients showing no mechanically elicited activity had poor prognosis. Intraoperative monitoring affects decision taking during surgery for traumatic FN paralysis and provides prognostication with sufficient accuracy. The detection of mechanically elicited EMG activity is an additional sign predicting favorable outcome. However, absence of responses did not alter surgeon decision when the nerve was found evidently intact.

  20. The value of intraoperative electrocorticography in surgical decision making for temporal lobe epilepsy with normal MRI

    PubMed Central

    Luther, Neal; Rubens, Elayna; Sethi, Nitin; Kandula, Padmaja; Labar, Douglas R.; Harden, Cynthia; Perrine, Kenneth; Christos, Paul J.; Iorgulescu, J. Bryan; Lancman, Guido; Schaul, Neil S.; Kolesnik, Dmitriy V.; Nouri, Shahin; Dawson, Andrew; Tsiouris, Apostolos J.; Schwartz, Theodore H.

    2013-01-01

    SUMMARY Purpose We hypothesized that acute intraoperative electrocorticography (ECoG) might identify a subset of patients with magnetic resonance imaging (MRI)–negative temporal lobe epilepsy (TLE) who could proceed directly to standard anteromesial resection (SAMR), obviating the need for chronic electrode implantation to guide resection. Methods Patients with TLE and a normal MRI who underwent acute ECoG prior to chronic electrode recording of ictal onsets were evaluated. Intraoperative interictal spikes were classified as mesial (M), lateral (L), or mesial/lateral (ML). Results of the acute ECoG were correlated with the ictal-onset zone following chronic ECoG. Onsets were also classified as “M,” “L,” or “ML.” Positron emission tomography (PET), scalp-EEG (electroencephalography), and Wada were evaluated as adjuncts. Key Findings Sixteen patients fit criteria for inclusion. Outcomes were Engel class I in nine patients, Engel II in two, Engel III in four, and Engel IV in one. Mean postoperative follow-up was 45.2 months. Scalp EEG and PET correlated with ictal onsets in 69% and 64% of patients, respectively. Wada correlated with onsets in 47% of patients. Acute intraoperative ECoG correlated with seizure onsets on chronic ECoG in all 16 patients. All eight patients with “M” pattern ECoG underwent SAMR, and six (75%) experienced Engel class I outcomes. Three of eight patients with “L” or “ML” onsets (38%) had Engel class I outcomes. Significance Intraoperative ECoG may be useful in identifying a subset of patients with MRI-negative TLE who will benefit from SAMR without chronic implantation of electrodes. These patients have uniquely mesial interictal spikes and can go on to have improved postoperative seizure-free outcomes. PMID:21480886

  1. Changes in cerebrospinal fluid flow assessed using intraoperative MRI during posterior fossa decompression for Chiari malformation.

    PubMed

    Bond, Aaron E; Jane, John A; Liu, Kenneth C; Oldfield, Edward H

    2015-05-01

    OBJECT The authors completed a prospective, institutional review board-approved study using intraoperative MRI (iMRI) in patients undergoing posterior fossa decompression (PFD) for Chiari I malformation. The purpose of the study was to examine the utility of iMRI in determining when an adequate decompression had been performed. METHODS Patients with symptomatic Chiari I malformations with imaging findings of obstruction of the CSF space at the foramen magnum, with or without syringomyelia, were considered candidates for surgery. All patients underwent complete T1, T2, and cine MRI studies in the supine position preoperatively as a baseline. After the patient was placed prone with the neck flexed in position for surgery, iMRI was performed. The patient then underwent a bone decompression of the foramen magnum and arch of C-1, and the MRI was repeated. If obstruction was still present, then in a stepwise fashion the patient underwent dural splitting, duraplasty, and coagulation of the tonsils, with an iMRI study performed after each step guiding the decision to proceed further. RESULTS Eighteen patients underwent PFD for Chiari I malformations between November 2011 and February 2013; 15 prone preincision iMRIs were performed. Fourteen of these patients (93%) demonstrated significant improvement of CSF flow through the foramen magnum dorsal to the tonsils with positioning only. This improvement was so notable that changes in CSF flow as a result of the bone decompression were difficult to discern. CONCLUSIONS The authors observed significant CSF flow changes when simply positioning the patient for surgery. These results put into question intraoperative flow assessments that suggest adequate decompression by PFD, whether by iMRI or intraoperative ultrasound. The use of intraoperative imaging during PFD for Chiari I malformation, whether by ultrasound or iMRI, is limited by CSF flow dynamics across the foramen magnum that change significantly when the patient is

  2. Language areas involving the inferior temporal cortex on intraoperative mapping in a bilingual patient with glioblastoma.

    PubMed

    Kin, Hidehiro; Ishikawa, Eiichi; Takano, Shingo; Ayuzawa, Satoshi; Matsushita, Akira; Muragaki, Yoshihiro; Aiyama, Hitoshi; Sakamoto, Noriaki; Yamamoto, Tetsuya; Matsumura, Akira

    2013-01-01

    A 40-year-old bilingual man underwent removal of glioblastoma multiforme with intraoperative language mapping, mainly using the picture-naming and auditory responsive-naming tasks under cortical stimulation. Multiple language areas were identified, including one located in the middle of the inferior temporal cortex (ITC). Individual mapping for glioma patients must be performed because language areas might be located in various and unexpected regions, including the ITC.

  3. Effects of intraoperative single bolus fentanyl administration and remifentanil infusion on postoperative nausea and vomiting

    PubMed Central

    Lim, Hyungsun; Doo, A Ram; Son, Ji-Seon; Kim, Jin-Wan; Lee, Ki-Jae; Kim, Dong-Chan

    2016-01-01

    Background Although the use of postoperative opioids is a well-known risk factor for postoperative nausea and vomiting (PONV), few studies have been performed on the effects of intraoperative opioids on PONV. We examined the effects of a single bolus administration of fentanyl during anesthesia induction and the intraoperative infusion of remifentanil on PONV. Methods Two hundred and fifty women, aged 20 to 65 years and scheduled for thyroidectomy, were allocated to a control group (Group C), a single bolus administration of fentanyl 2 µg/kg during anesthesia induction (Group F), or 2 ng/ ml of effect-site concentration-controlled intraoperative infusion of remifentanil (Group R) groups. Anesthesia was maintained with sevoflurane and 50% N2O. The incidence and severity of PONV and use of rescue antiemetics were recorded at 2, 6, and 24 h postoperatively. Results Group F showed higher incidences of nausea (60/82, 73% vs. 38/77, 49%; P = 0.008), vomiting (40/82, 49% vs. 23/77 30%; P = 0.041) and the use of rescue antiemetics (47/82, 57% vs. 29/77, 38%; P = 0.044) compared with Group C at postoperative 24 h. However, there were no significant differences in the incidence of PONV between Groups C and R. The overall incidences of PONV for postoperative 24 h were 49%, 73%, and 59% in Groups C, F, and R, respectively (P = 0.008). Conclusions A single bolus administration of fentanyl 2 µg/kg during anesthesia induction increases the incidence of PONV, but intraoperative remifentanil infusion with 2 ng/ml effect-site concentration did not affect the incidence of PONV. PMID:26885302

  4. Pose-independent surface matching for intra-operative soft-tissue marker-less registration.

    PubMed

    dos Santos, Thiago Ramos; Seitel, Alexander; Kilgus, Thomas; Suwelack, Stefan; Wekerle, Anna-Laura; Kenngott, Hannes; Speidel, Stefanie; Schlemmer, Heinz-Peter; Meinzer, Hans-Peter; Heimann, Tobias; Maier-Hein, Lena

    2014-10-01

    One of the main challenges in computer-assisted soft tissue surgery is the registration of multi-modal patient-specific data for enhancing the surgeon's navigation capabilities by observing beyond exposed tissue surfaces. A new approach to marker-less guidance involves capturing the intra-operative patient anatomy with a range image device and doing a shape-based registration. However, as the target organ is only partially visible, typically does not provide salient features and underlies severe non-rigid deformations, surface matching in this context is extremely challenging. Furthermore, the intra-operatively acquired surface data may be subject to severe systematic errors and noise. To address these issues, we propose a new approach to establishing surface correspondences, which can be used to initialize fine surface matching algorithms in the context of intra-operative shape-based registration. Our method does not require any prior knowledge on the relative poses of the input surfaces to each other, does not rely on the detection of prominent surface features, is robust to noise and can be used for overlapping surfaces. It takes into account (1) similarity of feature descriptors, (2) compatibility of multiple correspondence pairs, as well as (3) the spatial configuration of the entire correspondence set. We evaluate the algorithm on time-of-flight (ToF) data from porcine livers in a respiratory liver motion simulator. In all our experiments the alignment computed from the established surface correspondences yields a registration error below 1cm and is thus well suited for initializing fine surface matching algorithms for intra-operative soft-tissue registration. PMID:25038492

  5. Clinical implementation of intraoperative cone-beam CT in head and neck surgery

    NASA Astrophysics Data System (ADS)

    Daly, M. J.; Chan, H.; Nithiananthan, S.; Qiu, J.; Barker, E.; Bachar, G.; Dixon, B. J.; Irish, J. C.; Siewerdsen, J. H.

    2011-03-01

    A prototype mobile C-arm for cone-beam CT (CBCT) has been translated to a prospective clinical trial in head and neck surgery. The flat-panel CBCT C-arm was developed in collaboration with Siemens Healthcare, and demonstrates both sub-mm spatial resolution and soft-tissue visibility at low radiation dose (e.g., <1/5th of a typical diagnostic head CT). CBCT images are available ~15 seconds after scan completion (~1 min acquisition) and reviewed at bedside using custom 3D visualization software based on the open-source Image-Guided Surgery Toolkit (IGSTK). The CBCT C-arm has been successfully deployed in 15 head and neck cases and streamlined into the surgical environment using human factors engineering methods and expert feedback from surgeons, nurses, and anesthetists. Intraoperative imaging is implemented in a manner that maintains operating field sterility, reduces image artifacts (e.g., carbon fiber OR table) and minimizes radiation exposure. Image reviews conducted with surgical staff indicate bony detail and soft-tissue visualization sufficient for intraoperative guidance, with additional artifact management (e.g., metal, scatter) promising further improvements. Clinical trial deployment suggests a role for intraoperative CBCT in guiding complex head and neck surgical tasks, including planning mandible and maxilla resection margins, guiding subcranial and endonasal approaches to skull base tumours, and verifying maxillofacial reconstruction alignment. Ongoing translational research into complimentary image-guidance subsystems include novel methods for real-time tool tracking, fusion of endoscopic video and CBCT, and deformable registration of preoperative volumes and planning contours with intraoperative CBCT.

  6. Intraoperative finding of gross lymph node metastasis during robot-assisted prostatectomy.

    PubMed

    Jeong, Wooju; Sukumar, Shyam; Petros, Firas; Menon, Mani; Peabody, James O; Rogers, Craig G

    2012-12-01

    Discovery of macroscopically positive lymph nodes (LN) during radical prostatectomy for clinically localized prostate cancer (PCa) is a rare event. We describe our experience of intraoperative finding of grossly positive LN during radical prostatectomy and evaluate outcomes and predictors. A total of 4,480 patients underwent robot-assisted radical prostatectomy (RARP) for clinically localized PCa from 2001 to 2010, and pelvic LN dissection was performed in 4,090 of these patients (91.3%). Patients with macroscopically positive LN discovered and confirmed intraoperatively were assessed, as was surgical decision (abort versus continue RARP). Patients with macroscopic LN-positive disease were also evaluated and oncologic outcomes were compared with patients with microscopic LN-positive disease on final pathology. LN-positive disease was found at final pathology in 87 patients (2.1%), of whom 13 (14.9%) had grossly abnormal LN confirmed intraoperatively by frozen section. RARP was aborted in nine cases and completed in four patients. All patients received adjuvant therapy with hormonal deprivation and/or radiation. Two patients in the aborted RARP subset died of PCa. All patients who underwent completion RARP are still alive at a mean follow-up of 57.2 months with one patient still alive at 95 months. Patients with macroscopically positive LN had a higher median preoperative prostate serum antigen (PSA) (17.2 vs. 6.7 μg/L, P = 0.002) and were more likely have biopsy perineural invasion (77.8 vs. 32.4%, P = 0.012). Intraoperative findings of macroscopically positive LN during RARP is a rare event that may occur in high-risk patients, particularly in those with a high PSA and biopsy perineural invasion. Long-term survival is possible after completion RARP. PMID:27628473

  7. Intraoperative detection and elimination of microscopic tumors in head and neck (Conference Presentation)

    NASA Astrophysics Data System (ADS)

    Lukianova-Hleb, Ekaterina Y.; Kim, Yoo-Shin; Belatsarkouski, Ihar; Hanna, Ehab Y.; Gillenwater, Ann M.; O'Neill, Brian; Lapotko, Dmitri

    2016-02-01

    Failure of cancer surgery to intraoperatively detect and eliminate microscopic residual disease (MRD) causes lethal recurrence and metastases, whereas removal of important normal tissues causes excessive morbidity. We report plasmonic nanobubble (PNB) surgical technology to intraoperatively detect and eliminate MRD in surgical bed. PNBs were generated in vivo in head and neck cancer cells by systemically targeting tumor with gold colloids and locally-applied near-infrared low energy short laser pulse, and were simultaneously detected with acoustic probe. In mouse models of head and neck squamous cell carcinoma, single cancer cells and MRD (undetectable with standard histological methods) were instantaneously non-invasively detected in solid tissue in surgical bed. In resectable MRD, PNB-guided surgery prevented local recurrence and delivered 100% tumor-free survival. In unresectable MRD, PNB nano-surgery improved survival by two-fold compared to standard surgery. PNB metrics correlated with the tumor recurrence rate. PNB surgical technology precisely detects and immediately eliminates MRD at macro- and micro-scale in a simple and safe intraoperative procedure.

  8. Use of multimodal intra-operative monitoring in averting nerve injury during complex hip surgery.

    PubMed

    Sutter, M; Hersche, O; Leunig, M; Guggi, T; Dvorak, J; Eggspuehler, A

    2012-02-01

    Peripheral nerve injury is an uncommon but serious complication of hip surgery that can adversely affect the outcome. Several studies have described the use of electromyography and intra-operative sensory evoked potentials for early warning of nerve injury. We assessed the results of multimodal intra-operative monitoring during complex hip surgery. We retrospectively analysed data collected between 2001 and 2010 from 69 patients who underwent complex hip surgery by a single surgeon using multimodal intra-operative monitoring from a total pool of 7894 patients who underwent hip surgery during this period. In 24 (35%) procedures the surgeon was alerted to a possible lesion to the sciatic and/or femoral nerve. Alerts were observed most frequently during peri-acetabular osteotomy. The surgeon adapted his approach based on interpretation of the neurophysiological changes. From 69 monitored surgical procedures, there was only one true positive case of post-operative nerve injury. There were no false positives or false negatives, and the remaining 68 cases were all true negative. The sensitivity for predicting post-operative nerve injury was 100% and the specificity 100%. We conclude that it is possible and appropriate to use this method during complex hip surgery and it is effective for alerting the surgeon to the possibility of nerve injury.

  9. Intraoperative Neural Response Telemetry and Neural Recovery Function: a Comparative Study between Adults and Children.

    PubMed

    Carvalho, Bettina; Hamerschmidt, Rogerio; Wiemes, Gislaine

    2015-01-01

    Introduction Neural response telemetry (NRT) is a method of capturing the action potential of the distal portion of the auditory nerve in cochlear implant (CI) users, using the CI itself to elicit and record the answers. In addition, it can also measure the recovery function of the auditory nerve (REC), that is, the refractory properties of the nerve. It is not clear in the literature whether the responses from adults are the same as those from children. Objective To compare the results of NRT and REC between adults and children undergoing CI surgery. Methods Cross-sectional, descriptive, and retrospective study of the results of NRT and REC for patients undergoing IC at our service. The NRT is assessed by the level of amplitude (microvolts) and REC as a function of three parameters: A (saturation level, in microvolts), t0 (absolute refractory period, in seconds), and tau (curve of the model function), measured in three electrodes (apical, medial, and basal). Results Fifty-two patients were evaluated with intraoperative NRT (26 adults and 26 children), and 24 with REC (12 adults and 12 children). No statistically significant difference was found between intraoperative responses of adults and children for NRT or for REC's three parameters, except for parameter A of the basal electrode. Conclusion The results of intraoperative NRT and REC were not different between adults and children, except for parameter A of the basal electrode. PMID:25992145

  10. Rapid immunohistochemistry based on alternating current electric field for intraoperative diagnosis of brain tumors.

    PubMed

    Tanino, Mishie; Sasajima, Toshio; Nanjo, Hiroshi; Akesaka, Shiori; Kagaya, Masami; Kimura, Taichi; Ishida, Yusuke; Oda, Masaya; Takahashi, Masataka; Sugawara, Taku; Yoshioka, Toshiaki; Nishihara, Hiroshi; Akagami, Yoichi; Goto, Akiteru; Minamiya, Yoshihiro; Tanaka, Shinya

    2015-01-01

    Rapid immunohistochemistry (R-IHC) can contribute to the intraoperative diagnosis of central nervous system (CNS) tumors. We have recently developed a new IHC method based on an alternating current electric field to facilitate the antigen-antibody reaction. To ensure the requirement of R-IHC for intraoperative diagnosis, 183 cases of CNS tumors were reviewed regarding the accuracy rate of diagnosis without R-IHC. The diagnostic accuracy was 90.7 % (166/183 cases) [corrected] in which definitive diagnoses were not provided in 17 cases because of the failure of glioma grading and differential diagnosis of lymphoma and glioma. To establish the clinicopathological application, R-IHC for frozen specimens was compared with standard IHC for permanent specimens. 33 gliomas were analyzed, and the Ki-67/MIB-1 indices of frozen specimens by R-IHC were consistent with the grade and statistically correlated with those of permanent specimens. Thus, R-IHC provided supportive information to determine the grade of glioma. For discrimination between glioma and lymphoma, R-IHC was able to provide clear results of CD20 and Ki-67/MIB-1 in four frozen specimens of CNS lymphoma as well as standard IHC. We conclude that the R-IHC for frozen specimens can provide important information for intraoperative diagnosis of CNS tumors.

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

    NASA Astrophysics Data System (ADS)

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

    2009-02-01

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

  12. Quantitative validation of a method for correction of intraoperative brain shift

    NASA Astrophysics Data System (ADS)

    Bates, Lisa M.; Goerss, Stephan J.; Robb, Richard A.

    2000-05-01

    Stereotactic neuronavigational systems have demonstrated significant clinical influence during the past decade, and are being used in an increasing number of neurosurgical procedures. Pre-operatively acquired 3D images are used for planning purposes, and also are employed in intraoperative navigations to help localize and resect brain lesions. However, as the operation progresses, multiple factors contribute the changes that limit the accuracy of the navigation based on pore-operative images alone. The opening of the dura with the associated loss of CSF and cortical swelling, the effect of gravity relative to the craniotomy location, tumor decompression, and collapse of neural tissue around the operative site are some of the factors that contribute to errors in navigation, particularly navigation based solely on pre-operatively acquired images. Neuronavigational system assume a one-to-one correlation between patient anatomy in the operating room and the pre- operatively acquired MRI images. Since the brain deforms in a non-linear manner, intraoperative brain shift can really only be corrected via intraoperative sensing methods that effectively update the pre-operatively acquired image data during surgery.

  13. Intraoperative Neural Response Telemetry and Neural Recovery Function: a Comparative Study between Adults and Children

    PubMed Central

    Carvalho, Bettina; Hamerschmidt, Rogerio; Wiemes, Gislaine

    2014-01-01

    Introduction Neural response telemetry (NRT) is a method of capturing the action potential of the distal portion of the auditory nerve in cochlear implant (CI) users, using the CI itself to elicit and record the answers. In addition, it can also measure the recovery function of the auditory nerve (REC), that is, the refractory properties of the nerve. It is not clear in the literature whether the responses from adults are the same as those from children. Objective To compare the results of NRT and REC between adults and children undergoing CI surgery. Methods Cross-sectional, descriptive, and retrospective study of the results of NRT and REC for patients undergoing IC at our service. The NRT is assessed by the level of amplitude (microvolts) and REC as a function of three parameters: A (saturation level, in microvolts), t0 (absolute refractory period, in seconds), and tau (curve of the model function), measured in three electrodes (apical, medial, and basal). Results Fifty-two patients were evaluated with intraoperative NRT (26 adults and 26 children), and 24 with REC (12 adults and 12 children). No statistically significant difference was found between intraoperative responses of adults and children for NRT or for REC's three parameters, except for parameter A of the basal electrode. Conclusion The results of intraoperative NRT and REC were not different between adults and children, except for parameter A of the basal electrode. PMID:25992145

  14. In vivo dosimetry with MOSFETs: Dosimetric characterization and first clinical results in intraoperative radiotherapy

    SciTech Connect

    Consorti, Rita . E-mail: consort@tin.it; Petrucci, Assunta; Fortunato, Falbo; Soriani, Antonella; Marzi, Simona; Iaccarino, Giuseppe; Landoni, Valeria; Benassi, Marcello

    2005-11-01

    Purpose: To investigate the use of metal oxide silicon field effect transistors (MOSFETs) as in vivo dosimetry detectors during electron beams at high dose-per-pulse intraoperative radiotherapy. Methods and Materials: The MOSFET system response in terms of reproducibility, energy, dose rate and temperature dependence, dose-linearity from 1 to 25 Gy, angular response, and dose perturbation was analyzed in the 6-9-MeV electron beam energy range produced by an intraoperative radiotherapy-dedicated mobile accelerator. We compared these with the 6- and 9-MeV electron beams produced by a conventional accelerator. MOSFETs were also used in clinical dosimetry. Results: In experimental conditions, the overall uncertainty of the MOSFET response was within 3.5% ({+-}SD). The investigated electron energies and the dose rate did not significantly influence the MOSFET calibration factors. The dose perturbation was negligible. In vivo dosimetry results were in accordance with the predicted values within {+-}5%. A discordance occurred either for an incorrect position of the dosimeter on the patient or when a great difference existed between the clinical and calibration setup, particularly when performing exit dose measurements. Conclusion: Metal oxide silicon field effect transistors are suitable for in vivo dosimetry during intraoperative radiotherapy because their overall uncertainty is comparable to the accuracy required in target dose delivery.

  15. Intraoperative magnetic resonance imaging and magnetic resonance imaging-guided therapy for brain tumors.

    PubMed

    Jolesz, Ferenc A; Talos, Ion-Florin; Schwartz, Richard B; Mamata, Hatsuho; Kacher, Daniel F; Hynynen, Kullervo; McDannold, Nathan; Saivironporn, Pairash; Zao, Lei

    2002-11-01

    Since their introduction into surgical practice in the mid 1990s, intraoperative MRI systems have evolved into essential, routinely used tools for the surgical treatment of brain tumors in many centers. Clear delineation of the lesion, "under-the-surface" vision, and the possibility of obtaining real-time feedback on the extent of resection and the position of residual tumor tissue (which may change during surgery due to "brain-shift") are the main strengths of this method. High-performance computing has further extended the capabilities of intraoperative MRI systems, opening the way for using multimodal information and 3D anatomical reconstructions, which can be updated in "near real time." MRI sensitivity to thermal changes has also opened the way for innovative, minimally invasive (LASER ablations) as well as noninvasive therapeutic approaches for brain tumors (focused ultrasound). Although we have not used intraoperative MRI in clinical applications sufficiently long to assess long-term outcomes, this method clearly enhances the ability of the neurosurgeon to navigate the surgical field with greater accuracy, to avoid critical anatomic structures with greater efficacy, and to reduce the overall invasiveness of the surgery itself.

  16. Intraoperative magnetic resonance for the surgical treatment of lesions producing seizures.

    PubMed

    Walker, David G; Talos, Florin; Bromfield, Edward B; Black, Peter McL

    2002-09-01

    Seizures are a major presenting feature of several non-neoplastic cerebral lesions. We reviewed the experience at the Brigham and Women's Hospital, Boston, on the surgical management of benign intracerebral lesions presenting with seizures with intraoperative magnetic resonance imaging (iMRI) guidance. Our aim was to demonstrate that this is an effective and efficient treatment for these lesions. The histories of thirteen patients who presented with seizures secondary to benign intraaxial lesions treated by craniotomy and resection within the iMRI unit at our institution were reviewed. The surgical results, histology and clinical outcomes were reviewed. The mean follow-up was 22.1 months (range 2-48). In all cases, lesions were accurately located with iMRI. After initial macroscopic resection, 5 cases were found to have residual lesion. All had complete radiological resection at the end of the procedure. At follow-up, five patients had no seizures, 5 had rare seizures and the remaining 3 had worthwhile improvement in seizure frequency. Intraoperative MRI is a safe and effective adjunct for the surgical treatment of benign intracerebral lesions presenting with seizures. It provides effective and efficient intraoperative guidance for planning and approach to the lesion and the assurance that the lesion is totally removed. Surgical resection with iMRI may, therefore, provide a useful approach to these lesions.

  17. Photoacoustic intra-operative nodal staging using clinically approved superparamagnetic iron oxide nanoparticles

    NASA Astrophysics Data System (ADS)

    Grootendorst, Diederik J.; Fratila, Raluca M.; Visscher, Martijn; Ten Haken, Bennie; van Wezel, Richard; Steenbergen, Wiendelt; Manohar, Srirang; Ruers, Theo J. M.

    2013-02-01

    Detection of tumor metastases in the lymphatic system is essential for accurate staging of various malignancies, however fast, accurate and cost-effective intra-operative evaluation of the nodal status remains difficult to perform with common available medical imaging techniques. In recent years, numerous studies have confirmed the additional value of superparamagnetic iron oxide dispersions (SPIOs) for nodal staging purposes, prompting the clearance of different SPIO dispersions for clinical practice. We evaluate whether a combination of photoacoustic (PA) imaging and a clinically approved SPIO dispersion, could be applied for intra-operative nodal staging. Metastatic adenocarcinoma was inoculated in Copenhagen rats for 5 or 8 days. After SPIO injection, the lymph nodes were photoacoustically imaged both in vivo and ex vivo whereafter imaging results were correlated with MR and histology. Results were compared to a control group without tumor inoculation. In the tumor groups clear irregularities, as small as 1 mm, were observed in the PA contrast pattern of the nodes together with an decrease of PA response. These irregularities could be correlated to the absence of contrast in the MR images and could be linked to metastatic deposits seen in the histological slides. The PA and MR images of the control animals did not show these features. We conclude that the combination of photoacoustic imaging with a clinically approved iron oxide nanoparticle dispersion is able to detect lymph node metastases in an animal model. This approach opens up new possibilities for fast intra-operative nodal staging in a clinical setting.

  18. Intra-operative micro-electrode recording in functional neurosurgery: Past, present, future.

    PubMed

    Maiti, Tanmoy K; Konar, Subhas; Bir, Shyamal; Kalakoti, Piyush; Nanda, Anil

    2016-10-01

    The field of functional neurosurgery has experienced a rise, fall and lastly a renaissance over the past 75years. Micro-electrode recording (MER) played a key role during this eventful journey. However, as the intra-operative MRI continues to evolve, a pertinent question about the utility of MER has been raised in recent years. In this article, we critically review these current controversies. The English literature is reviewed and the complex technique of MER is discussed in a simplified manner. The improvement of neuroimaging and its application in functional neurosurgery, especially in deep brain stimulation, is discussed. Finally, the current controversies and technical advances which can direct the future are reviewed. The results of existing meta-analyses addressing the controversies are summarized. Wide variations of pre-operative and intra-operative targeting methods have been described in the literature. Though functional neurosurgery is generally safe, complications do occur and multiple passes during MER can certainly add to the risk of inadvertent hemorrhage and infection. Additionally, the recent introduction of newer MRI modalities has ensured better delineation of the target. However, MER is still useful to address brain shift, for mapping of newer targets, for ablative surgeries and in centers without an intra-operative imaging facility. In the current scenario, it is nearly impossible to conduct a prospective study to decide the utility of MER. The importance of MER may further diminish in the future as a routine procedure, but its role as a gold standard procedure may still persist.

  19. Intraoperative Perfusion Computed Tomography in Carotid Endarterectomy: Initial Experience in 16 Cases

    PubMed Central

    Xue, Zhe; Peng, Dingwei; Sun, Zhenghui; Wu, Chen; Xu, Bainan; Wang, Fuyu; Zhou, Dingbiao; Dong, Tianxiang

    2016-01-01

    Background This study aimed to evaluate the changes in perfusion computed tomography (PCT) parameters in carotid endarterectomy (CEA), and to discuss the use of intraoperative PCT in CEA. Material/Methods Sixteen patients with carotid stenosis who also underwent CEA with intraoperative CT were recruited in this study. We calculated quantitative data on cerebral blood flow (CBF), cerebral blood volume (CBV), time to peak (TTP), and the relative parameter values, including relative CBF (rCBF), relative CBV (rCBV), and relative TTP (rTTP). The role of PCT was assessed and compared to conventional monitoring methods. Results There were no significant differences in any of the parameters in the anterior cerebral artery (ACA) territory (P>0.05). In the middle cerebral artery (MCA) territory, the CBF and CBV increased and TTP decreased in the operated side during CEA; the rCBF and rCBV increased and the rTTP decreased significantly (P<0.05). In 16 patients, CT parameters were improved, SSEP was normal, and MDU was abnormal. In 3 patients, CBF increased by more than 70% during CEA. Relative PCT parameters are sensitive indicators for detecting early cerebral hemodynamic changes during CEA. Cerebral hemodynamics changed significantly in the MCA territory during CEA. Conclusions Intraoperative PCT could be an important adjuvant monitoring method in CEA. PMID:27657307

  20. The relationship between preoperative tympanograms and intraoperative ear examination results in children.

    PubMed

    Knopke, Steffen; Irune, Ekpemi; Olze, Heidi; Bast, Florian

    2015-12-01

    The tympanogram is an objective audiological method in adults and children which is often used in the evaluation of middle ear pathology. This should be alongside a thorough patient history and clinical examination prior to the decision to carry out a paracentesis or tympanostomy tube insertion. The goal of the study was to evaluate the relationship between the preoperative tympanogram and intraoperative ear examination results or middle ear findings. The retrospective study included 654 ears in 333 patients who underwent paracentesis with or without tympanostomy tube insertion between January and December 2011. The study cohort consisted of 206 male and 127 female patients with an average age of 3.7 ± 2.5 years. The results of the preoperative tympanogram were compared to those of the intraoperative ear findings. In 18.4 % of ears with a flat tympanogram, an air-filled middle ear was found intraoperatively (p < 0.01). Thus, tympanometry results cannot serve as the only indication for surgical intervention. A decision to treat should always be based on the merits of the symptomatology of the patient in conjunction with tympanometry findings.

  1. Intraoperative Pachymetry Using Spectral-Domain Optical Coherence Tomography during Accelerated Corneal Collagen Crosslinking

    PubMed Central

    Chow, Vanissa W. S.; Biswas, Sayantan; Yu, Marco; Wong, Victoria W. Y.; Jhanji, Vishal

    2013-01-01

    Purpose. To evaluate the role of spectral-domain optical coherence tomography (SDOCT) to measure corneal thickness during accelerated corneal crosslinking (CXL). Methods. Intraoperative pachymetry was performed using SDOCT and ultrasound pachymetry (USP) in 6 eyes of 6 patients with keratoconus. Pachymetry readings were obtained at baseline, after epithelium removal and after 30 minutes of riboflavin instillation. SDOCT measurements of eyes with and without lid speculum during riboflavin instillation were compared. Results. There was no statistically significant difference in central corneal thickness (CCT) measurements between SDOCT and USP (P > 0.05 for all). A significant decrease in both CCT (P = 0.031) and the thinnest corneal thickness (TCT) (P = 0.031) was observed during CXL. There was a greater reduction in CCT (38 ± 6%) with the use of lid speculum as compared to the no-speculum eyes (18 ± 9%) (P = 0.100). TCT was also reduced by a greater extent with the use of lid speculum (40 ± 5% versus 26 ± 7%; P = 0.100). Conclusion. SDOCT can be successfully used to measure intraoperative corneal pachymetry during corneal CXL. SDOCT measurements demonstrated corneal thinning intraoperatively during CXL, which was further accentuated by the use of a lid speculum during the procedure. PMID:23984411

  2. Intraoperative Vagus Nerve Monitoring: A Transnasal Technique during Skull Base Surgery

    PubMed Central

    Schutt, Christopher A.; Paskhover, Boris; Judson, Benjamin L.

    2014-01-01

    Objectives Intraoperative vagus nerve monitoring during skull base surgery has been reported with the use of an oral nerve monitoring endotracheal tube. However, the intraoral presence of an endotracheal tube can limit exposure by its location in the operative field during transfacial approaches and by limiting superior mobilization of the mandible during transcervical approaches. We describe a transnasal vagus nerve monitoring technique. Design and Participants Ten patients underwent open skull base surgery. Surgical approaches included transcervical (five), transfacial/maxillary swing (three), and double mandibular osteotomy (two). The vagus nerve was identified, stimulated, and monitored in all cases. Main Outcome Measures Intraoperative nerve stimulation, pre- and postoperative vagus nerve function through the use of flexible laryngoscopy in conjunction with assessment of subjective symptoms of hoarseness, voice change, and swallowing difficulty. Results Three patients had extensive involvement of the nerve by tumor with complete postoperative nerve deficit, one patient had a transient deficit following dissection of tumor off of nerve with resolution, and the remaining patients had nerve preservation. One patient experienced minor epistaxis during monitor tube placement that was managed conservatively. Conclusions Transnasal vagal nerve monitoring is a simple method that allows for intraoperative monitoring during nerve preservation surgery without limiting surgical exposure. PMID:25844292

  3. Intraoperative Fluid Excess Is a Risk Factor for Pancreatic Fistula after Partial Pancreaticoduodenectomy

    PubMed Central

    Kortendieck, Veronika; Raab, Hans-Rudolf; Antolovic, Dalibor

    2016-01-01

    Background. After pancreaticoduodenectomy (PD), pancreatic fistulas (PF) are a frequent complication. Infusions may compromise anastomotic integrity. This retrospective analysis evaluated associations between intraoperative fluid excess and PF. Methods. Data on perioperative parameters including age, sex, laboratory findings, histology, infusions, surgery time, and occurrence of grade B/C PF was collected from all PD with pancreaticojejunostomy (PJ) performed in our department from 12/2011 till 02/2015. The glomerular filtration rate (GFR), infusion rate, and the ratio of both and its association with PF were calculated. ROC analysis was employed to identify a threshold. Results. Complete datasets were available for 83 of 86 consecutive cases. Median age was 66 years (34–84; 60% male), GFR was 93 mL/min (IQR 78–113), and surgery time was 259 min (IQR 217–307). Intraoperatively, 13.6 mL/min (7–31) was infused. In total, n = 18 (21%) PF occurred. When the infusion : GFR ratio exceeded 0.15, PF increased from 11% to 34% (p = 0.0157). No significant association was detected for any of the other parameters. Conclusions. This analysis demonstrates for the first time an association between intraoperative fluid excess and PF after PD with PJ even in patients with normal renal function. A carefully patient-adopted fluid management with due regard to renal function may help to prevent postoperative PF. PMID:27738384

  4. Intraoperative use of cone-beam computed tomography in a cadaveric ossified cochlea model

    PubMed Central

    Barker, Emma; Trimble, Keith; Chan, Harley; Ramsden, James; Nithiananthan, Sajendra; James, Adrian; Bachar, Gideon; MikeDaly; Irish, Jonathan; Siewerdsen, Jeff

    2010-01-01

    Objectives To describes a cadaveric temporal bone model of labyrinthitis ossificans and investigate the utility of intra-operative C-arm computed tomography (CBCT) in facilitating cochlear implantation. Design Cadaveric temporal bone study. Methods Five cadaveric heads had cement introduced into the 10 cochleas. CBCT and a conventional CT scans were compared to asses the extent of cochlear obliteration. The cement was drilled-out (under CBCT guidance, if required) and a cochlear implant electrode arrays (from 3 different manufacturers) inserted. Results CBCT images demonstrated temporal bone anatomy and the extent of cochlear obliteration as clearly as conventional CT in all cases. Intra-operative CBCT guided drilling and facilitated electrode placement in 2 out of 5 heads (3/10 ears). Streak-artifact from the electrodes of two devices partially obscured image clarity. Conclusions The obliterated cochlear model reproduced a disease-ossified cochlear both radiographically and surgically. CBCT is useful for intra-operative imaging, to facilitate electrode array placement in the obliterated or congenitally abnormal cochlea. PMID:19393414

  5. Management of intraoperative fluid balance and blood conservation techniques in adult cardiac surgery.

    PubMed

    Vretzakis, George; Kleitsaki, Athina; Aretha, Diamanto; Karanikolas, Menelaos

    2011-02-01

    Blood transfusions are associated with adverse physiologic effects and increased cost, and therefore reduction of blood product use during surgery is a desirable goal for all patients. Cardiac surgery is a major consumer of donor blood products, especially when cardiopulmonary bypass (CPB) is used, because hematocrit drops precipitously during CPB due to blood loss and blood cell dilution. Advanced age, low preoperative red blood cell volume (preoperative anemia or small body size), preoperative antiplatelet or antithrombotic drugs, complex or re-operative procedures or emergency operations, and patient comorbidities were identified as important transfusion risk indicators in a report recently published by the Society of Cardiovascular Anesthesiologists. This report also identified several pre- and intraoperative interventions that may help reduce blood transfusions, including off-pump procedures, preoperative autologous blood donation, normovolemic hemodilution, and routine cell saver use.A multimodal approach to blood conservation, with high-risk patients receiving all available interventions, may help preserve vital organ perfusion and reduce blood product utilization. In addition, because positive intravenous fluid balance is a significant factor affecting hemodilution during cardiac surgery, especially when CPB is used, strategies aimed at limiting intraoperative fluid balance positiveness may also lead to reduced blood product utilization.This review discusses currently available techniques that can be used intraoperatively in an attempt to avoid or minimize fluid balance positiveness, to preserve the patient's own red blood cells, and to decrease blood product utilization during cardiac surgery. PMID:21345774

  6. Mapping the ‘Depression Switch’ During Intraoperative Testing of Subcallosal Cingulate Deep Brain Stimulation

    PubMed Central

    Choi, Ki Sueng; Riva-Posse, Patricio; Gross, Robert E.; Mayberg, Helen S.

    2016-01-01

    Importance The clinical utility of monitoring behavioral changes during intraoperative testing of acute subcallosal cingulate deep brain stimulation (DBS) is unknown. Objective To characterize structural connectivity correlates of DBS evoked behavioral effects using probabilistic tractography. Design Categorization of acute behavioral effects was conducted during DBS implantation surgery for treatment-resistant depression in a randomized and blinded testing session. Post-hoc analyses of the structural tractography patterns mediating distinct categories of evoked behavioral effects were defined. Setting Intra-operative testing during DBS surgery for depression at Emory University. Participants 9 adult participants with chronic treatment-resistant depression undergoing DBS surgery. Main Outcomes and Measures Categorization of stimulation-induced transient behavioral effects and delineation of the shared white matter tracts mediating response subtypes. Results Two stereotypical behavior patterns were identified: changes in interoceptive (noted changes in body state) and in exteroceptive awareness (shift in attention from patient to others). Structural connectivity showed that ‘best’ responses had a pattern of connections to bilateral ventromedial frontal cortex (via uncinate fasciculus and forceps minor) and cingulate cortex (via cingulum bundle) while ‘salient’ contacts had only cingulate involvement. Conclusions and Relevance This analysis of acute intraoperative behaviors in SCC DBS, and the subsequent identification of unique connectivity patterns may provide a potential biomarker to guide and optimize surgical implantation and to refine and optimize algorithms for selection of contacts in chronic stimulation PMID:26408865

  7. Association of pre and intraoperative variables with postoperative complications in coronary artery bypass graft surgery

    PubMed Central

    Gimenes, Camila; Barrile, Silvia Regina; Martinelli, Bruno; Ronchi, Carlos Fernando; Arca, Eduardo Aguilar; Gimenes, Rodrigo; Okoshi, Marina Politi; Okoshi, Katashi

    2013-01-01

    Objective To associate the pre- and intraoperative variables with postoperative complications of patients undergoing coronary artery bypass graft surgery. Methods The pre- and intraoperative risk factors of individuals of both genders with diagnosis of coronary insufficiency undergoing coronary artery bypass graft have been studied. Results Fifty-eight individuals with median age 62 ± 10 year-old were included in the study, 67% of whom were male. Fourteen (24.1%) patients were smokers, 39 (67.2%) had previous myocardial infarction history, 11 (19%) had undergone coronary angioplasty, 74% had hypertension, 27% had diabetes mellitus, 64% had dyslipidemia and 15.5% had chronic obstructive pulmonary disease. Eighteen (31%) patients presented postoperative complications, most frequent being: infection in surgical incision, difficulties in deambulation, dyspnea, urinary infection and generalized weakness. Male patients had fewer complications than females (P=0.005). Patients with chronic obstructive pulmonary disease remained hospitalized for longer time periods (P=0.019). Postoperative complications occurred in 50% of the patients with creatinine increased, while only 27.1% of the patients with normal value of creatinine had complications (P=0.049). In addition, complications occurred in 50% of the patients with diabetes mellitus, while only 23.8% of patients without diabetes mellitus had complications (P=0.032). The intraoperative factors showed no statistically significant differences. Conclusion The preoperative factors are associated with postoperative complications in patients undergoing coronary artery bypass graft surgery. PMID:24598958

  8. [Application of intraoperative microvascular dopplerography in surgical treatment of arterial aneurysm of the brain].

    PubMed

    Hloba, M V; Lytvak, S O

    2013-10-01

    The possibilities and results of the intraoperative microvascular dopplerography application in microsurgical exclusion of the brain arterial aneurysm (BAA) were estimated. The investigation was conducted during operative intervention in 30 patients, suffering hemorrhagic type of the brain acute blood flow disorder as a consequence of the BAA rupture. In an acute period (the first-14th day) 23 patients were operated, in the early restoration period (after 30th day)--7. Intraoperative express estimation of the blood flow have permitted to diagnose and to correct timely some typical technical complications, in particular, noncomplete BAA exclusion from the blood flow, the arterial lumen, containing the clipped aneurysm, stenosing; to reveal the arterial segments vasospasm objectively in the patients, operated on in an acute period of hemorrhage, and to diagnose a reactive spasm during manipulations on the arteries. All the patients, operated on in the early restoration period and 82.6% of patients, operated on in an acute period of subarachnoidal hemorrhage, have had reconvalesced. Application of the microvascular dopplerography secures objectivization, simplifies intraoperative estimation of the BAA radicality and the according arterial segments passability in the operative intervention zone, what promotes reduction of the ischemic complications rate and positively impacts the results of treatment.

  9. Potential of activatable FAP-targeting immunoliposomes in intraoperative imaging of spontaneous metastases.

    PubMed

    Tansi, Felista L; Rüger, Ronny; Böhm, Claudia; Kontermann, Roland E; Teichgraeber, Ulf K; Fahr, Alfred; Hilger, Ingrid

    2016-05-01

    Despite intensive research and medical advances met, metastatic disease remains the most common cause of death in cancer patients. This results from late diagnosis, poor therapeutic response and undetected micrometastases and tumor margins during surgery. One approach to overcome these challenges involves fluorescence imaging, which exploits the properties of fluorescent probes for diagnostic detection of molecular structures at the onset of transformation and for intraoperative detection of metastases and tumor margins in real time. Considering these benefits, many contrast agents suitable for fluorescence imaging have been reported. However, most reports only demonstrate the detection of primary tumors and not the detection of metastases or their application in models of image-guided surgery. In this work, we demonstrate the influence of fibroblast activation protein (FAP) on the metastatic potential of fibrosarcoma cells and elucidate the efficacy of activatable FAP-targeting immunoliposomes (FAP-IL) for image-guided detection of the spontaneous metastases in mice models. Furthermore, we characterized the biodistribution and cellular localization of the liposomal fluorescent components in mice organs and traced their excretion over time in urine and feces. Taken together, activatable FAP-IL enhances intraoperative imaging of metastases. Their high accumulation in metastases, subsequent localization in the bile canaliculi and liver kupffer cells and suitable excretion in feces substantiates their potency as contrast agents for intraoperative imaging.

  10. Intra-operative micro-electrode recording in functional neurosurgery: Past, present, future.

    PubMed

    Maiti, Tanmoy K; Konar, Subhas; Bir, Shyamal; Kalakoti, Piyush; Nanda, Anil

    2016-10-01

    The field of functional neurosurgery has experienced a rise, fall and lastly a renaissance over the past 75years. Micro-electrode recording (MER) played a key role during this eventful journey. However, as the intra-operative MRI continues to evolve, a pertinent question about the utility of MER has been raised in recent years. In this article, we critically review these current controversies. The English literature is reviewed and the complex technique of MER is discussed in a simplified manner. The improvement of neuroimaging and its application in functional neurosurgery, especially in deep brain stimulation, is discussed. Finally, the current controversies and technical advances which can direct the future are reviewed. The results of existing meta-analyses addressing the controversies are summarized. Wide variations of pre-operative and intra-operative targeting methods have been described in the literature. Though functional neurosurgery is generally safe, complications do occur and multiple passes during MER can certainly add to the risk of inadvertent hemorrhage and infection. Additionally, the recent introduction of newer MRI modalities has ensured better delineation of the target. However, MER is still useful to address brain shift, for mapping of newer targets, for ablative surgeries and in centers without an intra-operative imaging facility. In the current scenario, it is nearly impossible to conduct a prospective study to decide the utility of MER. The importance of MER may further diminish in the future as a routine procedure, but its role as a gold standard procedure may still persist. PMID:27396672

  11. Intraoperative Imaging-Guided Cancer Surgery: From Current Fluorescence Molecular Imaging Methods to Future Multi-Modality Imaging Technology

    PubMed Central

    Chi, Chongwei; Du, Yang; Ye, Jinzuo; Kou, Deqiang; Qiu, Jingdan; Wang, Jiandong; Tian, Jie; Chen, Xiaoyuan

    2014-01-01

    Cancer is a major threat to human health. Diagnosis and treatment using precision medicine is expected to be an effective method for preventing the initiation and progression of cancer. Although anatomical and functional imaging techniques such as radiography, computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) have played an important role for accurate preoperative diagnostics, for the most part these techniques cannot be applied intraoperatively. Optical molecular imaging is a promising technique that provides a high degree of sensitivity and specificity in tumor margin detection. Furthermore, existing clinical applications have proven that optical molecular imaging is a powerful intraoperative tool for guiding surgeons performing precision procedures, thus enabling radical resection and improved survival rates. However, detection depth limitation exists in optical molecular imaging methods and further breakthroughs from optical to multi-modality intraoperative imaging methods are needed to develop more extensive and comprehensive intraoperative applications. Here, we review the current intraoperative optical molecular imaging technologies, focusing on contrast agents and surgical navigation systems, and then discuss the future prospects of multi-modality imaging technology for intraoperative imaging-guided cancer surgery. PMID:25250092

  12. Comparison of intraoperative completion flowmeter versus duplex ultrasonography and contrast arteriography for carotid endarterectomy.

    PubMed

    Winkler, Gabor A; Calligaro, Keith D; Kolakowski, Steven; Doerr, Kevin J; McAffee-Bennett, Sandy; Muller, Kathy; Dougherty, Matthew J

    Intraoperative completion studies of the internal carotid artery following carotid endarterectomy are recommended to ensure technical perfection of the repair. Transit time ultrasound flowmeter does not require trained technicians, requires less time than other completion studies such as duplex ultrasonography and contrast arteriography, and is noninvasive. Flowmetry was compared with duplex ultrasonography and contrast arteriography to determine if the relatively simpler flowmetry could replace these two more widely accepted completion studies in the intraoperative assessment of carotid endarterectomy. Comparative intraoperative assessment was performed in 116 carotid endarterectomies using all three techniques between December 1, 2000 and November 30, 2003. Eversion endarterectomy was performed in 51 cases and standard endarterectomy with prosthetic patching in 65 cases. Patients underwent completion flowmetry, duplex ultrasonography, and contrast arteriography studies of the exposed arteries, which were performed by vascular fellows or senior surgical residents under direct supervision of board-certified vascular surgeons. Duplex ultrasonography surveillance was performed 1 and 6 months postoperatively and annually thereafter. Mean follow-up was 18 months (range, 6-42 months). The combined ipsilateral stroke and death rate was 0%. The mean internal carotid artery flow using flowmetry was 249 mL/min (range, 60-750 mL/min). Five (4.3%) patients had flow < 100 mL/min as measured with flowmetry, but completion contrast arteriography and duplex ultrasonography were normal and none of the arteries were re-explored. One carotid endarterectomy was re-explored based on completion duplex ultrasonography that showed markedly elevated internal carotid artery peak systolic velocity (> 500 cm/sec); however, exploration was normal and completion flowmetry and contrast arteriography were normal. Duplex ultrasonography studies revealed internal carotid artery peak systolic

  13. Intraoperative Schnellschnittuntersuchungen parapylorischer Lymphknoten bei der pyloruserhaltenden Pankreaskopfresektion: Gibt es eine klinische Relevanz?

    PubMed Central

    Riediger, Hartwig; Schulz, Antje; Adam, Ulrich; Krüger, Colin M.

    2014-01-01

    Zusammenfassung Hintergrund Die pyloruserhaltende Pankreaskopfresektion (PPPD) ist als onkologisches Standardverfahren etabliert. Lokal fortgeschrittene Tumoren können eine erweiterte Resektion erforderlich machen. Ebenso soll früheren Arbeiten zufolge bei Tumornachweis in den parapylorischen Lymphknoten (PLK) eine distale Magenresektion im Sinne einer klassischen Whipple-Operation indiziert sein. Entsprechend diesen Empfehlungen haben wir intraoperative Schnellschnittuntersuchungen der PLK in unseren Routineablauf integriert. Im Rahmen dieser Studie haben wir die klinische Relevanz dieses Vorgehens hinterfragt. Methoden Bei 105 onkologischen Patienten im Zeitraum von 2006-2012 bestand die Indikation zur PPPD. In allen Fällen erfolgte eine intraoperative Schnellschnittuntersuchung der PLK. Die Patienten wurden bezüglich Primärtumor, Anzahl der untersuchten Lymphknoten (LK) (gesamt und parapylorisch) sowie Auswirkungen auf das operative Konzept untersucht. Es handelt sich um eine retrospektive Studie, die auf prospektiv erhobenen Daten unserer Pankreasdatenbank basiert. Ergebnisse Die Primärtumoren waren 72 Pankreaskopfkarzinome und 33 extrapankreatische Karzinome (Gallengangskarzinom, Ampullenkarzinom, Duodenalkarzinom). 73 Patienten waren nodalpositiv. Insgesamt wurden 2391 LK untersucht, von denen 325 parapylorisch lokalisiert waren. Die intraoperative Schnellschnittuntersuchung erbrachte lediglich bei 4 Patienten mit Pankreaskopfkarzinom jeweils einen positiven PLK; daraufhin erfolgte eine distale Magenresektion. In keinem der distalen Magenresektate waren Tumorresiduen nachweisbar. Lokale chirurgisch-technische Probleme im Sinne von Durchblutungsstörungen des Magens ergaben sich durch die regionale Lymphadenektomie nicht. PLK waren nur beim Pankreaskarzinom positiv. In der Subgruppe der nodalpositiven Patienten mit Pankreaskopfkarzinom hatten 8% der Patienten einen positiven PLK. Schlussfolgerung Die regionale parapylorische Lymphadenektomie ist beim

  14. A novel and stable approach to anatomical structure morphing for enhanced intraoperative 3D visualization

    NASA Astrophysics Data System (ADS)

    Rajamani, Kumar T.; Gonzalez Ballester, Miguel A.; Nolte, Lutz-Peter; Styner, Martin

    2005-04-01

    The use of three dimensional models in planning and navigating computer assisted surgeries is now well established. These models provide intuitive visualization to the surgeons contributing to significantly better surgical outcomes. Models obtained from specifically acquired CT scans have the disadvantage that they induce high radiation dose to the patient. In this paper we propose a novel and stable method to construct a patient-specific model that provides an appropriate intra-operative 3D visualization without the need for a pre or intra-operative imaging. Patient specific data consists of digitized landmarks and surface points that are obtained intra-operatively. The 3D model is reconstructed by fitting a statistical deformable model to the minimal sparse digitized data. The statistical model is constructed using Principal Component Analysis from training objects. Our morphing scheme efficiently and accurately computes a Mahalanobis distance weighted least square fit of the deformable model to the 3D data model by solving a linear equation system. Relaxing the Mahalanobis distance term as additional points are incorporated enables our method to handle small and large sets of digitized points efficiently. Our novel incorporation of M-estimator based weighting of the digitized points enables us to effectively reject outliers and compute stable models. Normalization of the input model data and the digitized points makes our method size invariant and hence applicable directly to any anatomical shape. The method also allows incorporation of non-spatial data such as patient height and weight. The predominant applications are hip and knee surgeries.

  15. Targeted intraoperative radiotherapy (TARGIT) yields very low recurrence rates when given as a boost

    SciTech Connect

    Vaidya, Jayant S. . E-mail: j.s.vaidya@dundee.ac.uk; Baum, Michael; Tobias, Jeffrey S.; Massarut, Samuele; Wenz, Frederik; Murphy, Olive; Hilaris, Basil; Houghton, Joan B.Sc.; Saunders, Christobel; Corica, Tammy; Roncadin, Mario; Kraus-Tiefenbacher, Uta; Melchaert, Frank; Keshtgar, Mohammed; Sainsbury, Richard; Douek, Michael; Harrison, Elly; Thompson, Alastair; Joseph, David

    2006-12-01

    Purpose: Patients undergoing breast-conserving surgery were offered boost radiotherapy with targeted intraoperative radiotherapy (TARGIT) using the Intrabeam system to test the feasibility, safety, and efficacy of the new approach. Methods and Materials: We treated 302 cancers in 301 unselected patients. This was not a low-risk group. One-third of patients (98/301) were younger than 51 years of age. More than half of the tumors (172, 57%) were between 1 cm and 2 cm, and one-fifth (62, 21%) were >2 cm; 29% (86) had a Grade 3 tumor and, in 29% (87), axillary lymph nodes contained metastasis. After primary surgery, 20 Gy was delivered intraoperatively to the surface of the tumor bed, followed by external-beam radiotherapy (EBRT), but excluding the usual boost. Results: The treatment was well tolerated. The follow-up ranged from 3 to 80 months (164 and 90 patients completed 2 and 3 years follow-up, respectively). Four patients (1.3%) had local recurrence. The Kaplan-Meier estimate of local recurrence is 2.6% (SE = 1.7) at 5 years. This compares favorably with the 4.3% recurrence rate in boosted patients from the EORTC boost study, in which only 8.1% patients were node-positive, as opposed to 29% in our series. Conclusion: Targeted intraoperative radiotherapy combined with EBRT results in a low local recurrence rate. This could be attributed to both accurate targeting and timeliness of the treatment. These data support the need for a randomized trial to test whether the TARGIT boost is superior to conventional external boost, especially in high-risk women.

  16. Usefulness of intraoperative monitoring of visual evoked potentials in transsphenoidal surgery.

    PubMed

    Kamio, Yoshinobu; Sakai, Naoto; Sameshima, Tetsuro; Takahashi, Goro; Koizumi, Shinichiro; Sugiyama, Kenji; Namba, Hiroki

    2014-01-01

    Postoperative visual outcome is a major concern in transsphenoidal surgery (TSS). Intraoperative visual evoked potential (VEP) monitoring has been reported to have little usefulness in predicting postoperative visual outcome. To re-evaluate its usefulness, we adapted a high-power light-stimulating device with electroretinography (ERG) to ascertain retinal light stimulation. Intraoperative VEP monitoring was conducted in TSSs in 33 consecutive patients with sellar and parasellar tumors under total venous anesthesia. The detectability rates of N75, P100, and N135 were 94.0%, 85.0%, and 79.0%, respectively. The mean latencies and amplitudes of N75, P100, and N135 were 76.8 ± 6.4 msec and 4.6 ± 1.8 μV, 98.0 ± 8.6 msec and 5.0 ± 3.4 μV, and 122.1 ± 16.3 msec and 5.7 ± 2.8 μV, respectively. The amplitude was defined as the voltage difference from N75 to P100 or P100 to N135. The criterion for amplitude changes was defined as a > 50% increase or 50% decrease in amplitude compared to the control level. The surgeon was immediately alerted when the VEP changed beyond these thresholds, and the surgical manipulations were stopped until the VEP recovered. Among the 28 cases with evaluable VEP recordings, the VEP amplitudes were stable in 23 cases and transiently decreased in 4 cases. In these 4 cases, no postoperative vision deterioration was observed. One patient, whose VEP amplitude decreased without subsequent recovery, developed vision deterioration. Intraoperative VEP monitoring with ERG to ascertain retinal light stimulation by the new stimulus device was reliable and feasible in preserving visual function in patients undergoing TSS.

  17. Usefulness of Intraoperative Monitoring of Visual Evok ed Potentials in Transsphenoidal Surgery

    PubMed Central

    KAMIO, Yoshinobu; SAKAI, Naoto; SAMESHIMA, Tetsuro; TAKAHASHI, Goro; KOIZUMI, Shinichiro; SUGIYAMA, Kenji; NAMBA, Hiroki

    2014-01-01

    Postoperative visual outcome is a major concern in transsphenoidal surgery (TSS). Intraoperative visual evoked potential (VEP) monitoring has been reported to have little usefulness in predicting postoperative visual outcome. To re-evaluate its usefulness, we adapted a high-power light-stimulating device with electroretinography (ERG) to ascertain retinal light stimulation. Intraoperative VEP monitoring was conducted in TSSs in 33 consecutive patients with sellar and parasellar tumors under total venous anesthesia. The detectability rates of N75, P100, and N135 were 94.0%, 85.0%, and 79.0%, respectively. The mean latencies and amplitudes of N75, P100, and N135 were 76.8 ± 6.4 msec and 4.6 ± 1.8 μV, 98.0 ± 8.6 msec and 5.0 ± 3.4 μV, and 122.1 ± 16.3 msec and 5.7 ± 2.8 μV, respectively. The amplitude was defined as the voltage difference from N75 to P100 or P100 to N135. The criterion for amplitude changes was defined as a > 50% increase or 50% decrease in amplitude compared to the control level. The surgeon was immediately alerted when the VEP changed beyond these thresholds, and the surgical manipulations were stopped until the VEP recovered. Among the 28 cases with evaluable VEP recordings, the VEP amplitudes were stable in 23 cases and transiently decreased in 4 cases. In these 4 cases, no postoperative vision deterioration was observed. One patient, whose VEP amplitude decreased without subsequent recovery, developed vision deterioration. Intraoperative VEP monitoring with ERG to ascertain retinal light stimulation by the new stimulus device was reliable and feasible in preserving visual function in patients undergoing TSS.

  18. Usefulness of intraoperative monitoring of visual evoked potentials in transsphenoidal surgery.

    PubMed

    Kamio, Yoshinobu; Sakai, Naoto; Sameshima, Tetsuro; Takahashi, Goro; Koizumi, Shinichiro; Sugiyama, Kenji; Namba, Hiroki

    2014-01-01

    Postoperative visual outcome is a major concern in transsphenoidal surgery (TSS). Intraoperative visual evoked potential (VEP) monitoring has been reported to have little usefulness in predicting postoperative visual outcome. To re-evaluate its usefulness, we adapted a high-power light-stimulating device with electroretinography (ERG) to ascertain retinal light stimulation. Intraoperative VEP monitoring was conducted in TSSs in 33 consecutive patients with sellar and parasellar tumors under total venous anesthesia. The detectability rates of N75, P100, and N135 were 94.0%, 85.0%, and 79.0%, respectively. The mean latencies and amplitudes of N75, P100, and N135 were 76.8±6.4 msec and 4.6±1.8 μV, 98.0±8.6 msec and 5.0±3.4 μV, and 122.1±16.3 msec and 5.7±2.8 μV, respectively. The amplitude was defined as the voltage difference from N75 to P100 or P100 to N135. The criterion for amplitude changes was defined as a >50% increase or 50% decrease in amplitude compared to the control level. The surgeon was immediately alerted when the VEP changed beyond these thresholds, and the surgical manipulations were stopped until the VEP recovered. Among the 28 cases with evaluable VEP recordings, the VEP amplitudes were stable in 23 cases and transiently decreased in 4 cases. In these 4 cases, no postoperative vision deterioration was observed. One patient, whose VEP amplitude decreased without subsequent recovery, developed vision deterioration. Intraoperative VEP monitoring with ERG to ascertain retinal light stimulation by the new stimulus device was reliable and feasible in preserving visual function in patients undergoing TSS.

  19. Are flash-evoked visual potentials useful for intraoperative monitoring of visual pathway function?

    PubMed

    Cedzich, C; Schramm, J; Fahlbusch, R

    1987-11-01

    Flash-evoked visual potentials (VEPs) recorded from the scalp were used in a series of 35 patients with tumors along the visual pathway: 3 orbital tumors, 25 perisellar tumors, 4 intraventricular tumors, and 3 occipital lesions. Preoperatively, various combinations of impaired visual fields and visual acuity were observed in over 90% of the patients. A postoperative decrease in visual function was observed in 3 cases. Of the 25 perisellar lesions, 13 were operated through a standard frontotemporal craniotomy and 12 were operated through a transnasal-transsphenoidal approach. VEPs were highly susceptible to volatile anesthetics, and there was a significant incidence of spontaneous latency increases and amplitude decreases in a large number of patients. There was an unacceptably high number of cases with significant VEP alteration occurring without concomitant visual function change. During trepanation or the transnasal approach, a reversible potential loss was observed in 11 patients, a profoundly altered wave form was seen in 8 cases, and a loss of single peaks was observed in 15 patients. During dissection of the tumor, a reversible potential loss or a potential with unidentifiable peaks was found in 25 cases; however, the VEPs recovered during closure or in the recovery room. There was no correlation between intraoperative VEP changes and the postoperative changes in visual function. In only 1 patient with an insignificant postoperative decrease in visual acuity from 0.4 to 0.3 was there a concomitant intraoperative potential loss. The major conclusion of our findings is that light-emitting diode flash-evoked VEPs demonstrate intraoperative changes that appear too early and too prominently to be caused solely by manipulation of the optic pathways.(ABSTRACT TRUNCATED AT 250 WORDS)

  20. Intraoperative hepatic artery blood flow predicts early hepatic artery thrombosis after liver transplantation.

    PubMed

    Marín-Gómez, L M; Bernal-Bellido, C; Alamo-Martínez, J M; Porras-López, F M; Suárez-Artacho, G; Serrano-Diaz-Canedo, J; Padillo-Ruiz, J; Gómez-Bravo, M A

    2012-09-01

    Hepatic artery complications after orthotopic liver transplantation are associated with a high rate of graft loss and mortality (23% to 35%) because they can lead to liver ischemia. The reported incidence of hepatic artery thrombosis (HAT) after adult liver transplantation is 2.5% to 6.8%. Typically, these patients are treated with urgent surgical revascularization or emergent liver retransplantation. Since January 2007, we have recorded the postanastomotic hepatic artery flow after revascularization. The aim of this study was to assess the relationship between hepatic blood flow on revascularization and early HAT. Retrospectively, we reviewed perioperative variables from 110 consecutive liver transplantation performed at the Virgen del Rocío University Hospital (Seville, Spain) between January 2007 and October 2010. We evaluated the following preoperative (donor and recipient) and intraoperative variables: donor and recipient age, cytomegalovirus serology, ABO-compatibility, anatomical variations of the donor hepatic artery, number of arterial anastomoses, portal and hepatic artery flow before closure, cold ischemia time, and blood transfusion. These variables were included in a univariate analysis. Of the 110 patients included in the study, 85 (77.7%) were male. The median age was 52 years. ABO blood groups were identical between donor and recipient in all the patients. The prevalence of early HAT was 6.36% (7 of 110). Crude mortality with/without HAT was 22% versus 2% (P = .001), respectively. Crude graft loss rate with/without HAT was 27% versus 4% (P = .003), respectively. Early HAT was shown to be primarily associated with intraoperative hepatic artery blood flow (93.3 mL/min recipients with HAT versus 187.7 mL/min recipients without HAT, P < .0001). No retransplantation showed early HAT. In our experience, intraoperative hepatic artery blood flow predicts early HAT after liver transplantation.