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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. Three-dimensional Transesophageal Echocardiography-guided Transcathetar Closure of Ruptured Noncoronary Sinus of Valsalva Aneurysm

    PubMed Central

    Kumar, G Anil; Parimala, P S; Jayaranganath, M; Jagadeesh, A M

    2017-01-01

    Sinus of Valsalva aneurysm accounts for only 1% of congenital cardiac anomalies. Sinus of Valsalva aneurysm can cause aortic insufficiency, coronary artery flow compromise, cardiac arrhythmia, or aneurysm rupture. Three-dimensional transesophageal echocardiography (3DTEE) represents an adjunctive tool to demonstrate the ruptured sinus of Valsalva with better delineation. We present an adult patient with rupture of noncoronary sinus of Valsalva aneurysm into the right atrium (RA). 3DTEE accurately delineated the site of rupture into the RA and showed the exact size and shape of the defect, which helped in the successful transcatheter closure of the defect with a duct occluder device. PMID:28074828

  3. Three-dimensional transesophageal echocardiography-guided transcathetar closure of ruptured noncoronary sinus of valsalva aneurysm.

    PubMed

    Kumar, G Anil; Parimala, P S; Jayaranganath, M; Jagadeesh, A M

    2017-01-01

    Sinus of Valsalva aneurysm accounts for only 1% of congenital cardiac anomalies. Sinus of Valsalva aneurysm can cause aortic insufficiency, coronary artery flow compromise, cardiac arrhythmia, or aneurysm rupture. Three-dimensional transesophageal echocardiography (3DTEE) represents an adjunctive tool to demonstrate the ruptured sinus of Valsalva with better delineation. We present an adult patient with rupture of noncoronary sinus of Valsalva aneurysm into the right atrium (RA). 3DTEE accurately delineated the site of rupture into the RA and showed the exact size and shape of the defect, which helped in the successful transcatheter closure of the defect with a duct occluder device.

  4. Live three-dimensional transesophageal echocardiography-guided transcatheter closure of a mitral paraprosthetic leak by Amplatzer occluder.

    PubMed

    Biner, Simon; Rafique, Asim M; Kar, Saibal; Siegel, Robert J

    2008-11-01

    Recently introduced real-time 3-dimensional transesophageal echocardiography allows online accurate assessment of cardiac structures. Initial experience indicates that this new technique provides improved anatomic definition and novel views of complex cardiac abnormalities in valve anatomy. We demonstrated the utility of live 3-dimensional transesophageal echocardiography in the assisted transcatheter closure of a mitral prosthesis paravalvular leak by Amplatzer occluder.

  5. Early Detection of Coronary Artery Graft Dysfunction with Intraoperative 2-Dimensional Transesophageal Echocardiography

    PubMed Central

    Sisto, Donato A.; Hoffman, Darryl M.; Fernandes, Sylvia; Frater, Robert W.M.; Orihashi, Kazumasa; Oka, Yasu

    1992-01-01

    We report 5 cases in which intraoperative transesophageal echocardiography was instrumental in the early detection of a left ventricular wall-motion abnormality caused by acute dysfunction of a coronary artery bypass graft. The appearance of a wall-motion abnormality on transesophageal echocardiography preceded signs of myocardial ischemia when such signs were detectable with routine monitoring. By facilitating prompt, appropriate correction of technical problems, transesophageal echocardiography enabled the blood flow to be restored and the ischemic insult to be resolved without further complication. (Texas Heart Institute Journal 1992;19:130-3) Images PMID:15227425

  6. Intraoperative cardiac assessment with transesophageal echocardiography for decision-making in cardiac anesthesia.

    PubMed

    Akiyama, Koichi; Arisawa, Shoji; Ide, Masahiro; Iwaya, Masaaki; Naito, Yoshiyuki

    2013-06-01

    Transesophageal echocardiography is an invaluable hemodynamic monitoring modality. Extended and anatomically based evaluation of cardiac function with transesophageal echocardiography is essential to prompt and accurate decision-making in anesthetic management during cardiac surgery. Fractional shortening and fractional area changes are indices widely used to assess the global systolic performance of the left ventricle. Monitoring regional function using semi-quantitative scoring has been demonstrated to be a more sensitive indicator of myocardial ischemia. Assessment of left ventricular diastolic function should be performed in a systematic way, measuring transmitral flow, pulmonary venous flow, transmitral color M-mode flow propagation velocity, and mitral annulus tissue Doppler imaging. The unique anatomical features of the right ventricle make echocardiographic evaluation complicated and therefore less frequently employed. Right ventricular fractional area change, tricuspid annular plane systolic excursion, maximal systolic tricuspid annular velocity with tissue Doppler imaging, and myocardial performance index are indices successfully incorporated into intraoperative right ventricular assessment. Left ventricular outflow tract obstruction with systolic anterior motion of the mitral valve may develop after cardiac procedures. Transesophageal echocardiography plays a central role in prevention as well as diagnosis of systolic anterior motion. Transesophageal echocardiography is extremely useful not only for detecting and locating intracardiac air, but also for guiding and evaluating the procedures to remove air. Air is likely to persist in the right and left superior pulmonary vein, left ventricular apex, left atrium, right coronary sinus of Valsalva, and ascending aorta. Accurate evaluation of cardiac function depends on performing TEE examination properly and obtaining optimal images.

  7. Customized CT angiogram planning for intraoperative transesophageal echography-guided endovascular exclusion of thoracic aorta penetrating ulcer.

    PubMed

    Piazza, Michele; Lupia, Mario; Grego, Franco; Antonello, Michele

    2015-04-01

    The technique is demonstrated in a 78-year-old man; the preoperative CT angiogram showed a descending thoracic aorta ulcer of 5.9 cm in maximum diameter and 3.8 cm longitudinal extension. A ZTEG-2P-36-127-PF (Cook Medical) single tubular endograft was planned to be deployed. From the preoperative CT angiogram we planned to land 4.7 cm above the midline of the descending thoracic aorta ulcer and 8.0 cm below. In the operating room, under radioscopic vision the centre of the transesophageal echography probe was used as marker to identify the correspondent midline of the descending thoracic aorta ulcer and a centimeter-sized pigtail catheter in the aorta was used to calculate the desired length above and below the ulcer midline. The endograft was introduced and placed in the desired position compared to the transesophageal echography probe and the catheter; under transesophageal echography vision the graft was finally deployed. The CT angiogram at 1 month showed the correct endograft position, descending thoracic aorta ulcer exclusion with no signs of endoleak. In selected cases, this method allows planning in advance safe stent graft positioning and deployment totally assisted by transesophageal echography, with no risk of periprocedural contrast-related renal failure and reduced radiation exposure for the patient and operators.

  8. Interventricular septal hydatid cyst: Transesophageal echocardiography as a therapeutic tool during bypass

    PubMed Central

    Jain, Pawan Kumar; Malik, Vishwas; Divya, Abha; Narula, Jitin; Hote, Milind

    2015-01-01

    Cystic echinococcosis (hydatid disease) arising from infestation with a larval or adult form of the Echinococcus granulosus tapeworm is endemic in certain states of India, but affecting interventricular septum (IVS) solitarily is a scarce phenomenon. We present a rare case of transesophageal echocardiography guided management of IVS hydatid cyst even during cardiopulmonary bypass, which presented with a rather unusual complaint of repeated syncope. PMID:26139754

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

    PubMed

    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.

  10. 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.

  11. 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.

  12. 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.

  13. Transesophageal Echocardiography and Radiation-induced Damages

    PubMed Central

    Cottini, Marzia; Polizzi, Vincenzo; Pino, Paolo Giuseppe; Buffa, Vitaliano; Musumeci, Francesco

    2016-01-01

    The long-term sequelae of mantle therapy include, especially lung and cardiac disease but also involve the vessels and the organs in the neck and thorax (such as thyroid, aorta, and esophagus). We presented the case of 66-year-old female admitted for congestive heart failure in radiation-induced heart disease. The patient had undergone to massive radiotherapy 42 years ago for Hodgkin's disease (type 1A). Transesophageal echocardiography was performed unsuccessfully with difficulty because of the rigidity and impedance of esophageal walls. Our case is an extraordinary report of radiotherapy's latency effect as a result of dramatic changes in the structure of mediastinum, in particular in the esophagus, causing unavailability of a transesophageal echocardiogram. PMID:27867461

  14. Transesophageal echocardiography evaluation of the thoracic aorta

    PubMed Central

    Patil, T. A.; Nierich, Arno

    2016-01-01

    Transesophageal echocardiography (TEE) can be used to identify risk factors such as aortic atherosclerosis[2] before any sort of surgical manipulations involving aorta and its related structures. TEE has become an important noninvasive tool to diagnose acute thoracic aortic pathologies. TEE evaluation of endoleaks helps early detection and immediate corrective interventions. TEE is an invaluable imaging modality in the management of aortic pathology. TEE has to a large extent improved the patient outcomes. PMID:27762248

  15. Acyanotic Congenital Heart Disease and Transesophageal Echocardiography

    PubMed Central

    Sreedhar, Rupa

    2017-01-01

    The spectrum of congenital heart disease (CHD) seen in the adult varies widely. Malformations range from mild anomalies requiring no intervention to extremely complex pathologies characterized by the presence of multiple coexistent defects. Echocardiography represents the primary noninvasive imaging modality in the assessment of these lesions. The transesophageal approach expands the applications of echocardiography by allowing the acquisition of anatomic and functional information that may not be obtainable by transthoracic imaging. PMID:28074821

  16. Measurement of Thrombus Flux Using Transesophageal Echocardiography

    NASA Astrophysics Data System (ADS)

    Yamaguchi, Tadashi; Hirai, Kazuki; Aoki, Masami; Miyagi, Jin; Suzuki, Masahiko; Moriya, Hideshige; Hachiya, Hiroyuki

    2006-05-01

    Deep venous thrombosis (DVT) and pulmonary thromboembolism (PTE) are serious problem of total knee replacement (TKR). These diseases may be caused by a thrombus formed during the TKR operation. Therefore, understanding the flow volume of thrombus is important for curing and preventing PTE. In this paper, we tried to understanding the situation of the flow of thrombus by using transesophageal echocardiography movies. We applied the signal processing technique the FSET to extract the anomalous information from ultrasonic echo image. As a result of processing, the time change of the flow volume of thrombus was confirmed.

  17. 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.

  18. An update on transesophageal echocardiography views 2016: 2D versus 3D tee views

    PubMed Central

    Kapoor, Poonam Malhotra; Muralidhar, Kanchi; Nanda, Navin C.; Mehta, Yatin; Shastry, Naman; Irpachi, Kalpana; Baloria, Aditya

    2016-01-01

    In 1980, Transesophageal Echocardiography (TEE) first technology has introduced the standard of practice for most cardiac operating rooms to facilitate surgical decision making. Transoesophageal echocardiography as a diagnostic tool is now an integral part of intraoperative monitoring practice of cardiac anaesthesiology. Practice guidelines for perioperative transesophageal echocardiography are systematically developed recommendations that assist in the management of surgical patients, were developed by Indian Association of Cardiac Anaesthesiologists (IACTA). This update relates to the former IACTA practice guidelines published in 2013 and the ASE/EACTA guidelines of 2015. The current authors believe that the basic echocardiographer should be familiar with the technical skills for acquiring 28 cross sectional imaging planes. These 28 cross sections would provide also the format for digital acquisition and storage of a comprehensive TEE examination and adds 5 more additional views, introduced for different clinical scenarios in recent times. A comparison of 2D TEE views versus 3D TEE views is attempted for the first time in literature, in this manuscript. Since, cardiac anaesthesia variability exists in the precise anatomic orientation between the heart and the oesophagus in individual patients, an attempt has been made to provide specific criteria based on identifiable anatomic landmarks to improve the reproducibility and consistency of image acquisition for each of the standard cross sections. PMID:27762249

  19. Biplane transesophageal echocardiography in the normal cat.

    PubMed

    Kienle, R D; Thomas, W P; Rishniw, M

    1997-01-01

    Eight healthy, adult cats were examined with biplane transesophageal echocardiography (TEE). Cats were sedated with a combination of diazepam and propofol and were examined using a 5 mm x 80 cm pediatric biplane TEE probe. Consistent images were obtained at three imaging depths within the esophagus. The caudal position provided satisfactory short-axis images of the left ventricle and heart base. The middle position provided the best long-axis views of the left atrium, left ventricle, and aorta and allowed Doppler examination of transmitral left ventricular inflow. The cranial position provided satisfactory imaging of the aorta and pulmonary artery and allowed Doppler examination of right ventricular and left ventricular outflow. Biplane TEE provides an additional method of imaging the feline heart which is complimentary to other imaging techniques and the images obtained were similar to those reported for dogs. Although TEE offers a slight advantage over transthorcic imaging for Doppler examination, the quality of the images of heart base structures was not as consistently superior to transthoracic images in cats as reported in dogs.

  20. [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.

  1. Peratrial Device Closure of Atrial Septal Defect Under Transesophageal Echocardiographic Guidance without Fluoroscopy Compared to Conventional On-Pump Surgical Closure

    PubMed Central

    Guo, Zhixiang; Zhang, Chengxin; Wang, Huan; Ge, Shenglin

    2017-01-01

    Objective This study is designed to evaluate the advantages between peratrial device closure under transesophageal echocardiographic guidance and open heart surgery in atrial septal defect. Methods From November 2011 to September 2014, 28 patients with atrial septal defect were treated. Fourteen patients received peratrial device closure under transesophageal echocardiographic guidance (TEE group) and 14 patients received cardiopulmonary bypass (CPB group). Clinical parameters during intraoperative and postoperative periods were examined. Results All patients recovered after surgery without serious complications. Compared with that in CPB group, clinical observations in TEE group showed significant decreases in the operation time (193.6±35.5 vs. 77.4±22.7 min, P<0.05), periods in intensive care unit (31.6±23.3 vs. 17.5±8.1 hours, P<0.05), fluid volume after operation (502.5±439.3 vs. 32.5±7.3 ml, P<0.05), postoperative length of hospital stay (8.9±2.8 vs. 6.8±2.4 days, P<0.05) and total hospitalization cost (7205.9±1617.6 vs. 5882.3±441.2 $, P<0.05). Conclusion The peratrial device closure of atrial septal defect under transesophageal echocardiographic guidance is a mini-invasive, simple, safe and effective intervention. Its use in the clinical practice should be encouraged.

  2. Benzocaine Induced Methemoglobinemia: A Potentially Fatal Complication of Transesophageal Echocardiography

    PubMed Central

    Chander, Keshav; Lavie, Carl J.; Ventura, Hector O.; Milani, Richard V.

    2003-01-01

    Transesophageal echocardiography (TEE) is a relatively safe procedure with complications including bleeding, esophageal perforation, and respiratory failure being rare. One of our patients recently developed severe cyanosis despite pulse oximetry of 85% following TEE. This directs our attention to a rare, easily treatable, but potentially fatal complication of this procedure. PMID:22826681

  3. 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.

  4. 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.

  5. Endocardial left ventricle feature tracking and reconstruction from tri-plane trans-esophageal echocardiography data

    NASA Astrophysics Data System (ADS)

    Dangi, Shusil; Ben-Zikri, Yehuda K.; Cahill, Nathan; Schwarz, Karl Q.; Linte, Cristian A.

    2015-03-01

    Two-dimensional (2D) ultrasound (US) has been the clinical standard for over two decades for monitoring and assessing cardiac function and providing support via intra-operative visualization and guidance for minimally invasive cardiac interventions. Developments in three-dimensional (3D) image acquisition and transducer design and technology have revolutionized echocardiography imaging enabling both real-time 3D trans-esophageal and intra-cardiac image acquisition. However, in most cases the clinicians do not access the entire 3D image volume when analyzing the data, rather they focus on several key views that render the cardiac anatomy of interest during the US imaging exam. This approach enables image acquisition at a much higher spatial and temporal resolution. Two such common approaches are the bi-plane and tri-plane data acquisition protocols; as their name states, the former comprises two orthogonal image views, while the latter depicts the cardiac anatomy based on three co-axially intersecting views spaced at 600 to one another. Since cardiac anatomy is continuously changing, the intra-operative anatomy depicted using real-time US imaging also needs to be updated by tracking the key features of interest and endocardial left ventricle (LV) boundaries. Therefore, rapid automatic feature tracking in US images is critical for three reasons: 1) to perform cardiac function assessment; 2) to identify location of surgical targets for accurate tool to target navigation and on-target instrument positioning; and 3) to enable pre- to intra-op image registration as a means to fuse pre-op CT or MR images used during planning with intra-operative images for enhanced guidance. In this paper we utilize monogenic filtering, graph-cut based segmentation and robust spline smoothing in a combined work flow to process the acquired tri-plane TEE time series US images and demonstrate robust and accurate tracking of the LV endocardial features. We reconstruct the endocardial LV

  6. [Peculiarities of the transesophageal echocardiography in octogenarian patients].

    PubMed

    Canale, Jesús M; Cardoza-Encinas, Rubén; Canale-Segovia, Andrés

    The growing trend in the absolute and relative number of elderly in the population scheme, the increasing prevalence of heart disease as people get older and the impressive technological development of ultrasound devices have all together recently contributed to promote an increasing number of transesophageal echocardiograms in older patients, however, the already published information about the distinguishing features of this diagnostic methodology in elderly patients is still scarce and seems to be insufficient. This review focuses on the already published methodological and diagnostic features related to the transesophageal echocardiography in the octogenarian -or even older patient- in order to show them in an orderly and systematic manner to provide elements that induce useful clinical criteria for the physician who attends patients in this age group in whom this diagnostic modality is now increasingly requested.

  7. Utilization of Intraoperative TEE to Assess Supraventricular Tachycardia-Inducing Right-Sided Cardiac Compression by the Liver, Post-Liver-Transplantation Status

    PubMed Central

    Stoll, W. David; Hand, William R.; Rohan, Vinayak S.; Gaddy, Parker M.; Reeves, Scott T.; Chavin, Kenneth D.

    2015-01-01

    This unique and interesting case report involves a patient who recently underwent a combined liver and kidney transplant (due to autosomal dominant polycystic kidney disease) and subsequently suffered from episodes of supraventricular tachycardia (SVT) secondary to the new liver graft compressing the right atrium and ventricle. After this was diagnosed, the patient underwent operative plication of the right hemidiaphragm. Intraoperative transesophageal echocardiography was used to demonstrate cardiac compression from the liver and demonstrate resolution of compression after plication of the hemidiaphragm. PMID:25861512

  8. 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

  9. Acute Intraoperative Pulmonary Aspiration.

    PubMed

    Nason, Katie S

    2015-08-01

    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 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.

  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. 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.

  12. 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

  13. Case report of latex aerosolization from a transesophageal echocardiogram machine.

    PubMed

    Muller, Barbara A; Steelman, Victoria J

    2004-01-01

    Aerosolized natural rubber latex proteins produce latex sensitization and can cause acute allergic reactions in susceptible individuals. The objective of this study is to describe measures that should be taken to ensure a latex-safe hospital environment. A case of latex-induced anaphylaxis prompted a survey of air quality in acute care areas of a major tertiary health care center that had eliminated the use of powder-free latex gloves years earlier. Six air samples were collected using pre- and postcalibrated sampling pumps operating at 2.7 L/minute. Samples were collected in duplicate on three-piece 37-mm Teflon filters in open-faced cassettes and tested for latex allergen by inhibition immunoassay. All samples had less than the detection limit > 5 ng/m3 for aerosolized latex except for the echocardiogram suite where the transesophageal echocardiogram machine was located. After thorough cleaning of the suite and echocardiogram machine, subsequent air sampling showed no detectable latex aerosolization particles. Follow-up investigation to discover the source of contamination revealed that the department performing routine maintenance on the echocardiogram equipment used powdered latex gloves obtained outside the hospital. Employees who are latex allergic may experience symptoms even in an environment of powder-free, nonlatex gloves. The site was a contaminated transesophageal echocardiogram machine. Institutional policies should be in place to monitor employee complaints and address allergic reactions to latex.

  14. 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.

  15. 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.

  16. History of intraoperative ultrasound.

    PubMed

    Makuuchi, M; Torzilli, G; Machi, J

    1998-11-01

    Intraoperative ultrasound (IOUS) using A-mode or non-real-time B-mode imaging started in the 1960s; however, it was not widely accepted mainly because of difficulty in image interpretation. In the late 1970s, IOUS became one of the topics in the surgical communities upon the introduction of high-frequency real-time B-mode ultrasound. Special probes for operative use were developed. In the 1980s, all over the world the use of IOUS spread to a variety of surgical fields, such as hepatobiliary pancreatic surgery, neurosurgery, and cardiovascular surgery. IOUS changed hepatic surgery dramatically because IOUS was the only modality that was capable of delineating and examining the interior of the liver during surgery. After 1990, color Doppler imaging and laparoscopic ultrasound were incorporated into IOUS. Currently, IOUS is considered an indispensable operative procedure for intraoperative decision-making and guidance of surgical procedures. For better surgical practice, education of surgeons in the use of ultrasound is the most important issue.

  17. [Intraoperative floppy iris syndrome].

    PubMed

    Mazal, Z

    2007-04-01

    In the year 2005, Chang and Cambell described unusual reaction of the iris during the cataract surgery in patients treated with tamsulosine. This was named as IFIS, an acronym for the Intraoperative Floppy Iris Syndrome. In its advanced stage, the syndrome is characterized by insufficient mydfiasis before the surgery, narrowing of the pupil during the surgery, its impossible dilatation during the surgery by means of stretching, unusual elasticity of the pupilar margin, surging and fluttering iris with tendency to prolapse. The same manifestations we observed in our patients and we confirm the direct connection with tamsulosine hydrochloride treatment. Tamsulosine is the antagonist of alpha 1A adrenergic receptors whose are present, except in the smooth musculature of the prostate gland and the urinary bladder, in the iris dilator as well. At the same time we observed this syndrome rarely in some patients not using tamsulosine. In most cases, these patients were treated with antipsychotic drugs.

  18. Mycotic aneurysm of the descending thoracic aorta: the role of transesophageal echocardiography.

    PubMed

    Joffe, I I; Emmi, R P; Oline, J; Jacobs, L E; Owen, A N; Ioli, A; Najjar, D; Kotler, M N

    1996-01-01

    Mycotic aneurysms of the aorta are prone to rupture. Thus rapid and accurate diagnosis is essential so that surgical repair can be undertaken. We report a case of mycotic aortic aneurysm caused by mitral valve endocarditis. The aneurysm situated at the junction of the thoracoabdominal aorta was readily detected by transesophageal echocardiography. Computed tomography and aortography were complementary to transesophageal echocardiography in establishing the diagnosis. The patient underwent successful repair and acute inflammation of the aneurysm was present at histologic examination.

  19. Papillary muscle rupture caused by bacterial endocarditis: role of transesophageal echocardiography.

    PubMed

    Habib, G; Guidon, C; Tricoire, E; Djiane, V; Monties, J R; Luccioni, R

    1994-01-01

    A 22-year-old man had severe pulmonary congestion and required mechanical ventilation. Endocarditis was suspected because a 2/6 systolic murmur was heard at the apex and because Osler nodes were present. Transthoracic and transesophageal echocardiography allowed correct diagnosis of papillary muscle rupture causing massive mitral regurgitation. To our knowledge, this is the first reported case of papillary muscle rupture caused by bacterial endocarditis diagnosed by transthoracic and transesophageal echocardiography.

  20. Induction of left ventricular fascicular tachycardia with transesophageal pacing in a toddler.

    PubMed

    Williams, Conrad S P; Khatib, Sammy; Dorotan-Guevara, Maria Malaya; Snyder, Christopher S

    2010-01-01

    J.V. is a 3(1/2)-year-old patient with left ventricular fascicular ventricular tachycardia that had been well controlled on verapamil for 3 years. He was taken for a transesophageal electrophysiology study prior to discontinuing medication in an attempt to induce his tachycardia. We report the use of transesophageal electrophysiology study as a noninvasive method to induce left ventricular fascicular ventricular tachycardia in a toddler.

  1. The impact of transesophageal echocardiography on daily clinical practice.

    PubMed

    Kühl, H P; Hanrath, P

    2004-12-01

    The development of transesophageal echocardiography (TEE) almost 20 years ago has tremendously widened the diagnostic potential of cardiac ultrasound and has, without doubt, strongly improved our pathophysiological understanding of many cardiovascular diseases such as aortic dissection, mitral valve disease or ischemic stroke. Especially the introduction of multiplane transducers that allow imaging of the cardiac structures from various scan plane orientations has yielded a level of diagnostic accuracy that is seldom attained by other imaging modalities. The outstanding image quality as well as the high temporal and spatial resolution provided by TEE renders the method especially suited to visualize small and rapidly moving structures, such as left atrial thrombus formation and valvular vegetations. In addition, TEE is exceptional in its capability to scan the heart from perspectives that cannot be easily attained by any other modality, thus enhancing its diagnostic yield. In the last few years the clinical application of TEE has been extended from a pure diagnostic tool to an indispensable monitoring adjunct for percutaneous interventional procedures as well as for the intra- and peri-operative monitoring in the operating theatre and on the intensive care unit. In the surroundings of emerging sophisticated technologies to image the heart and the great vessels within the thorax such as multi-slice computed tomography and cardiovascular magnetic resonance imaging TEE asserts a firm place in the diagnostic armamentarium for the cardiologist. This review will focus the impact of TEE in daily clinical practice and on possible future applications of the technique.

  2. Potential applications for transesophageal echocardiography in hypertrophic cardiomyopathies.

    PubMed

    Widimsky, P; Ten Cate, F J; Vletter, W; van Herwerden, L

    1992-01-01

    The purpose of the present study was to evaluate the potential advantages of transesophageal echocardiography (TEE) in comparison with transthoracic echocardiography (TTE) in selected patients with hypertrophic cardiomyopathy. Ten patients with previously established or suspected diagnosis of hypertrophic cardiomyopathy were examined by TEE to solve specific clinical questions. TEE was well tolerated by all patients; no arrhythmias were seen during the procedure. The comparison of TTE and TEE showed the following: Advantages of TTE--better assessment of the left ventricle, myocardial thickness measurements available in all regions and sufficient for the diagnosis of hypertrophic cardiomyopathy in nine out of 10 patients; advantages of TEE--precise assessment of mitral valve morphology and regurgitant jets, detailed evaluation of systolic anterior motion, and subaortic membrane (not seen by TTE) recognized in one patient. Clinically, in three patients TEE influenced the management (mitral leaflet perforation, subaortic membrane, and residual mitral regurgitation after valvuloplasty). Thus TEE enables more precise diagnosis in some patients with hypertrophic cardiomyopathy and has the potential to influence their surgical management. However, for medical treatment of hypertrophic cardiomyopathy, TTE is sufficient.

  3. The transesophageal echocardiography simulator based on computed tomography images.

    PubMed

    Piórkowski, Adam; Kempny, Aleksander

    2013-02-01

    Simulators are a new tool in education in many fields, including medicine, where they greatly improve familiarity with medical procedures, reduce costs, and, importantly, cause no harm to patients. This is so in the case of transesophageal echocardiography (TEE), in which the use of a simulator facilitates spatial orientation and helps in case studies. The aim of the project described in this paper is to simulate an examination by TEE. This research makes use of available computed tomography data to simulate the corresponding echocardiographic view. This paper describes the essential characteristics that distinguish these two modalities and the key principles of the wave phenomena that should be considered in the simulation process, taking into account the conditions specific to the echocardiography. The construction of the CT2TEE (Web-based TEE simulator) is also presented. The considerations include ray-tracing and ray-casting techniques in the context of ultrasound beam and artifact simulation. An important aspect of the interaction with the user is raised.

  4. Detection of gas embolism by transesophageal echocardiography during laparoscopic cholecystectomy.

    PubMed

    Derouin, M; Couture, P; Boudreault, D; Girard, D; Gravel, D

    1996-01-01

    Using transesophageal echocardiography (TEE), 16 patients (ASA physical status I-III), undergoing laparoscopic cholecystectomy, were assessed for the occurrence of episodes of gas embolism and cardiovascular changes related to those emboli. The long-axis four-chamber view was monitored continuously, except for predetermined intervals where the transgastric short-axis view was obtained to derive the end-diastolic area (EDA), the end-systolic area (ESA), and the ejection fraction (EF). In one patient, we monitored the longitudinal view of the superior and the inferior vena cava. The monitoring of the patients also included: heart rate (HR), mean arterial pressure (MAP), arterial saturation by pulse oximetry (Spo2), end-tidal CO2 (ETCO2), minute ventilation (VE), and peak inspiratory pressure (PIP). Embolic events were defined as the appearance of gas bubbles in the right cardiac chambers. We observed gas embolism in 11/16 patients (five during peritoneal insufflation and six during gallbladder dissection). Using the longitudinal view of the superior and inferior vena cava (IVC), we found that these emboli were transmitted through the IVC. No episode of cardiorespiratory instability (decrease in MAP > or = 10 mm Hg, Spo2 < 90%) was observed. There was no significant difference in cardiorespiratory variables between patients who presented gas embolism (n = 11) and patients who did not (n = 5) during the studied period. In this small group of patients, we conclude that gas embolism occurs commonly during laparoscopic cholecystectomy but that these gas emboli cause minimal cardiorespiratory instability.

  5. Intraoperative fracture of phacoemulsification tip.

    PubMed

    Angmo, Dewang; Khokhar, Sudarshan K; Ganguly, Anasua

    2014-01-01

    Phacoemulsification (phaco) is an established procedure for cataract extraction and has undergone a significant advances in techniques, machines and phaco tips. The Aspiration Bypass System (ABS) phaco tip was introduced for phacoemulsification in 1998. The ABS tip allows fluid to be drawn through the opening when the phaco tip is occluded by nuclear material. The ABS tip allowed the safe use of high vacuum and flow rates and improved chamber stability by decreasing surge and therefore reducing intraoperative complications. To date, no disadvantages of ABS tips have been reported. We report a unique case of an intraoperative break of an ABS phaco tip during routine cataract surgery.

  6. Comparison of Transesophageal and Transthoracic Contrast Echocardiography for Detection of a Patent Foramen Ovale

    NASA Technical Reports Server (NTRS)

    Siostrzonek, Peter; Zangeneh, Massoud; Gossinger, Heinz; Lang, Wilfried; Rosenmayr, Georg; Heinz, Gottfried; Stumpflen, Andreas; Zeiler, Karl; Schwarz, Martin; Mosslacher, Herbert

    1991-01-01

    Presence of a patent foramen ovale may indicate paradoxic embolism in patients with otherwise unexplained embolic disease. Transthoracic contrast echocardiography has been used as a simple technique for detecting patent foramen ovale. However, particularly in patients with poor transthoracic image quality, presence of a patent foramen ovale might be missed. Transesophageal contrast echocardiography provides superior visualization of the atrial septum and therefore is believed to improve diagnostic accuracy. The present study investigates the influence of image quality on the detection of a patent foramen ovale by both transthoracic and transesophageal contrast echocardiography.

  7. 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

  8. Usefulness of transesophageal pacing during exercise for evaluating palpitations in top-level athletes.

    PubMed

    Biffi, A; Ammirati, F; Caselli, G; Fernando, F; Cardinale, M; Faletra, E; Mazzuca, V; Verdile, L; Santini, M

    1993-10-15

    The aim of this study was to verify the use of transesophageal atrial pacing in reproducing tachyarrhythmias in 22 top-level athletes symptomatic for palpitations, with no evidence of arrhythmias or cardiac anomalies by the standard noninvasive diagnostic techniques. The transesophageal stimulation protocol was divided in 2 sections: at rest and during exercise on the bicycle ergometer in the upright position. Although transesophageal pacing at rest did not induce any arrhythmias in 18 of 22 athletes, during exercise it induced tachyarrhythmias. This occurred in all 16 athletes who had palpitations during physical activity. Electrophysiologic characteristics of induced atrial tachyarrhythmia suggested reentry within the atrioventricular node in 9 of 18 athletes: atrial fibrillation in 5, atrial flutter in 2, orthodromic reciprocating tachycardia due to concealed anomalous pathway in 1, and automatic atrial tachycardia in 1. This study stresses the clinical importance of palpitations during physical exercise and shows that transesophageal pacing performed during exercise is an important diagnostic tool in reproducing the previously described symptoms and in detecting the underlying tachyarrhythmias.

  9. 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

  10. 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

  11. Early experience of intraoperative autotransfusion.

    PubMed Central

    Wilson, A J; Cuddigan, B J; Wyatt, A P

    1988-01-01

    Intraoperative autotransfusion of whole blood was performed using the Solcotrans device in 45 patients undergoing major vascular surgery or other procedures in which there was a clean operative field. Overall, 60% of the blood shed during these operations was reinfused. Approximately 50% of patients avoided the potential complications of homologous transfusion. There were no complications attributable to the use of this device although in a sample of 13 patients, 30% of the erythrocytes were haemolysed and there were other minor haematological abnormalities. In conclusion this device provides a simple method of autotransfusing 2 or 3 litres of blood aspirated from an uncontaminated operative field. PMID:3411587

  12. Transesophageal Echocardiographic Diagnosis and Management of Circumflex Artery Injury Following Mitral Valve Repair

    PubMed Central

    Murugesan, Chinnamuthu; Raghu, Bheemaiah; Rao, Parachuri Venkateshwara

    2011-01-01

    A 16-year-old woman with severe mitral regurgitation as a result of rheumatic heart disease underwent mitral valve repair with posterior mitral annuloplasty. ST elevation was observed in leads II, III and aVF after weaning from cardiopulmonary bypass. On transesophageal echocardiography, the stenosis of the circumflex artery was suggested by a modified midesophageal long axis. Since the patient was hemodynamically unstable, an emergency coronary angiography could not be considered. An urgent cardiopulmonary bypass was re-instituted; the first two sutures in the P1 region of the posterior mitral annulus were translocated more superficially. Transesophageal echocardiography revealed good opening of the circumflex artery and improvement in regional wall motion abnormality following the corrected procedure.

  13. Incremental value of 3-D transesophageal echocardiographic imaging of the mitral valve.

    PubMed

    Jain, Sonia; Malouf, Joseph F

    2014-01-01

    Transesophageal echocardiography provides excellent visualization of the posteriorly located mitral valve. Over the last decade, 3-dimensional transesophageal echocardiography (3D TEE) has emerged as an exciting imaging modality, particularly of the mitral valve. The current generation matrix array technology allows the operator to perform 2D and 3D imaging with a single transducer. 3D TEE affords the unique ability to view the mitral valve and its surrounding structures "en face" in real time (RT), and provide contextual anatomical guidance during surgical and transcatheter interventions. Additionally, offline quantification has made significant contributions to our mechanistic understanding of the normal and diseased mitral valve, and alterations induced by therapeutic intervention such as surgical repair. This review will address recent advances in the incremental role of 3D TEE in mitral valve imaging.

  14. Feasibility of in vivo transesophageal cardiac ablation using a phased ultrasound array.

    PubMed

    Werner, Jacob; Park, Eun-Joo; Lee, Hotaik; Francischelli, David; Smith, Nadine Barrie

    2010-05-01

    Over 2.2 million Americans suffer from atrial fibrillation making it one of the most common arrhythmias. Cardiac ablation has shown a high rate of success in treating paroxysmal atrial fibrillation. Prevailing modalities for this treatment are catheter based radio-frequency ablation or surgery. However, there is measurable morbidity and significant costs and time associated with these invasive procedures. Due to these issues, developing a method that is less invasive to treat atrial fibrillation is needed. In the development of such a device, a transesophageal ultrasound applicator for cardiac ablation was designed, constructed and evaluated. A goal of this research was to create lesions in myocardial tissue using a phased array. Based on multiple factors from array simulations, transesophageal imaging devices and throat anatomy, a phased ultrasound transducer that can be inserted into the esophagus was designed and tested. In this research, a two-dimensional sparse phased array with the aperture size of 20.7 mm x 10.2 mm with flat tapered elements as a transesophageal ultrasound applicator was fabricated and evaluated with in vivo experiments. Five pigs were anesthetized; the array was passed through the esophagus and positioned over the heart. The array was operated for 8-15 min at 1.6 MHz with the acoustic intensity of 150-300 W/cm(2) resulting 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. Based on the experimental results, the array delivered sufficient power to the focal point to produce ablation while not grossly damaging nearby tissue outside the target area. These results demonstrate a potential application of the ultrasound applicator to transesophageal cardiac surgery in atrial fibrillation treatment.

  15. 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

  16. Transesophageal echocardiography monitoring in the delivery of a preeclamptic parturient with severe left ventricular noncompaction.

    PubMed

    Ashford, Eric J; Klimkina, Oksana; Hassan, Zaki-Udin; Colclough, George; Fragneto, Regina

    2014-09-01

    A multidisciplinary approach to the preterm delivery of a preeclamptic parturient with severe left ventricular (LV) noncompaction and pulmonary hypertension using transesophageal echocardiography (TEE) as a monitor of hemodynamic status in lieu of a pulmonary artery catheter during general anesthesia for Cesarean section is presented. This case adds to the available literature on LV noncompaction with pulmonary hypertension in preeclamptic parturients, and addresses the anesthetic concerns and approaches to management using echocardiography in these highly complex patients.

  17. Intraoperative magnification: Who uses it?

    PubMed

    Jarrett, Paul Max

    2004-01-01

    Surgeons over recent decades have made increasing use of intraoperative magnification to enhance the outcome of surgical procedures, yet no published information exists regarding the extent of magnification use within surgical specialties. A sample of surgeons consisting of 148 specialists and senior surgical trainees in the west of Scotland was surveyed by postal questionnaire regarding their frequency and types of magnification use. Patterns of use were similar within each specialty, but varied markedly between specialties. Otolaryngologists and plastic, maxillofacial, and ophthalmic surgeons use both loupes and microscopes frequently. Cardiothoracic and pediatric surgeons tend only to utilize loupes, whereas neurosurgeons tend only to use microscopes. General surgeons, urologists, orthopedic surgeons, and gynecologists are infrequent users or nonusers of magnification, and when required will utilize loupes rather than microscopes. As a clear pattern of magnification use exists, it should be possible to anticipate the equipment needs of surgeons when providing theater services.

  18. 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.

  19. Intraoperative management of critical arrhythmia

    PubMed Central

    2017-01-01

    The incidence of intraoperative arrhythmia is extremely high, and some arrhythmias require clinical attention. Therefore, it is essential for the anesthesiologist to evaluate risk factors for arrhythmia and understand their etiology, electrophysiology, diagnosis, and treatment. Anesthetic agents reportedly affect normal cardiac electrical activity. In the normal cardiac cycle, the sinoatrial node initiates cardiac electrical activity through intrinsic autonomous pacemaker activity. Sequential atrial and ventricular contractions result in an effective cardiac pumping mechanism. Arrhythmia occurs due to various causes, and the cardiac pumping mechanism may be affected. A severe case may result in hemodynamic instability. In this situation, the anesthesiologist should eliminate the possible causes of arrhythmia and manage the condition, creating hemodynamic stability under proper electrocardiographic monitoring. PMID:28367281

  20. 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

  1. Usefulness of two- and three-dimensional transesophageal echocardiography in the assessment of proximal left coronary system compression by a paraprosthetic aortic valve abscess.

    PubMed

    Ahmad, Amier; McElwee, Samuel K; Jiang, Amy Z; Barssoum, Kirolos N; Elkaryoni, Ahmed E; Arisha, Mohammed J; Srialluri, Swetha; Seghatol, Frank; Nanda, Navin C

    2017-02-01

    Paraprosthetic aortic valve abscess represents a rare, but lethal complication of infective endocarditis. We report a case of proximal left coronary system compression by a paraprosthetic aortic valve abscess whose detection was augmented using live/real time three-dimensional transesophageal echocardiography. Our case illustrates the usefulness of combined two- and three-dimensional transesophageal echocardiography in detecting this finding.

  2. The basics of intraoperative diagnosis in neuropathology.

    PubMed

    Lee, Han S; Tihan, Tarik

    2015-03-01

    Intraoperative pathologic consultation continues to be an essential tool during neurosurgical procedures, helping to ensure adequacy of material for achieving a pathologic diagnosis and to guide surgeons. For pathologists, successful consultation with central nervous system lesions involves not only a basic familiarity with the pathologic features of such lesions but also an understanding of their clinical and radiologic context. This review discusses a basic approach to intraoperative diagnosis for practicing pathologists, including preparation for, performance of, and interpretation of an intraoperative neuropathologic evaluation. The cytologic and frozen section features of select examples of common pathologic entities are described.

  3. Intraoperative scintigraphy for active small intestinal bleeding

    SciTech Connect

    Biener, A.; Palestro, C.; Lewis, B.S.; Katz, L.B. )

    1990-11-01

    Localizing active sites of bleeding within the small intestine remains a difficult task. Endoscopic, angiographic or scintigraphic studies may point to the small intestine as the site of blood loss, but at operation, without a palpable lesion, the exact site of bleeding remains elusive. Patients are managed at laparotomy with intraoperative endoscopy, angiography, multiple enterotomies, blind resections, or placement of an enterostomy. We describe two patients in whom intraoperative scintigraphy accurately identified active sites of bleeding in the small intestine when other modalities failed. Intraoperative scintigraphy is rapid, easy to perform and is an effective means of identifying active sites of bleeding within the small intestine.

  4. 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.

  5. 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.

  6. Usefulness of intravenously administered fluid replenishment for detection of patent foramen ovale by transesophageal echocardiography.

    PubMed

    Afonso, Luis; Kottam, Anupama; Niraj, Ashutosh; Ganguly, Joya; Hari, Pawan; Simegn, Mengistu; Sudhakar, Rajeev; Jacob, Sony; Chaturvedi, Seemant; Ensing, Greg J; Abraham, Theodore P

    2010-10-01

    Patent foramen ovale (PFO) is associated with cryptogenic stroke, migraine headache, decompression sickness, and platypnea-orthodeoxia syndrome. Patients undergoing transesophageal echocardiography are often hypovolemic from preprocedural fasting and might not demonstrate right to left shunting owing to insufficient right atrial pressure generation, despite provocative maneuvers. We hypothesized that volume replenishment with saline loading could potentially unmask a PFO by favorably modulating the interatrial pressure gradient. Our study sought to examine the role of pre- or intraprocedural intravenous fluid replenishment on PFO detection during transesophageal echocardiography. A total of 103 patients were enrolled. An initial series of bubble injections was performed unprovoked and then with provocative maneuvers such as the Valsalva maneuver and coughing. The patients were then given a rapid 500 ml saline bolus, and the same sequence of bubble injections was repeated. The presence, type, and magnitude of the right to left shunts were noted before and after the saline bolus. The detection rate of PFO increased from 10.6% to 26.2% after saline loading without any provocative maneuvers. When combined with provocative maneuvers (Valsalva or cough), saline loading improved the detection rate from 17.4% to 32.0%. Overall, from amongst the 103 enrolled patients, saline bolusing resulted in a de novo diagnosis of PFO in 15 patients, atrial septal aneurysm in 15, PFO coexisting with an atrial septal aneurysm in 10, and pulmonary arteriovenous fistula in 5 patients. In conclusion, saline infusion in appropriately selected patients during transesophageal echocardiography significantly enhances the detection of PFOs and pulmonary arteriovenous fistulas.

  7. 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.

  8. Practical intraoperative stereo camera calibration.

    PubMed

    Pratt, Philip; Bergeles, Christos; Darzi, Ara; Yang, Guang-Zhong

    2014-01-01

    Many of the currently available stereo endoscopes employed during minimally invasive surgical procedures have shallow depths of field. Consequently, focus settings are adjusted from time to time in order to achieve the best view of the operative workspace. Invalidating any prior calibration procedure, this presents a significant problem for image guidance applications as they typically rely on the calibrated camera parameters for a variety of geometric tasks, including triangulation, registration and scene reconstruction. While recalibration can be performed intraoperatively, this invariably results in a major disruption to workflow, and can be seen to represent a genuine barrier to the widespread adoption of image guidance technologies. The novel solution described herein constructs a model of the stereo endoscope across the continuum of focus settings, thereby reducing the number of degrees of freedom to one, such that a single view of reference geometry will determine the calibration uniquely. No special hardware or access to proprietary interfaces is required, and the method is ready for evaluation during human cases. A thorough quantitative analysis indicates that the resulting intrinsic and extrinsic parameters lead to calibrations as accurate as those derived from multiple pattern views.

  9. Intraoperative Radiotherapy in Childhood Malignant Astrocytoma

    PubMed Central

    Rana, Sohail R.; Haddy, Theresa B.; Ashayeri, Ebrahim; Goldson, Alfred L.

    1984-01-01

    A 12-year-old black male patient with glioblastoma multiforme was treated with intraoperative radiotherapy followed by conventional external beam radiation and chemotherapy. The authors' clinical experience with these therapeutic measures is discussed. PMID:6330375

  10. 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

  11. Value of Intraoperative Sonography in Pancreatic Surgery.

    PubMed

    Weinstein, Stefanie; Morgan, Tara; Poder, Liina; Shin, Lewis; Jeffrey, R Brooke; Aslam, Rizwan; Yee, Judy

    2015-07-01

    The utility of intraoperative sonography for pancreatic disease has been well described for detection and evaluation of neoplastic and inflammatory pancreatic disease. Intraoperative sonography can help substantially reduce surgical time as well as decrease potential injury to tissues and major structures. Imaging with sonography literally at the point of care--the surgeon's scalpel--can precisely define the location of pancreatic lesions and their direct relationship with surrounding structures in real time during surgery. This article highlights our experience with intraoperative sonography at multiple institutional sites for both open and laparoscopic surgical procedures. We use intraoperative sonography for a wide range of pancreatic disease to provide accurate localization and staging of disease, provide guidance for enucleation of nonpalpable, nonvisible tumors, and in planning the most direct and least invasive surgical approach, avoiding injury to the pancreatic duct or other vital structures.

  12. Extrinsic Esophageal Compression by Cervical Osteophytes in Diffuse Idiopathic Skeletal Hyperostosis: A Contraindication to Transesophageal Echocardiography?

    PubMed

    Chang, Kevin; Barghash, Maya; Donnino, Robert; Freedberg, Robin S; Hagiwara, Mari; Bennett, Genevieve; Benenstein, Ricardo; Saric, Muhamed

    2016-02-01

    Contraindications to transesophageal echocardiography (TEE) include various esophageal pathologies, but compression of the esophagus by vertebral osteophytes is not listed in the current American Society of Echocardiography guidelines. We report a case of diffuse idiopathic skeletal hyperostosis (DISH) in an 81-year-old man who had incidentally been found to have extrinsic esophageal compression by cervical osteophytes prior to a proposed TEE. The incidence of esophageal perforation in patients with DISH and vertebral osteophytes is not well documented. We believe these patients are at increased risk of esophageal perforation during TEE, and thus, TEE may be relatively contraindicated in patients with DISH.

  13. 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.

  14. Pediatric urological complications with intraoperative radiation therapy

    SciTech Connect

    Ritchey, M.L.; Gunderson, L.L.; Smithson, W.A.; Kelalis, P.P.; Kaufman, B.H.; Telander, R.L.; Evans, R.G.; Kramer, S.A. )

    1990-01-01

    Intraoperative radiotherapy with variable energy electrons has been used as a supplemental boost to treat 6 children with locally advanced retroperitoneal malignancies. Of the patients 4 had treatment-related injuries to portions of the urinary tract within the intraoperative and external radiation fields. Three patients had significant renal impairment requiring surgical correction. The pathogenesis and management of treatment-induced injury to the urinary tract are discussed.

  15. Clinical Reasoning of Infectious Diseases Physicians Behind the Use or Nonuse of Transesophageal Echocardiography in Staphylococcus aureus Bacteremia

    PubMed Central

    Young, Heather; Knepper, Bryan C.; Price, Connie S.; Heard, Susan

    2016-01-01

    In this prospective cohort with Staphylococcus aureus bacteremia, transesophageal echocardiography (TEE) was performed in 24% of cases. Consulting Infectious Diseases physicians most frequently cited low suspicion for endocarditis due to rapid clearance of blood cultures and the presence of a secondary focus requiring an extended treatment duration as reasons for foregoing TEE. PMID:27833929

  16. Multiplanar transesophageal echocardiography for the evaluation and percutaneous management of ostium secundum atrial septal defects in the adult.

    PubMed

    Sobrino, Ayax; Basmadjian, Arsène J; Ducharme, Anique; Ibrahim, Reda; Mercier, Lise-Andrée; Pelletier, Guy B; Marcotte, François; Garceau, Patrick; Burelle, Denis; O'Meara, Eileen; Dore, Annie

    2012-01-01

    The purpose of this paper is to review the usefulness of multiplanar transesophageal echocardiography before, during and after percutaneous transcatheter closure of secundum atrial septal defects. Transesophageal echocardiography imaging techniques,including their role in patient selection, procedural guidance and immediate assessment of technical success and complications are described and discussed in this review. Percutaneous transcatheter closure is indicated for ostium secundum atrial septal defects of less than 40 mm in maximal diameter. The defect must have a favorable anatomy, with adequate rims of at least 5 mm to anchor the prosthesis. Transesophageal echocardiography plays a critical role before the procedure in identifying potential candidates for percutaneous closure and to exclude those with unfavorable anatomy or associated lesions, which could not be addressed percutaneously. Transesophageal echocardiography is also important during the procedure to guide the deployment of the device. After device deployment, the echocardiographer must assess the device (integrity, position and stability), residual shunt, atrio-ventricular valve regurgitation, obstruction to systemic or venous return and pericardial effusion, in order to determine procedural success and diagnose immediate complications.

  17. [Esophageal injury after insertion of a transesophageal echocardiography probe in a patient with an aberrant right subclavian artery].

    PubMed

    Suzuki, Satomi; Omori, Keiko; Kimura, Yuriko; Furuya, Atsushi; Tamaki, Fumimasa; Nonaka, Akihiko

    2012-01-01

    We describe a case of an esophageal injury caused by insertion of a transesophageal cardiac echo probe in a 66-year-old man with an aberrant right subclavian artery, who was scheduled for Bentall surgery for aortic regurgitation and annuloaortic ectasia. Preoperative CT scan showed an aberrant right subclavian artery compressed from the back of the esophagus. General anesthesia was induced with midazolam and fentanyl, and maintained with midazolam, remifentanil and fentanyl. After induction of anesthesia, a transesophageal cardiac echo probe was inserted without abnormal resistance. The operation was performed uneventfully. On the second day after surgery, gastrointestinal bleeding was suspected and the upper gastrointestinal endoscopy (GIF) was performed. GIF revealed ulceration at the mid-esophagus and gastroesophageal junction, and a large amount of fresh blood in the stomach. The location of the ulcer at mid-esophagus was likely to be over the aberrant right subclavian artery. Ulcers were treated conservatively. GIF on the postoperative day 16 revealed that ulcers had healed. Transesophageal echo probe insertion is potentially hazardous in a patient with an aberrant right subclavian artery. Although aberrant right subclavian artery is rare, transesophageal echocardiography should be performed with extreme caution.

  18. [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.

  19. Intraoperative Period and Breast Cancer: Review

    PubMed Central

    Akan, Arzu; Şimsek, Şerife

    2014-01-01

    Intraoperative radiation therapy in breast cancer (IORT) delivers a concentrated dose of radiation therapy to a tumor bed during surgery. IORT offers some of the following advantages with typically fewer complications like; maximum effect, sparing healthy tissues and organs, to help the patients finish treatment and get back to their normal activities. The goal of IORT is to improve local tumor control and survival rates for patients with breast cancer. IORT can both be performed with electron beams (ELIOT) and X-rays. Two main randomised trials testing intraoperative partial breast radiotherapy are TARGIT trial and the ELIOT (intraoperative radiotherapy with electrons) trial, but the techniques are fundamentally different. Whereas TARGIT delivers radiation from within the undisturbed tumour bed, for ELIOT, the mammary gland is mobilised, a prepectoral lead shield is inserted, the edges of the tumour bed are apposed, and radiation is delivered from without.

  20. 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.

  1. Intraoperative Optical Coherence Tomography Guided Bleb Needling.

    PubMed

    Dada, Tanuj; Angmo, Dewang; Midha, Neha; Sidhu, Talvir

    2016-01-01

    Two patients with history of trabeculectomy presented with uncontrolled intraocular pressure (IOP) postoperatively. The first patient had a flat and vasularized bleb 10 weeks after the surgery, and the second subject developed encapsulated bleb 3 months postoperatively. Both patients were taken to the operating room and intraoperative optical coherence tomography (OCT) guided bleb needling was performed to restore aqueous egress into the subconjunctival space. Postoperatively, IOP of the operated eyes ranged 14-18 mmHg at week 6 and month 3. None of the eyes had any intraoperative or postoperative complications. This novel application of the intraoperative OCT for bleb needling facilitates precision surgery under direct visualization and reduces the risk of complications.

  2. Intraoperative Optical Coherence Tomography Guided Bleb Needling

    PubMed Central

    Dada, Tanuj; Angmo, Dewang; Midha, Neha; Sidhu, Talvir

    2016-01-01

    Two patients with history of trabeculectomy presented with uncontrolled intraocular pressure (IOP) postoperatively. The first patient had a flat and vasularized bleb 10 weeks after the surgery, and the second subject developed encapsulated bleb 3 months postoperatively. Both patients were taken to the operating room and intraoperative optical coherence tomography (OCT) guided bleb needling was performed to restore aqueous egress into the subconjunctival space. Postoperatively, IOP of the operated eyes ranged 14-18 mmHg at week 6 and month 3. None of the eyes had any intraoperative or postoperative complications. This novel application of the intraoperative OCT for bleb needling facilitates precision surgery under direct visualization and reduces the risk of complications. PMID:27994819

  3. 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.

  4. Pediatric Spinal Ultrasound: Neonatal and Intraoperative Applications.

    PubMed

    Alvarado, Enrique; Leach, James; Caré, Marguerite; Mangano, Francesco; O Hara, Sara

    2017-04-01

    The purpose of this article is to review the use of ultrasound as a screening tool for spinal diseases in neonates and infants and its intraoperative value in selected pediatric neurosurgical disorders. A review of spinal embryology followed by a description of common spinal diseases in neonates assessed with ultrasound is presented. Indications for spinal ultrasound in neonates, commonly identified conditions, and the importance of magnetic resonance imaging in selected cases are emphasized. Additionally, the use of ultrasound in selected neurosurgical spinal diseases in pediatric patients is presented with magnetic resonance imaging and intraoperative correlation. Technique, limitations, and pitfalls are discussed.

  5. Transesophageal echocardiography using cypress-miniaturized echocardiogram unit: initial clinical experience.

    PubMed

    Herzog, Eyal; Pudpud, Danny; Chaudhry, Farooq A

    2005-11-01

    Transesophageal echocardiography (TEE) was introduced clinically in the United States in 1987. Recent technologic advances have resulted in the creation of a small portable hand-carried ultrasound (HCU) device that can be easily carried throughout the hospital with greater flexibility for cardiac imaging. These HCU devices have harmonic, color, and spectral Doppler (continuous/pulsed wave). Siemens Medical Solutions USA, Inc. has incorporated a TEE connector, which connects to its Cypress (highly miniaturized echocardiogram unit) and allows the performance of a TEE with this unit, which is mildly heavier than a typical HCU. We describe our initial clinical experience with this unit. The image quality is comparable to routine TEEs, with the advantages of shorter duration, portability, affordable cost, avoiding the use of high-end machine from the echo lab, availability of non-HCU units for other studies, and preventing the need for an echo technician to be involved in the procedure.

  6. Standard transthoracic echocardiography and transesophageal echocardiography views of mitral pathology that every surgeon should know

    PubMed Central

    Tan, Timothy C.

    2015-01-01

    The mitral valve is the most commonly diseased heart valve and the prevalence of mitral valve disease increases proportionally with age. Echocardiography is the primary diagnostic imaging modality used in the assessment of patients with mitral valve disease. It is a noninvasive method which provides accurate anatomic and functional information regarding the mitral valve and can identify the mechanism of mitral valve pathology. This is especially useful as it may guide surgical repair. This is increasingly relevant given the growing trend of patients undergoing mitral valve repair. Collaboration between cardiac surgeons and echocardiographers is critical in the evaluation of mitral valve disease and for identification of complex valvular lesions that require advanced surgical skill to repair. This article will provide an overview of transthoracic and transesophageal assessment of common mitral valve pathology that aims to aid surgical decision making. PMID:26539350

  7. Monitoring Cardiac Output and Transesophageal Echocardiography during Removal of a Ventricular Assist Device.

    PubMed

    Demir, Aslı; Karadeniz, Ümit; Aydınlı, Bahar; Taş, Murat; Erdemli, Özcan

    2013-12-01

    A ventricular assist device (VAD) is a mechanical pump used to support heart function and blood flow in patients with poor heart functions. For selected patients who are too ill to wait for a heart transplant or are not eligible for a heart transplant because of age or other medical problems, ventricular assist devices offer life-saving therapy. This device has also become a life-saving approach for patients with acute viral myocarditis. Following the acute illness phase, when heart function has improved, the VAD is carefully removed. It is very important to continuously monitor myocardial functions during this period. In this paper, we present a patient who underwent cardiac output and transesophageal echocardiography monitoring during VAD removal.

  8. Monitoring Cardiac Output and Transesophageal Echocardiography during Removal of a Ventricular Assist Device

    PubMed Central

    Demir, Aslı; Karadeniz, Ümit; Aydınlı, Bahar; Taş, Murat; Erdemli, Özcan

    2013-01-01

    A ventricular assist device (VAD) is a mechanical pump used to support heart function and blood flow in patients with poor heart functions. For selected patients who are too ill to wait for a heart transplant or are not eligible for a heart transplant because of age or other medical problems, ventricular assist devices offer life-saving therapy. This device has also become a life-saving approach for patients with acute viral myocarditis. Following the acute illness phase, when heart function has improved, the VAD is carefully removed. It is very important to continuously monitor myocardial functions during this period. In this paper, we present a patient who underwent cardiac output and transesophageal echocardiography monitoring during VAD removal. PMID:27366376

  9. 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.

  10. 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.

  11. Intraoperative imaging in orbital and midface reconstruction.

    PubMed

    Wilde, Frank; Schramm, Alexander

    2014-10-01

    The orbit is very often affected by injuries which can leave patients not only with esthetic deficits, but also with functional impairments if reconstruction is inadequate. Computer-assisted surgery helps to achieve predictable outcomes in reconstruction. Today, intraoperative three-dimensional (3D) imaging is an important element in the workflow of computer-assisted orbital surgery. Clinical and radiological diagnosis by means of computed tomography is followed by preoperative computer-assisted planning to define and simulate the desired outcome of reconstruction. In difficult cases, intraoperative navigation helps in the implementation of procedure plans at the site of surgery. Intraoperative 3D imaging then allows an intraoperative final control to be made and the outcome of the surgery to be validated. Today, this is preferably done using 3D C-arm devices based on cone beam computed tomography. They help to avoid malpositioning of bone fragments and/or inserted implants assuring the quality of complex operations and reducing the number of secondary interventions necessary.

  12. Intraoperative BiPAP in OSA Patients

    PubMed Central

    Singh, Bhavna P

    2015-01-01

    Obstructive sleep apnea syndrome (OSA) is characterized by recurrent episodes of partial or complete upper airway obstructions during sleep. Severe OSA presents with a number of challenges to the anesthesiologist, the most life threatening being loss of the airway. We are reporting a case where we successfully used intraoperative bi level positive pressure ventilation (BiPAP) with moderate sedation and a regional technique in a patient with severe OSA posted for total knee replacement (TKR). A 55-year-old lady with osteoarthritis of right knee joint was posted for total knee replacement. She had severe OSA with an apnea-hypopnea index of 35. She also had moderate pulmonary hypertension due to her long standing OSA. We successfully used in her a combined spinal epidural technique with intraoperative BiPAP and sedation. She had no complications intraoperatively or post operatively and was discharged on day 5. Patients with OSA are vulnerable to sedatives, anaesthesia and analgesia which even in small doses can cause complete airway collapse. The problem, with regional techniques is that it requires excellent patient cooperation. We decided to put our patient on intraoperative BiPAP hoping that this would allow us to sedate her adequately for the surgery. As it happened we were able to successfully sedate her with slightly lesser doses of the commonly used sedatives without any episodes of desaturation, snoring or exacerbation of pulmonary hypertension. Many more trials are required before we can conclusively say that intraoperative BiPAP allows us to safely sedate OSA patients but we hope that our case report draws light on this possibility. Planning ahead and having a BiPAP machine available inside the operating may allow us to use sedatives in these patients to keep them comfortable under regional anaesthesia. PMID:26023625

  13. Usefulness of the transgastric view by transesophageal echocardiography in evaluating thickened pericardium in patients with constrictive pericarditis.

    PubMed

    Izumi, Chisato; Iga, Kanji; Sekiguchi, Kiyomi; Takahashi, Shuichi; Konishi, Takashi

    2002-09-01

    Detection of thickened pericardium in patients with constrictive pericarditis is essential for pericardiectomy because restrictive cardiomyopathy and severe tricuspid regurgitation show similar hemodynamic data. The purpose of this study was to clarify whether transesophageal echocardiography can evaluate thickened pericardium. We investigated 7 patients with constrictive pericarditis who underwent pericardiectomy. Thickened pericardium over the right atrium was detected in 6 patients, but the borders were not clear. Thickened pericardium over the left ventricle was not detected in any patients in the standard longitudinal and horizontal views. On the other hand, thickened pericardium over the ventricles was detected in all patients in the transgastric view as an echogenic area between the liver and ventricular wall. Tissue characteristics of the thickened pericardium could be evaluated because of the high-quality images in the transgastric view. The transgastric view by transesophageal echocardiography allows high-quality images of the pericardium, which might be useful in diagnosing constrictive pericarditis.

  14. 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

  15. 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

  16. 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.

  17. Descending aortic mechanics and atrial fibrillation: a two-dimensional speckle tracking transesophageal echocardiography study.

    PubMed

    Teixeira, Rogério; Monteiro, Ricardo; Dinis, Paulo; Santos, Maria José; Botelho, Ana; Quintal, Nuno; Cardim, Nuno; Gonçalves, Lino

    2017-04-01

    Vascular mechanics assessed with two-dimensional speckle tracking echocardiography (2D-STE) could be used as a new imaging surrogate of vascular stiffening. The CHA2DS2-VASc score is considered accurate as an estimate of stroke risk in non-valvular AF, although many potential stroke risk factors have not been included in this scoring method. The purpose of this research is to study the feasibility of evaluating vascular mechanics at the descending aorta in non-valvular AF patients using transesophageal 2D-STE and to analyze the association between descending aortic mechanics and stroke. We prospectively recruited a group of 44 patients referred for a transesophageal echocardiogram (TEE) in the context of cardioversion for non-valvular AF. A short-axis view of the descending aorta, one to two centimeters after the aortic arch was selected for the vascular mechanics assessment with the 2D-STE methodology. The vascular mechanics parameters analyzed were circumferential aortic strain (CAS) and early circumferential aortic strain rate (CASR). A clinical assessment was performed with focus on the past stroke history and the CHA2DS2-VASc score. The mean age of our cohort was 65 ± 13 years and 75% were men; AF was known for 2.8 ± 2.5 years and it was considered paroxystic in 41% of cases. Waveforms adequate for measuring 2D-STE were present in 85% of the 264 descending aortic wall segments. The mean CAS was 3.5 ± 1.2% and the mean CASR was 0.7 ± 0.3 s(-1). The inter- and intra-observer variability for aortic mechanics was considered adequate. The median CHA2DS2VASc score was 2 (2-3). As the score increased we noted that both the CAS (r = -0.38, P = 0.01) and the CASR (r = -0.42, P < 0.01) decreased. Over 16% of the AF patients had a past history of stroke. These patients had lower values of both descending aortic strain [2.2 (1.8-2.6) vs. 3.9 (3.3-4.9)%, P < 0.01] and strain rate [0.4 (0.3-0.4) vs. 0.7 (0.6-1.1) s(-1), P < 0

  18. Fluorescence goggle for intraoperative breast cancer imaging

    NASA Astrophysics Data System (ADS)

    Liu, Yang; Bauer, Adam Q.; Akers, Walter; Sudlow, Gail; Liang, Kexian; Charanya, Tauseef; Mondal, Suman; Culver, Joseph P.; Achilefu, Samuel

    2012-03-01

    We have developed a fluorescence goggle device for intraoperative oncologic imaging. With our system design, the surgeon can directly visualize the fluorescence information from the eyepieces in real time without any additional monitor, which can improve one's coordination and surgical accuracy. In conjunction with targeting fluorescent dyes, the goggle device can successfully detect tumor margins and small nodules that are not obvious to naked eye. This can potentially decrease the incidence of incomplete resection.

  19. Intraoperative molecular imaging to identify lung adenocarcinomas

    PubMed Central

    Newton, Andrew D.; Kennedy, Gregory T.; Predina, Jarrod D.; Low, Philip S.

    2016-01-01

    Intraoperative molecular imaging is a promising new technology with numerous applications in lung cancer surgery. Accurate identification of small nodules and assessment of tumor margins are two challenges in pulmonary resections for cancer, particularly with increasing use of video-assisted thoracoscopic surgery (VATS). One potential solution to these problems is intraoperative use of a fluorescent contrast agent to improve detection of cancer cells. This technology requires both a targeted fluorescent dye that will selectively accumulate in cancer cells and a specialized imaging system to detect the cells. In several studies, we have shown that intraoperative imaging with indocyanine green (ICG) can be used to accurately identify indeterminate pulmonary nodules. The use of a folate-tagged fluorescent molecule targeted to the folate receptor-α (FRα) further improves the sensitivity and specificity of detecting lung adenocarcinomas. We have demonstrated this technology can be used as an “optical biopsy” to differentiate adenocarcinoma versus other histological subtypes of pulmonary nodules. This strategy has potential applications in assessing bronchial stump margins, identifying synchronous or metachronous lesions, and rapidly assessing lymph nodes for lung adenocarcinoma. PMID:28066672

  20. 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

  1. 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.

  2. Intraoperative anterior cruciate ligament graft contamination.

    PubMed

    Pasque, Charles B; Geib, Timothy M

    2007-03-01

    Intraoperative anterior cruciate ligament graft contamination is a rare but potentially devastating occurrence for any surgeon to encounter. Most instances in our experience have happened when a surgeon first enters practice or is operating in a new environment with new staff. Based on the currently available literature and the senior author's personal experience with 3 cases, intraoperative cleansing of the graft followed by implantation is a reasonable option. The protocol used successfully in these 3 cases includes getting the graft off of the floor immediately, removing any suture material in the graft, cleansing the graft for 15 to 30 minutes each in chlorohexidine and triple antibiotic solution, followed by a normal saline rinse. All graft sutures should then be replaced. The graft should then be resized and the tibial and femoral tunnels adjusted if needed. After implantation of the graft, additional intraoperative and postoperative intravenous antibiotic and/or oral antibiotic administration is also recommended for the first 1 to 2 weeks. Close clinical follow-up is also very important the first 6 weeks postoperatively and should include candid communication with the patient and family.

  3. Delivery of stents to target lesions: techniques of intraoperative stent implantation and intraoperative angiograms.

    PubMed

    Ing, F F

    2005-01-01

    Mullins et al. [6] reported the first use of stent implantation to treat stenotic branch pulmonary arteries in 1988. In the early to mid-1990s, numerous reports confirmed its safety and efficacy, but there were limited stent and balloon designs and stent implantations were performed using relatively large delivery systems (10- to 12-Fr sheaths) [7, 8]. The general accepted patient size was limited to those weighing 12 kg or greater. Intraoperative stent implantation for branch pulmonary artery stenosis was reported in the early to mid-1990s [1-3, 5, 9]. Indications in these early reports included small patient size or difficult anatomy or patients who had additional cardiac lesions and needed surgery independent of the branch stenosis. The idea was to take advantage of the open-heart exposure provided in the operating room to permit direct access to the stenotic segment. Hence, all intraoperative stent implants were performed under direct visualization on bypass. There were no discussions on advantages over the routine percutaneous approach. Currently, with advances in stent and balloon technology as well as increased operator experience, many of those reported cases probably would have undergone cardiac catheterization for a percutaneous stent implant rather than open-heart surgery. The purpose of this report is to review the current indications, advantages, and disadvantages of intraoperative stent implantation as well as to discuss the techniques that are helpful to optimize intraoperative stent positioning. The role and advantages of intraoperative angiography will also be presented.

  4. Measurement of the aortic annulus size by real-time three-dimensional transesophageal echocardiography.

    PubMed

    Jánosi, Rolf Alexander; Kahlert, Philipp; Plicht, Björn; Wendt, Daniel; Eggebrecht, Holger; Erbel, Raimund; Buck, Thomas

    2011-04-01

    We sought to determine the level of agreement and the reproducibility of two-dimensional (2D) transthoracic (2D-TTE), 2D transesophageal (2D-TEE) and real-time three-dimensional (3D) transesophageal echocardiography (RT3D-TEE) for measurement of aortic annulus size in patients referred for transcatheter aortic valve implantation (TAVI). Accurate preoperative assessment of the dimensions of the aortic annulus is critical for patient selection and successful implantation in those undergoing TAVI for severe aortic stenosis (AS). Annulus size was measured using 2D-TTE, 2D-TEE and RT3D-TEE in 105 patients with severe AS referred for TAVI. Agreement between echocardiographic methods and interobserver variability was assessed using the Bland-Altman method and regression analysis, respectively. The mean aortic annuli were 21,7 ± 3 mm measured with 2D-TTE, 22,6 ± 2,8 mm with 2D-TEE and 22,3 ± 2,9 mm with RT3D-TEE. The results showed a small but significant mean difference and a strong correlation between the three measurement techniques (2D-TTE vs. 2D-TEE mean difference 0,84 ± 1,85 mm, r = 0,8, p < 0,0001; 2D-TEE vs. 3D-TEE 0,27 ± 1,14 mm, r = 0,91, p < 0,02; 2D-TTE vs. 3D-TEE 0,58 ± 2,21 mm, r = 0,72, p = 0,02); however, differences between measurements amounted up to 6,1 mm. Interobserver variability for 2D-TTE and 2D-TEE was substantially higher compared with RT3D-TEE. We found significant differences in the dimensions of the aortic annulus measured by 2D-TTE, 2D-TEE and RT3D-TEE. Thus, in patients referred for TAVI, the echocardiographic method used may have an impact on TAVI strategy.

  5. Role of transesophageal echocardiography in percutaneous aortic valve replacement with the CoreValve Revalving system.

    PubMed

    Berry, Colin; Oukerraj, Latifa; Asgar, Anita; Lamarche, Yoan; Marcheix, Bertrand; Denault, André Y; Laborde, Jean-Claude; Cartier, Raymond; Ducharme, Anique; Bonan, Raoul; Basmadjian, Arsène J

    2008-09-01

    Percutaneous aortic valve replacement (PAVR) is an emerging therapy for nonsurgical patients with severe aortic stenosis (AS). We examined the role of transesophageal echocardiography (TEE) in PAVR. TEE was used initially to assess the native valve and aortic root, and served as a guide during PAVR. Following prosthetic valve deployment, TEE was used to assess valve function. Eleven patients aged 82 +/- 10 years with NYHA III-IV underwent PAVR. Periprocedural TEE gave immediate information on prosthetic position and function, LV function, mitral regurgitation, pericardium, and thoracic aorta anatomy. There was excellent visual agreement between fluoroscopic and TEE images of prosthetic positioning and deployment. TEE facilitated the detection and management of procedure-related complications. Compared with pre-PAVR, AV area (0.56 +/- 0.19 cm(2) vs. 1.3 +/- 0.4 cm(2); P < 0.001) and LVEF (49 +/- 17% vs. 56 +/- 11%; P < 0.001) increased. TEE provides key anatomical and functional information, and serves as a diagnostic guide for complications, which may arise during PAVR.

  6. Three-dimensional shape, deformation, and motion analysis of mitral annuli using transesophageal echocardiographic data

    NASA Astrophysics Data System (ADS)

    Gaddipatti, Ajeetkumar; Chandra, Shalabh; Flachskampf, Frank A.; Powell, Kimerly; Thomas, James D.

    1998-07-01

    Deformation and motion of the Mitral Annulus (MA) is closely related to the left ventricular function. Measurement and visualization of the characteristic parameters in 3D will help in understanding the relationship. Data for this study was acquired from patients undergoing transesophageal echocardiographic examination with the transducer aligned along the axis roughly perpendicular to the annuli, and rotated automatically to cover 360 degrees. ECG gated images were acquired at 24 angles for each phase of the cardiac cycle. The annuli hinge points were identified from each echo image and the annuli reconstructed. The parameters measured to characterize the annuli were: (1) area of projection, (2) non- planarity, (3) excursion of annulus centroid, (4) change in the annulus orientation. We validated the method using a wire loop shaped in the form of a saddle and a planar rubber ring imaged in a water bath at different orientations. Four MAs were reconstructed using this method. Two were patients with dilated cardiomyopathy (DCM) and two were patients with normal ventricular function. The change in parameters was measured from systole to diastole. Percentage change in area (29% vs. 16%) and excursion (8 mm vs. 3 mm) were much larger for normals than for patients. While, changes in non-planarity (20%) and orientation (6 deg) were similar. These preliminary results show that MA parameters do reflect the abnormality, and could be used for diagnosis and prognosis of patients with bad ventricles.

  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. Practice guidelines for perioperative transesophageal echocardiography: recommendations of the Indian association of cardiovascular thoracic anesthesiologists.

    PubMed

    Muralidhar, Kanchi; Tempe, Deepak; Chakravarthy, Murali; Shastry, Naman; Kapoor, Poonam Malhotra; Tewari, Prabhat; Gadhinglajkar, Shrinivas V; Mehta, Yatin

    2013-01-01

    Transoesophageal Echocardiography (TEE) is now an integral part of practice of cardiac anaesthesiology. Advances in instrumentation and the information that can be obtained from the TEE examination has proceeded at a breath-taking pace since the introduction of this technology in the early 1980s. Recognizing the importance of TEE in the management of surgical patients, the American Societies of Anesthesiologists (ASA) and the Society of Cardiac Anesthesiologists, USA (SCA) published practice guidelines for the clinical application of perioperative TEE in 1996. On a similar pattern, Indian Association of Cardiac Anaesthesiologists (IACTA) has taken the task of putting forth guidelines for transesophageal echocardiography (TEE) to standardize practice across the country. This review assesses the risks and benefits of TEE for several indications or clinical scenarios. The indications for this review were drawn from common applications or anticipated uses as well as current clinical practice guidelines published by various society practicing Cardiac Anaesthesia and cardiology . Based on the input received, it was determined that the most important parts of the TEE examination could be displayed in a set of 20 cross sectional imaging planes. These 20 cross sections would provide also the format for digital acquisition and storage of a comprehensive TEE examination. Because variability exists in the precise anatomic orientation between the heart and the esophagus in individual patients, an attempt was made to provide specific criteria based on identifiable anatomic landmarks to improve the reproducibility and consistency of image acquisition for each of the standard cross sections.

  9. [Case in which transesophageal echocardiography after induction of anaesthesia was useful for reevaluation of preoperative diagnosis].

    PubMed

    Ueno, Megumi; Kunisawa, Takayuki; Nagashima, Michio; Suzuki, Akihiro; Takahata, Osamu; Iwasaki, Hiroshi

    2010-01-01

    A woman in her 70's had undergone two valve replacements (mitral valve and aortic valve). A transendothelial chest wall echocardiogram (TTE) showed that a flap lobe of a mitral mechanical valve had fixed the valve in a closed state, and it was diagnosed as stuck leaflet of a bileaflet prosthesis in the mitral position. She was scheduled for emergency surgery for mitral valve replacement. After induction of anaesthesia, a transesophageal echocardiography (TEE) probe was inserted. Observation of two-dimensional images showed that the bileaflet mechanical valve in the mitral position was functioning properly. Pulsed wave Doppler measurements showed that maximum blood flow rate, pressure-half-time, maximum gradient and average gradient were 1.5 m x sec(-1), 64 ms, 9.0 mmHg and 3.5 mmHg, respectively, and there were no findings suggesting mitral stenosis. TEE showed that there was no stuck leaflet of the bileaflet prosthesis in the mitral position, and the operation was called off. The patient was followed up in the intensive care unit. In this case, TEE was useful for reevaluation of the preoperative diagnosis and for reevaluation of indication for surgery.

  10. 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.

  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. 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.

  13. Brain mapping in tumors: intraoperative or extraoperative?

    PubMed

    Duffau, Hugues

    2013-12-01

    In nontumoral epilepsy surgery, the main goal for all preoperative investigation is to first determine the epileptogenic zone, and then to analyze its relation to eloquent cortex, in order to control seizures while avoiding adverse postoperative neurologic outcome. To this end, in addition to neuropsychological assessment, functional neuroimaging and scalp electroencephalography, extraoperative recording, and electrical mapping, especially using subdural strip- or grid-electrodes, has been reported extensively. Nonetheless, in tumoral epilepsy surgery, the rationale is different. Indeed, the first aim is rather to maximize the extent of tumor resection while minimizing postsurgical morbidity, in order to increase the median survival as well as to preserve quality of life. As a consequence, as frequently seen in infiltrating tumors such as gliomas, where these lesions not only grow but also migrate along white matter tracts, the resection should be performed according to functional boundaries both at cortical and subcortical levels. With this in mind, extraoperative mapping by strips/grids is often not sufficient in tumoral surgery, since in essence, it allows study of the cortex but cannot map subcortical pathways. Therefore, intraoperative electrostimulation mapping, especially in awake patients, is more appropriate in tumor surgery, because this technique allows real-time detection of areas crucial for cerebral functions--eloquent cortex and fibers--throughout the resection. In summary, rather than choosing one or the other of different mapping techniques, methodology should be adapted to each pathology, that is, extraoperative mapping in nontumoral epilepsy surgery and intraoperative mapping in tumoral surgery.

  14. Intraoperative blood salvage: a new artificial organ?

    PubMed

    Valbonesi, M; Frisoni, R; Florio, G; Ferrari, M

    1995-03-01

    Optimal blood supply is critical to modern medical practice. Among the different possibilities of improving the quality and safety of blood, it is generally felt that autologous donation has played an important role and has contributed to changing transfusional practices, mainly since the appearance of HIV and HCV on the blood transfusion scene. At the San Martino Hospital Immunohematology Service, the autotransfusion era began in 1985. Autologous predeposit donation was the first to be introduced, followed by intentional perioperative hemodilution, intraoperative blood salvage with DFC apparatuses and lastly post-operative blood salvage. From about 200 autologous donations in 1985 we reached 5,372 in 1993 and more than 6,000 autologous donations are expected for 1994. Only 189 intraoperative blood salvages, were carried out in 1986, 593 in 1989, 1,207 in 1993 and more than 1,500 blood salvage sessions are anticipated for 1994. In the meantime, the total number of homologous RBC units employed in the Hospital dropped from 45,000 in 1985 to 18,000 in 1994, with the Onco-hematological Divisions using approximately 10,000 units of packed RBC.

  15. [An evaluation of the pulmonary venous flow pattern by transesophageal and transthoracic Doppler echocardiography in a normal subject].

    PubMed

    Cottini, E; Giacone, G; Cosentino, M; Rando, G; Vintaloro, G; De Roberto, S

    1994-10-01

    Transesophageal echocardiographic studies have permitted a pulmonary venous flow velocity pattern to be identified which is comparable to that recorder using invasive methods. The pattern consists of 4 stages: an anterograde systolic flow with an early (S1) and late (S2) peak velocity, a diastolic anterograde flow (D) and a retrograde flow liked to atrial contraction (Ar). The aim of this study was to evaluate the pattern of pulmonary venous flow velocity using transesophageal and transthoracic colour Doppler echocardiography in normal subjects in an attempt to: 1) determine normal values derived from the pulmonary venous flow pattern which may contribute to future studies; 2) find correlations between the pattern of pulmonary venous flow and a number of physiological, hemodynamic and echocardiographic parameters which take account of the morphological variations of this flow pattern within a normal range; 3) demonstrate the possibility of being able to carry out study using transthoracic colour Doppler echocardiography. The study was carried out in 38 normal subjects aged between 15 and 76 years old (mean 45 +/- 15) who underwent transthoracic and transesophageal colour-Doppler echocardiography. The following parameters were measured: left atrium diameter, diameters and telediastolic and telesystolic volumes of the left ventricle, ejection fraction and systolic percentage shortening of the left ventricle, peak velocity of the mitral flow pattern and the pulmonary venous flow pattern. The results obtained show that: 1) the pattern of pulmonary venous flow alters with ageing causing the prevalence of systolic over diastolic peak velocity; 2) the pulmonary venous flow parameters which appear to be most significant in hemodynamic terms are the peak velocities of the early systolic flow and anterograde diastolic flow and the ratios S1/S2 and S2/D; 3) the echocardiographic parameters most closely correlated with the peak velocity of pulmonary venous flow are the

  16. Anesthetic management of a case of Gilbert's syndrome for mitral and aortic valve replacement: Role of transesophageal echocardiography

    PubMed Central

    Nagaraja, P. S.; Singh, Naveen G.; Subash, S.; Manjunatha, N.; Prabhushankar, C. G.; Sathish, N.

    2017-01-01

    Gilbert's syndrome (GS) is an autosomal inherited disorder characterized by relative deficiency of glucuronyl transferase and poor uptake of unconjugated bilirubin by hepatocytes. Cardiac surgery on cardiopulmonary bypass (CPB) in these patients triggers further hepatic dysfunction. Transesophageal echocardiography (TEE) and Doppler assessment of hepatic vein help in assessing hepatic blood flow (HBF) during cardiac surgery. Here, we discuss anesthetic management and role of TEE in maintaining HBF perioperatively in a 25-year-old male patient with GS undergoing double valve replacement with tricuspid valve plasty. TEE-guided HBF monitoring and management of hepatic perfusion by modifying anesthetic and CPB protocol resulted in the favorable outcome. PMID:28217062

  17. Role of Transesophageal Echocardiography in the Diagnosis of Paradoxical Low Flow, Low Gradient Severe Aortic Stenosis

    PubMed Central

    Abudiab, Muaz M.; Pandit, Anil

    2017-01-01

    Background and Objectives Prior studies indicate that up to 35% of cases of severe aortic stenosis (AS) have paradoxical low flow, low gradient despite preserved left ventricular ejection fraction (LVEF). However, error in left ventricular outflow tract (LVOT) diameter may lead to misclassification. Herein, we determined whether measurement of LVOT diameter by transesophageal echocardiography (TEE) results in reclassification of cases to non-severe AS. Subjects and Methods Patients with severe AS with aortic valve area (AVA) <1 cm2 by transthoracic echocardiography (TTE) within 6 months were studied. Paradoxical low flow, low gradient was defined as mean Doppler gradient (MG) <40 mm Hg and stroke volume index (SVI) ≤35 mL/m2. Preserved LVEF was defined as ≥0.50. Results Among 108 patients, 12 (15%) had paradoxical low flow, low gradient severe AS despite preserved LVEF based on TTE measurement. When LVOT diameter by TEE in 2D was used, only 5 (6.3%) patients had low flow, low gradient severe AS (p<0.001). Coefficients of variability for intraobserver and interobserver measurement of LVOT were <10%. However, the limits of agreement between TTE and TEE measurement of LVOT ranged from 0.43 cm (95% confidence interval [CI]: 0.36 to 0.5) to -0.31 cm (95% CI: -0.38 to -0.23). Conclusion TEE measured LVOT diameter may result in reclassification to moderate AS in some patients due to low prevalence of true paradoxical low flow, low gradient (PLFLG) severe AS. PMID:28154595

  18. Effects of postural change on transesophageal echocardiography views and parameters in healthy dogs

    PubMed Central

    GOYA, Seijirow; WADA, Tomoki; SHIMADA, Kazumi; HIRAO, Daiki; FUKUSHIMA, Ryuji; YAMAGISHI, Norio; SHIMIZU, Miki; TANAKA, Ryou

    2016-01-01

    The purpose of the present study is to investigate the effect of postural change on transesophageal echocardiography (TEE) views and parameters of interest anesthesia monitoring in healthy dogs. Twelve Beagle dogs were anesthetized and randomly positioned in one of four postures: right lateral-recumbency, left lateral-recumbency, supine position and prone position. After examinations in one posture, the same examination was demonstrated in another posture and repeated in all postures. In each posture, several standard TEE views were demonstrated: longitudinal cranial-esophageal aorta long-axis-view, transverse middle-esophageal mitral valve long-axis-view and transgastric middle short-axis-view. Additionally, echocardiographic parameters were attempted to measure, and direct blood pressure monitoring was performed in each view. As a result, oriented views, except for transgastric middle short-axis-view, could be obtained in all postures. Stroke volume and peak early diastolic velocity of mitral inflow were lower in supine position compared with those in right and left lateral-recumbency. Heart rate (HR) and systemic vascular resistance were higher in supine position compared with those in right and left lateral-recumbency. Left ventricular pre-ejection period/left ventricular ejection time corrected and uncorrected by HR were higher in supine position compared with those in right and left lateral-recumbency. In conclusion, longitudinal cranial-esophageal aorta long-axis-view and transverse middle-esophageal mitral valve long-axis-view provide useful information of interest anesthesia monitoring, because of their views enable to certainly obtain TEE parameters in various postures. Furthermore, TEE parameters allow to detect the changes of preload, afterload and HR that occur in supine position dogs. PMID:27980234

  19. 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)

  20. Cardiac Impairment Evaluated by Transesophageal Echocardiography and Invasive Measurements in Rats Undergoing Sinoaortic Denervation

    PubMed Central

    Sirvente, Raquel A.; Irigoyen, Maria C.; Souza, Leandro E.; Mostarda, Cristiano; La Fuente, Raquel N.; Candido, Georgia O.; Souza, Pamella R. M.; Medeiros, Alessandra; Mady, Charles; Salemi, Vera M. C.

    2014-01-01

    Background Sympathetic hyperactivity may be related to left ventricular (LV) dysfunction and baro- and chemoreflex impairment in hypertension. However, cardiac function, regarding the association of hypertension and baroreflex dysfunction, has not been previously evaluated by transesophageal echocardiography (TEE) using intracardiac echocardiographic catheter. Methods and Results We evaluated exercise tests, baroreflex sensitivity and cardiovascular autonomic control, cardiac function, and biventricular invasive pressures in rats 10 weeks after sinoaortic denervation (SAD). The rats (n = 32) were divided into 4 groups: 16 Wistar (W) with (n = 8) or without SAD (n = 8) and 16 spontaneously hypertensive rats (SHR) with (n = 8) or without SAD (SHRSAD) (n = 8). Blood pressure (BP) and heart rate (HR) did not change between the groups with or without SAD; however, compared to W, SHR groups had higher BP levels and BP variability was increased. Exercise testing showed that SHR had better functional capacity compared to SAD and SHRSAD. Echocardiography showed left ventricular (LV) concentric hypertrophy; segmental systolic and diastolic biventricular dysfunction; indirect signals of pulmonary arterial hypertension, mostly evident in SHRSAD. The end-diastolic right ventricular (RV) pressure increased in all groups compared to W, and the end-diastolic LV pressure increased in SHR and SHRSAD groups compared to W, and in SHRSAD compared to SAD. Conclusions Our results suggest that baroreflex dysfunction impairs cardiac function, and increases pulmonary artery pressure, supporting a role for baroreflex dysfunction in the pathogenesis of hypertensive cardiac disease. Moreover, TEE is a useful and feasible noninvasive technique that allows the assessment of cardiac function, particularly RV indices in this model of cardiac disease. PMID:24828834

  1. Surgeon-Performed Hemodynamic Transesophageal Echocardiography in the Burn Intensive Care Unit.

    PubMed

    Held, Jenny M; Litt, Jeffrey; Kennedy, Jason D; McGrane, Stuart; Gunter, Oliver L; Rae, Lisa; Kahn, Steven A

    2016-01-01

    The use of transesophageal echocardiography (TEE) for resuscitation after burn injury has been reported in small case studies. Conventional TEE is invasive and often requires a subspecialist with a high level of training. The authors report a series of surgeon-performed hemodynamic TEE with an indwelling, less bulky, user-friendly probe. Records of patients treated in a regional burn center who underwent hemodynamic TEE between October 1, 2012 and May 30, 2014 were reviewed. The clinical course of each patient was recorded. All bedside interpretations were retrospectively reviewed for accuracy by a cardiac anesthesiologist. Eleven patients were included in the study. Median age was 68.5 years (interquartile range, 49.5-79.5). Median burn size was 37% TBSA (interquartile range: 16.3-53%). Seven patients were male, and four suffered inhalation injury. The operator's interpretation matched that of the echocardiography technician and cardiac anesthesiologist in all instances. No complications occurred from probe placement. Four patients underwent hemodynamic TEE to determine volume status during resuscitation. Changes in volume status on echocardiography preceded the eventual changes in urine output and vital signs for one patient. Hemodynamic TEE diagnosed cardiogenic shock and was used to titrate inotropes and vasopressors in seven elderly patients. Hemodynamic TEE is a useful adjunct to manage the burn patient who deviates off the expected course, especially if there is a question of cardiac function or volume status. It is less invasive and can be accurately performed by surgical intensivists when transthoracic echo windows are limited. The role of echocardiography in optimizing routine burn resuscitations needs to be further studied.

  2. Comparison of spatiotemporal interpolators for 4D image reconstruction from 2D transesophageal ultrasound

    NASA Astrophysics Data System (ADS)

    Haak, Alexander; van Stralen, Marijn; van Burken, Gerard; Klein, Stefan; Pluim, Josien P. W.; de Jong, Nico; van der Steen, Antonius F. W.; Bosch, Johan G.

    2012-03-01

    °For electrophysiology intervention monitoring, we intend to reconstruct 4D ultrasound (US) of structures in the beating heart from 2D transesophageal US by scanplane rotation. The image acquisition is continuous but unsynchronized to the heart rate, which results in a sparsely and irregularly sampled dataset and a spatiotemporal interpolation method is desired. Previously, we showed the potential of normalized convolution (NC) for interpolating such datasets. We explored 4D interpolation by 3 different methods: NC, nearest neighbor (NN), and temporal binning followed by linear interpolation (LTB). The test datasets were derived by slicing three 4D echocardiography datasets at random rotation angles (θ, range: 0-180) and random normalized cardiac phase (τ, range: 0-1). Four different distributions of rotated 2D images with 600, 900, 1350, and 1800 2D input images were created from all TEE sets. A 2D Gaussian kernel was used for NC and optimal kernel sizes (σθ and στ) were found by performing an exhaustive search. The RMS gray value error (RMSE) of the reconstructed images was computed for all interpolation methods. The estimated optimal kernels were in the range of σθ = 3.24 - 3.69°/ στ = 0.045 - 0.048, σθ = 2.79°/ στ = 0.031 - 0.038, σθ = 2.34°/ στ = 0.023 - 0.026, and σθ = 1.89°/ στ = 0.021 - 0.023 for 600, 900, 1350, and 1800 input images respectively. We showed that NC outperforms NN and LTB. For a small number of input images the advantage of NC is more pronounced.

  3. Effects of postural change on transesophageal echocardiography views and parameters in healthy dogs.

    PubMed

    Goya, Seijirow; Wada, Tomoki; Shimada, Kazumi; Hirao, Daiki; Fukushima, Ryuji; Yamagishi, Norio; Shimizu, Miki; Tanaka, Ryou

    2017-02-28

    The purpose of the present study is to investigate the effect of postural change on transesophageal echocardiography (TEE) views and parameters of interest anesthesia monitoring in healthy dogs. Twelve Beagle dogs were anesthetized and randomly positioned in one of four postures: right lateral-recumbency, left lateral-recumbency, supine position and prone position. After examinations in one posture, the same examination was demonstrated in another posture and repeated in all postures. In each posture, several standard TEE views were demonstrated: longitudinal cranial-esophageal aorta long-axis-view, transverse middle-esophageal mitral valve long-axis-view and transgastric middle short-axis-view. Additionally, echocardiographic parameters were attempted to measure, and direct blood pressure monitoring was performed in each view. As a result, oriented views, except for transgastric middle short-axis-view, could be obtained in all postures. Stroke volume and peak early diastolic velocity of mitral inflow were lower in supine position compared with those in right and left lateral-recumbency. Heart rate (HR) and systemic vascular resistance were higher in supine position compared with those in right and left lateral-recumbency. Left ventricular pre-ejection period/left ventricular ejection time corrected and uncorrected by HR were higher in supine position compared with those in right and left lateral-recumbency. In conclusion, longitudinal cranial-esophageal aorta long-axis-view and transverse middle-esophageal mitral valve long-axis-view provide useful information of interest anesthesia monitoring, because of their views enable to certainly obtain TEE parameters in various postures. Furthermore, TEE parameters allow to detect the changes of preload, afterload and HR that occur in supine position dogs.

  4. Avoiding transthoracic echocardiography and transesophageal echocardiography for patients with variable body mass indexes in infective endocarditis

    PubMed Central

    Sogomonian, Robert; Alkhawam, Hassan; Vyas, Neil; Jolly, JoshPaul; Nguyen, James; Haftevani, Emma A. Moradoghli; Al-khazraji, Ahmed; Ashraf, Amar

    2016-01-01

    Background Echocardiography has been a popular modality used to aid in the diagnosis of infective endocarditis (IE) with the modified Duke criteria. We evaluated the necessity between the uses of either a transthoracic echocardiography (TTE) or transesophageal echocardiography (TEE) in patients with a body mass index (BMI) greater than or equal to 25 kg/m2 and less than 25 kg/m2. Methods A single-centered, retrospective study of 198 patients between 2005 and 2012 diagnosed with IE based on modified Duke criteria. Patients, required to be above age 18, had undergone an echocardiogram study and had blood cultures to be included in the study. Results Among 198 patients, two echocardiographic groups were evaluated as 158 patients obtained a TTE, 143 obtained a TEE, and 103 overlapped with TEE and TTE. Out of these patients, 167 patients were included in the study as 109 (65%) were discovered to have native valve vegetations on TEE and 58 (35%) with TTE. TTE findings were compared with TEE results for true negatives and positives to isolate valvular vegetations. Overall sensitivity of TTE was calculated to be 67% with a specificity of 93%. Patients were further divided into two groups with the first group having a BMI ≥25 kg/m2 and the subsequent group with a BMI <25 kg/m2. Patients with a BMI ≥25 kg/m2 who underwent a TTE study had a sensitivity and specificity of 54 and 92%, respectively. On the contrary, patients with a BMI < 25 kg/m2 had a TTE sensitivity and specificity of 78 and 95%, respectively. Conclusions Patients with a BMI <25 kg/m2 and a negative TTE should refrain from further diagnostic studies, with TEE strong clinical judgment is warranted. Patients with a BMI ≥ 25 kg/m2 may proceed directly to TEE as the initial study, possibly avoiding an additional study with a TTE. PMID:27124167

  5. Transesophageal dobutamine-atropine stress echocardiography: diagnostic accuracy for coronary stenosis detection and localization.

    PubMed

    Shahi, M; Radhakrishnan, S; Sinha, N; Shrivastava, S

    1996-10-11

    Transesophageal echocardiography with dobutamine-atropine stress (TE-DASE) is a recently described technique for evaluation of coronary artery disease (CAD). We undertook this study prospectively to determine the feasibility, reliability and safety of this procedure in patients with known CAD and to evaluate its diagnostic accuracy for coronary stenoses of varying severity. Thirty-seven patients who underwent coronary arteriography (CART) and TE-DASE within a 3-month interval without intervening ischemic events or revascularisation were included in the study CART and stress echograms were independently evaluated by different observers. Stenosis was measured with calipers and a > or = 50% lumen diameter stenosis was considered significant. A reduction or lack of endocardial motion and/or wall thickening on progressive incremental stress was considered an abnormal response. TE-DASE could be successfully completed in 33/37 (90%) patients. Using a modified 16-segment model of the left ventricle (LV), 15.2 +/- 0.8 segments/patient and 501/528 (95%) segments overall could be optimally evaluated. Inter-observer concordance for an abnormal response was 94%. Predictive accuracies for one-vessel disease (1-VD), two-vessel disease (2-VD) and three-vessel disease (3-VD) were 88, 58 and 23% respectively. Overall sensitivity for detection of a significant (> or = 50%) stenosis was 72% (32% for moderate (50-69%), 90% for severe (> or = 70%) stenosis) and specificity was 96%. Diagnostic accuracy for localisation of significant stenosis was 95% for the left anterior descending artery (LAD), 86% for the left circumflex artery (LCX) and 88% for the right coronary artery (RCA). There were no major complications. We conclude that TE-DASE is a safe, reliable and easily-performed procedure and provides excellent visualisation of myocardial segments. Diagnostic accuracy for detection of severe stenosis and its localisation is excellent.

  6. Fully automated software for mitral annulus evaluation in chronic mitral regurgitation by 3-dimensional transesophageal echocardiography

    PubMed Central

    Aquila, Iolanda; Fernández-Golfín, Covadonga; Rincon, Luis Miguel; González, Ariana; García Martín, Ana; Hinojar, Rocio; Jimenez Nacher, Jose Julio; Indolfi, Ciro; Zamorano, Jose Luis

    2016-01-01

    Abstract Three-dimensional (3D) transesophageal echocardiography (TEE) is the gold standard for mitral valve (MV) anatomic and functional evaluation. Currently, dedicated MV analysis software has limitations for its use in clinical practice. Thus, we tested here a complete and reproducible evaluation of a new fully automatic software to characterize MV anatomy in different forms of mitral regurgitation (MR) by 3D TEE. Sixty patients were included: 45 with more than moderate MR (28 organic MR [OMR] and 17 functional MR [FMR]) and 15 controls. All patients underwent TEE. 3D MV images obtained using 3D zoom were imported into the new software for automatic analysis. Different MV parameters were obtained and compared. Anatomic and dynamic differences between FMR and OMR were detected. A significant increase in systolic (859.75 vs 801.83 vs 607.78 mm2; P = 0.002) and diastolic (1040.60 vs. 1217.83 and 859.74 mm2; P < 0.001) annular sizes was observed in both OMR and FMR compared to that in controls. FMR had a reduced mitral annular contraction compared to degenerative cases of OMR and to controls (17.14% vs 32.78% and 29.89%; P = 0.007). Good reproducibility was demonstrated along with a short analysis time (mean 4.30 minutes). Annular characteristics and dynamics are abnormal in both FMR and OMR. Full 3D software analysis automatically calculates several significant parameters that provide a correct and complete assessment of anatomy and dynamic mitral annulus geometry and displacement in the 3D space. This analysis allows a better characterization of MR pathophysiology and could be useful in designing new devices for MR repair or replacement. PMID:27930514

  7. Dual thrombosis of the pulmonary arterial and venous anastomotic sites after single lung transplantation: role of transesophageal echocardiography in diagnosis and management.

    PubMed

    Fadel, Bahaa M; Abdulbaki, Khaled; Nambiar, Vijayaraghavan; Al Amri, Mohammad; Shahid, Maie; Khouqeer, Farid; Canver, Charles

    2007-04-01

    We present the case of a patient who developed severe respiratory and hemodynamic compromise shortly after single right lung transplantation. Transesophageal echocardiography showed a large intraluminal thrombus at the right pulmonary artery anastomosis resulting in severe obstruction to flow together with thrombosis of the right pulmonary veins extending into the left atrium. After thrombectomy and surgical revision of the vascular anastomoses, the patient made an uneventful recovery. This case illustrates the usefulness of transesophageal echocardiography in the diagnosis and treatment of patients who are hemodynamically unstable after lung transplantation.

  8. Three-dimensional transesophageal echocardiography incremental value in a rare case of a bileaflet tricuspid valve.

    PubMed

    Mahmoud, Hani M; Walley, Hossam; Hosny, Hatem; Yacoub, Magdi

    2016-09-01

    Detailed assessment of the tricuspid valve using two-dimensional echocardiography is always challenging, as only two of three leaflets can be seen at a time. Three-dimensional echocardiography can provide the enface view of the tricuspid valve that allows simultaneous visualization of all of the three leaflets. In a 42-year-old male patient scheduled for pulmonary endarterectomy, 3DTEE showed that the tricuspid valve is bileaflet, with one septal and another lateral leaflet. There were two commissures, one of them is anteriorly positioned and the other one is posterior. Our findings were confirmed intra-operatively by direct surgical visualization of the tricuspid valve.

  9. 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

  10. Brain tumors in eloquent areas: A European multicenter survey of intraoperative mapping techniques, intraoperative seizures occurrence, and antiepileptic drug prophylaxis.

    PubMed

    Spena, Giannantonio; Schucht, Philippe; Seidel, Kathleen; Rutten, Geert-Jan; Freyschlag, Christian Franz; D'Agata, Federico; Costi, Emanule; Zappa, Francesca; Fontanella, Marco; Fontaine, Denys; Almairac, Fabien; Cavallo, Michele; De Bonis, Pasquale; Conesa, Gerardo; Foroglou, Nicholas; Gil-Robles, Santiago; Mandonnet, Emanuel; Martino, Juan; Picht, Thomas; Viegas, Catarina; Wager, Michel; Pallud, Johan

    2017-04-01

    Intraoperative mapping and monitoring techniques for eloquent area tumors are routinely used world wide. Very few data are available regarding mapping and monitoring methods and preferences, intraoperative seizures occurrence and perioperative antiepileptic drug management. A questionnaire was sent to 20 European centers with experience in intraoperative mapping or neurophysiological monitoring for the treatment of eloquent area tumors. Fifteen centers returned the completed questionnaires. Data was available on 2098 patients. 863 patients (41.1%) were operated on through awake surgery and intraoperative mapping, while 1235 patients (58.8%) received asleep surgery and intraoperative electrophysiological monitoring or mapping. There was great heterogeneity between centers with some totally AW oriented (up to 100%) and other almost totally ASL oriented (up to 92%) (31% SD). For awake surgery, 79.9% centers preferred an asleep-awake-asleep anesthesia protocol. Only 53.3% of the centers used ECoG or transcutaneous EEG. The incidence of intraoperative seizures varied significantly between centers, ranging from 2.5% to 54% (p < 0.001). It there appears to be a statistically significant link between the mastery of mapping technique and the risk of intraoperative seizures. Moreover, history of preoperative seizures can significantly increase the risk of intraoperative seizures (p < 0.001). Intraoperative seizures occurrence was similar in patients with or without perioperative drugs (12% vs. 12%, p = 0.2). This is the first European survey to assess intraoperative functional mapping and monitoring protocols and the management of peri- and intraoperative seizures. This data can help identify specific aspects that need to be investigated in prospective and controlled studies.

  11. Optical technologies for intraoperative neurosurgical guidance

    PubMed Central

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

    2016-01-01

    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. PMID:26926066

  12. [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.

  13. 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.

  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 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.

  16. [Intra-operative cholangiography in laparoscopic cholecystectomy].

    PubMed

    Neufeld, D; Jessel, J; Freund, U

    1994-01-16

    Intraoperative cholangiography (IC) in laparoscopic cholecystectomy is a controversial issue. According to traditional teaching, the purpose of cholangiography in gallbladder surgery is to discover previously undiscovered common bile duct stones. This examination was extremely important in the era before ERCP. IC enabled surgeons to find stones and remove them at the same operation. With progress in ERCP, the importance of intraoperative cholangiography has diminished. A stone missed during surgery can most often be dealt with by the less invasive ERCP and papillotomy. There has been a difference of opinion in the literature as to whether to perform cholangiography routinely during gallbladder operations or only in cases in which there is a specific indication, such as an enlarged common bile duct, a history of pancreatitis, or elevated enzymes. Routine operative cholangiography prolongs operative time and carries its own inherent risks, such as injury to the bile ducts. The likelihood of stones is not high and over-diagnosis of stones would result in unwarranted common bile duct exploration and the danger of complications from the procedure. The tendency today is towards a more selective approach. In this era of laparoscopic gallbladder surgery, the controversy has come to the fore again, and there is now an additional aspect. In laparoscopic gallbladder surgery there is greater significance to the "road map" provided by X-rays. We rely mainly on the visual sense and have forgone the tactile sense. Therefore, any added visual input in this operation helps avoid the danger of injuring the main bile ducts. It is our contention that the indications for operative cholangiography in laparoscopic cholecystectomy should again be broadened.

  17. 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.

  18. An adult case of Kawasaki disease with multiplex coronary aneurysms and myocardial infarction: the role of transesophageal echocardiography.

    PubMed

    Habon, T; Toth, K; Keltai, M; Lengyel, M; Palik, I

    1998-07-01

    Kawasaki disease (mucocutaneous lymph node syndrome) is an acute inflammatory disease that primarily affects infants and young children. In spite of proper therapy, coronary aneurysms develop in 10 to 25% of cases. Adult diagnosis of coronary aneurysm, presumably caused by Kawasaki disease, is rare. A 37-year-old male patient with previous inferior wall myocardial infarction (MI) was admitted with an acute anterior wall MI. Coronary angiography, performed 2 weeks after successful thrombolytic therapy, showed right coronary artery occlusion and multiplex (left main, left anterior descending, left circumflex, right coronary artery) giant coronary aneurysms. Transthoracic echocardiography was unable to detect the aneurysms. Transesophageal echocardiography (TEE) visualized a large left main coronary aneurysm with an occlusive thrombus and measured low flow velocity (0.2 m/s) in the proximal left anterior descending artery. At 4 weeks control, TEE showed marked regression of the thrombus, and it was not detectable after 6 months of oral anticoagulation with acenocumarol (International Normalized Ratio: 3-3.5) and standard postinfarction therapy. After 2 years of follow-up, the patient has no symptoms, and myocardial ischemia could not be provoked by stress tests [treadmill, dipyridamole single-photon emission computed tomography (SPECT)]. We conclude that, for diagnosis and follow-up of adult Kawasaki disease, transesophageal echocardiography is indicated. The importance and efficacy of long-term anticoagulant treatment should be emphasized in this disease.

  19. [Clinical effectiveness of the infusion therapy under control of the transesophageal dopplerography in acute period of severe combined trauma].

    PubMed

    Vil'chinskiĭ, K E; Gutnikov, A I; Davydova, L A; Tsarenko, S V; Evdokimov, E A

    2011-01-01

    In 72 patients with combined trauma the impact of volume and consistence of infusion therapy on severity of the disease, frequency and severity of infectious complications, duration of MV and ICU stay was assessed. The patients were divided into 2 groups depending on the volemic status control method and infusion algorithm. The main group (35 patients) was controlled by transesophageal dopplerography Cardio Q apparatus ("Deltex Medical", GB) and the infusion therapy was carried out under the control of stroke volume and Ftc. In the control group (37 patients) the volemic status was assessed clinically: BP, CVP, HR, diuresis. The volume of the infusion therapy during the first 12 hours in the main group was significantly higher than in the control group which proved that patients were suffering from hypovolemia, which was not diagnosed by traditional clinical criteria. The ICU stay in the main group was significantly shorter compared to the control group 15.3 +/- 8.2 and 29.5 +/- 10.4 days respectively. Infectious complications occurred in 12 patients out of 35 in main group and 25 out of 37 in the control group. The conclusion of this study is that infusion therapy control with central hemodynamic parameters can shorten the MV time and ICU stay an lower the rate of infectious complications in patients with combined trauma. A mortality decrease in patients with transesophageal dopplerography controlled infusion is not shown.

  20. Safety, efficacy, and cost of intraoperative indocyanine green angiography compared to intraoperative catheter angiography in cerebral aneurysm surgery.

    PubMed

    Hardesty, Douglas A; Thind, Harjot; Zabramski, Joseph M; Spetzler, Robert F; Nakaji, Peter

    2014-08-01

    Intraoperative angiography in cerebrovascular neurosurgery can drive the repositioning or addition of aneurysm clips. Our institution has switched from a strategy of intraoperative digital subtraction angiography (DSA) universally, to a strategy of indocyanine green (ICG) videoangiography with DSA on an as-needed basis. We retrospectively evaluated whether the rates of perioperative stroke, unexpected postoperative aneurysm residual, or parent vessel stenosis differed in 100 patients from each era (2002, "DSA era"; 2007, "ICG era"). The clip repositioning rate for neck residual or parent vessel stenosis did not differ significantly between the two eras. There were no differences in the rate of perioperative stroke or rate of false-negative studies. The per-patient cost of intraoperative imaging within the DSA era was significantly higher than in the ICG era. The replacement of routine intraoperative DSA with ICG videoangiography and selective intraoperative DSA in cerebrovascular aneurysm surgery is safe and effective.

  1. Removal of a retained intracardiac radiolucent guidewire fragment using an Atrieve™ vascular snare using combined fluoroscopy and transesophageal echocardiography guidance in an infant

    PubMed Central

    Padiyath, Asif; Fontenot, Eudice E; Abraham, Boban P

    2017-01-01

    Retained intravascular foreign body is a well-known complication of central venous access placement in children as well as adults. Most of these foreign bodies are radio-opaque and hence are removed under fluoroscopy guidance. In our case, we describe the removal of an intracardiac radiolucent foreign body in an infant utilizing a combination technique - transesophageal echocardiogram and fluoroscopy. PMID:28163431

  2. Interventional left atrial appendage occlusion: added value of 3D transesophageal echocardiography for device sizing.

    PubMed

    Goebel, Björn; Wieg, Stephanie; Hamadanchi, Ali; Otto, Sylvia; Jung, Christian; Kretzschmar, Daniel; Figulla, Hans R; Christian Schulze, P; Poerner, Tudor C

    2016-09-01

    Aim of this study was the assessment of left atrial appendage (LAA) dimensions comparing 2D- to 3D-TEE measurements in patients with nonvalvular atrial fibrillation undergoing percutaneous LAA occlusion. Patients underwent transesophageal echocardiography (TEE) before, during and 45 days after intervention. The maximal LAA orifice diameters in 2D-TEE (LODmax 2D) were obtained from multiple views. Test-retest reliability (screening vs. implantation), inter- and intra-observer variability for echocardiographic parameters were assessed by two independent examiners. Overall, 74 patients underwent percutaneous LAA occlusion. 2D-TEE significantly underestimated the maximal LAA orifice diameter compared with 3D-TEE (screening LODmax 2D 21.11 ± 2.75 mm vs. 22.52 ± 3.45 mm for LODmax 3D, p < 0.001; during implantation LODmax 2D 21.56 ± 3.48 mm vs. 22.99 ± 3.24 mm for LODmax 3D, p < 0.001). The intraobserver and interobserver variability calculated as coefficient of variation (CV) were both lower for the 3D-TEE quantification of the maximal orifice diameter (intraobserver CV for 3D-TEE 6.07 % vs. 9.31 % for 2D-TEE; interobserver CV for 3D-TEE 6.73 % vs. 9.69 % for 2D-TEE). Compared to 3D-TEE the test-retest reliability of 2D-TEE showed a lower intraclass correlation coefficient calculated as average of raters (0.92 for 3D-TEE vs. for 2D-TEE 0.78). Firstly, 2D-TEE significantly underestimates the maximal LAA orifice diameter compared to 3D-TEE. Secondly, 3D-TEE measurements are associated with a lower observer variability and higher reliability than 2D-TEE.

  3. Transesophageal echocardiographic evaluation of baboons during microgravity induced by parabolic flight.

    PubMed

    Vernalis, M N; Latham, R D; Fanton, J W; Gaffney, F A

    1993-01-01

    The central cardiovascular responses to transient microgravity are not well understood. Theoretically, entrance into microgravity results in the loss of the hydrostatic pressure head and an increase in central venous pressure (CVP) as a consequence of augmented venous return. However, controversy exists regarding the time course and magnitude of cephalad blood volume shifts and its relationship to central atrial filling pressures. On the June 1991 STS 40 shuttle mission, pre-launch echocardiograms suggested changes in cardiac dimensions occurred while the astronauts were in the supine, feet-up position. Furthermore, a CVP line in an astronaut (n=1) demonstrated an unexpected abrupt decrease in CVP during orbital insertion. In April 1991, our laboratory performed Doppler echocardiography in 6 normal human volunteers during parabolic flight. Increases in right ventricular velocities reflecting a central shift of blood volume was demonstrated in subjects examined in the sitting position. However, test subjects examined in the horizontal positions had no significant rise in Doppler velocities. In addition, Latham et al noted variable central cardiovascular responses in chronically instrumented baboons during early microgravity. Transthoracic echocardiography (TTE) is a feasible method to noninvasively examine cardiac anatomy during parabolic flight. However, transducer placement on the chest wall is very difficult to maintain during transition to microgravity. In addition, TTE requires the use of low frequency transducers (2.5 MHz) which limits resolution. Transesophageal echocardiography (TEE) is an established imaging technique which obtains echocardiographic information from the esophagus. It is a safe procedure and provides higher quality images of cardiac structures than obtained with TTE. Since there are no interposed structures between the esophagus and the heart, higher frequency transducers can be used and resolution is enhanced. With TEE, a flexible

  4. Intraoperative monitoring technician: a new member of the surgical team.

    PubMed

    Brown, Molly S; Brown, Debra S

    2011-02-01

    As surgery needs have increased, the traditional surgical team has expanded to include personnel from radiology and perfusion services. A new surgical team member, the intraoperative monitoring technician, is needed to perform intraoperative monitoring during procedures that carry a higher risk of central and peripheral nerve injury. Including the intraoperative monitoring technician on the surgical team can create challenges, including surgical delays and anesthesia care considerations. When the surgical team members, including the surgeon, anesthesia care provider, and circulating nurse, understand and facilitate this new staff member's responsibilities, the technician is able to perform monitoring functions that promote the smooth flow of the surgical procedure and positive patient outcomes.

  5. Goal-directed therapy in intraoperative fluid and hemodynamic management

    PubMed Central

    Gutierrez, Maria Cristina; Moore, Peter G.; Liu, Hong

    2013-01-01

    Intraoperative fluid management is pivotal to the outcome and success of surgery, especially in high-risk procedures. Empirical formula and invasive static monitoring have been traditionally used to guide intraoperative fluid management and assess volume status. With the awareness of the potential complications of invasive procedures and the poor reliability of these methods as indicators of volume status, we present a case scenario of a patient who underwent major abdominal surgery as an example to discuss how the use of minimally invasive dynamic monitoring may guide intraoperative fluid therapy. PMID:24086168

  6. Intraoperative knee anthropometrics: correlation with cartilage wear.

    PubMed

    Rooney, N; Fitzpatrick, D P; Beverland, D E

    2006-08-01

    Accurate knee morphology is of value in determining the correct sizing of prosthetic implants. Intraoperative measurement of key linear dimensional variables was carried out on 196 Caucasian knees (osteoarthritic patients: 68 male and 128 female). Of the 196 knees measured, 70 had extensive cartilage degeneration. Statistical analysis was carried out on this large sample size of data. Summary statistics and correlation coefficients between variables were determined and compared between subgroups. Male knees were on average larger than female knees. Higher correlation was found between variables for males than between variables for females. Overall, the patellar dimensions were seen to correlate least well with other anatomical variables. High correlation between femoral variables supports current femoral sizing procedure, although routine patellar resection practices are called into question. Average values for the 70 knees with extensive cartilage degeneration were significantly smaller (P < 0.01) than their counterparts for the other 126 knees. For a measurement not containing cartilage, such as femoral epicondylar width, this difference cannot be accounted for by the loss of cartilage owing to wear. This suggests that, for similar height and weight, a naturally narrower femoral epicondylar width may be associated with severe osteoarthritis.

  7. Intraoperative anaphylaxis: verba volant, scripta manent!

    PubMed

    Bilò, M B; Cinti, B; Chiarello, M; Bonifazi, F; Moneret-Vautrin, D A

    2005-11-01

    We describe a case of intraoperative gelatine-induced anaphylaxis whose diagnosis was delayed as the use of gelatine during surgical procedures was omitted for two times in patient's medical records. The subject is a 66-year old woman, with a negative medical history of atopy, food and drug allergy, with arterial hypertension on a course of beta-blockers and with bladder carcinoma requiring surgery. The patient had tolerated both general and local anaesthesia on several previous occasions. On the first occasion she experienced arterial fibrillation secondary to a severe episode of hypotension following local anaesthesia, while on a course of beta-blockers. On the second occasion she developed a very severe episode of hypotension followed by the outbreak of a generalised rash during general anaesthesia. The tryptase sera level was 109 mg/L one hour after the reaction had subsided, while the basal values were normal. On the third occasion the patient redeveloped severe hypotension and a generalised rash during general anaesthesia. The allergological work-up was negative, except for intradermal test with gelatine. A study of the intra-cellular cytokines in blood lymphocytes showed a production of IL4 from CD4+ lymphocytes after stimulation by gelatine. The patient underwent a successive surgical procedure without any adverse event.

  8. 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.

  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. 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.

  11. Perspectives in Intraoperative Diagnostics of Human Gliomas

    PubMed Central

    Tyurikova, O.; Dembitskaya, Y.; Yashin, K.; Mishchenko, M.; Vedunova, M.; Medyanik, I.; Kazantsev, V.

    2015-01-01

    Amongst large a variety of oncological diseases, malignant gliomas represent one of the most severe types of tumors. They are also the most common type of the brain tumors and account for over half of the astrocytic tumors. According to different sources, the average life expectancy of patients with various glioblastomas varies between 10 and 12 months and that of patients with anaplastic astrocytic tumors between 20 and 24 months. Therefore, studies of the physiology of transformed glial cells are critical for the development of treatment methods. Modern medical approaches offer complex procedures, including the microsurgical tumor removal, radiotherapy, and chemotherapy, supplemented with photodynamic therapy and immunotherapy. The most radical of them is surgical resection, which allows removing the largest part of the tumor, reduces the intracranial hypertension, and minimizes the degree of neurological deficit. However, complete removal of the tumor remains impossible. The main limitations are insufficient visualization of glioma boundaries, due to its infiltrative growth, and the necessity to preserve healthy tissue. This review is devoted to the description of advantages and disadvantages of modern intraoperative diagnostics of human gliomas and highlights potential perspectives for development of their treatment. PMID:26543495

  12. A non-docking intraoperative electron beam applicator system.

    PubMed

    Palta, J R; Suntharalingam, N

    1989-08-01

    A non-docking intraoperative radiation therapy electron beam applicator system for a linear accelerator has been designed to minimize the mechanical, electrical, and tumor visualization problems associated with a docking system. A number of technical innovations have been used in the design of this system. These include: (a) a new intraoperative radiation therapy cone design that gives a better dose uniformity in the treatment volume at all depths; (b) a collimation system which reduces the leakage radiation dose to tissues outside the intraoperative radiation therapy cone; (c) a non-docking system with a translational accuracy of 2 mm and a rotational accuracy of 0.5 degrees; and (d) a rigid clamping system for the cones. A comprehensive set of dosimetric characteristics of the intraoperative radiation therapy applicator system is presented.

  13. Intraoperative Ultrasound to Assess for Pancreatic Duct Injuries

    DTIC Science & Technology

    2015-04-01

    cholecystocholangiopancreatography is often nondiagnostic, gastroenterologists may not be available for endoscopic retrograde cholangiopancreatography (ERCP...10MHz.We use the SonoSite MicroMaxx SLT 10-5 MHz 52mm broadband linear array intraoperative US probe ( FUJIFILM SonoSite, Inc., Bothell, WA). The duct...Intraoperative US Availability Is gastroenterology available? Is the fluoroscopic and endoscopic equipment available? Is MRCP available? Is a

  14. [Anesthetic Management Using Transesophageal Echocardiography and EV1000 in a Patient with Ebstein's Anomary Undergoing Scoliosis Surgery].

    PubMed

    Tanimura, Kazuki; Miura, Yukiko; Ishii, Hisanari

    2016-02-01

    An 18-year-old female patinet with Ebstein anomaly underwent surgical repair of scoliosis under total intravenous anesthesia. In addtition to normal monitors, we used transesophageal echocardiography (TEE) and EV1000 (Edwards Lifesciences, Irvine, USA), which show stroke volume variation and stroke volume index simultaneously in a rectangular coordinates. TEE detected reversal of intracardiac shunt which caused SpO2 decrease during fixing screws at thoracic vertebrae, then manual ventilation with oxygen unproved SpO2. Because of a high venous pressure due to Ebstein anomaly, surgical bleeding seemed to be larger than usual. By using EV1000, volume status and cardiac contractility were estimated and adequate volume loading and inoptrope injection were performed to stabilize circulatory condition. The operation was completed without any cardiac and respiratory complications.

  15. [Estimation using unipolar transesophageal recording of the interatrial conduction time in patients with paroxysmal atrial flutter and fibrillation].

    PubMed

    Simoncelli, U; Marchetti, A; Sorgato, A; Rusconi, C

    1991-06-01

    Twenty-three consecutive subjects (age 46.7 +/- 21, range 13-78) addressed to our attention for symptoms attributed to documented or suspected supra ventricular arrhythmias underwent transesophageal electrophysiologic study. On the basis of the preliminary investigations 15 proved free from organic heart disease, 2 were affected with ischemic heart disease (secondary angina), 6 with hypertensive cardiomyopathy. In each patient the sensibility, specificity and positive predictive value of the following reports regarding the occurrence of paroxysmal fibrillation and flutter (Ffap) were evaluated: a) echo reports of left atrial enlargement; b) ECG signs of atrial enlargement; c) interatrial conduction time (TCIA) assessed with unipolar transesophageal recording. As TCIA we adopted the time interval intercurrent from the first low-voltage deflection of the esophageal P wave (far field) and the apex of the intrinsecoid deflection of the same wave. TCIA proved significantly longer in the 12 patients affected with Ffap compared with those free from documented paroxysmal or inducible arrhythmias or affected with paroxysmal junctional reciprocating tachycardias: 76.6 +/- 11 vs 51.8 +/- 11.7; p less than 0.001. A TCIA greater than 63 msec characterizes with satisfactory sensibility and specificity the occurrence of Ffap: sens. 75%, spec. 91%, positive predictive value 90%. Echo and ECG reports of atrial enlargement behave as highly specific but not sufficiently sensitive indexes of the occurrence of Ffap: sens. 42%, spec. 100%, pos. pred. val. 100% and sens. 17%, spec. 100%, pos.pred.val. 100% resp. We concluded that TCIA is an index correlated with and predictive of the occurrence of Ffap in patients symptomatic for cardiopalmus or neurologic symptoms in the absence of other arrhythmias detectable with Holter monitoring which are able to produce clinical symptoms.

  16. 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.

  17. 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.

  18. 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

  19. 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

  20. 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.

  1. 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.

  2. Three-dimensional imaging in aortic disease by lighthouse transesophageal echocardiography using intravascular ultrasound catheters. Comparison to three-dimensional transesophageal echocardiography and three-dimensional intra-aortic ultrasound imaging.

    PubMed

    Buck, T; Görge, G; Hunold, P; Erbel, R

    1998-03-01

    Two-dimensional (2D) transesophageal echocardiography (TEE) and 2D intravascular ultrasound (IVUS) imaging face their greatest limitation in visualizing aortic disease in patients. With the aid of three-dimensional (3D) image reconstruction, TEE and IVUS can potentially overcome this limitation but still provide only limited spatial appreciation in aortic disease because 3D imaging of the thoracic aorta requires a broader spatial visualization of the mediastinum than provided by both techniques. Moreover, for timely decision making about aortic disease TEE is limited by a large probe, which requires sedation. Therefore, we developed an approach called 3D lighthouse transesophageal echocardiography (LTEE) using a thin intravascular ultrasound catheter, which provides a full circumferential (360 degree) image and requires no sedation. The purpose of this study was to compare the feasibility and accuracy of 3D TEE, 3D IVUS, and 3D LTEE for obtaining spatial visualization of the thoracic aorta to detect aortic diseases in patients. 3D image datasets were obtained for 3D LTEE by a manual pullback of a 3.3 mm thick, 10 MHz intravascular ultrasound catheter positioned in the esophagus; for 3D TEE using a conventional 15 mm thick probe; and for 3D IVUS using a 2.6 mm thick, 20 MHz intravascular ultrasound catheter. In 12 consecutive patients, three with aortic dissection (two with type III, one with type I) and 11 with suspected artherosclerosis, we analyzed and compared spatial visualization of the thoracic aorta, 3D image quality, patient discomfort, and study time. Providing a 3D dataset of 360-degree tomographic images of the mediastinum, 3D LTEE was the only approach that allowed broad spatial visualization of the aortic arch (9 of 12 patients) with the detection of aortic dissection or atherosclerotic plaques. Spatial visualization of the aortic arch by 3D TEE was incomplete because of the relatively narrow 90-degree image sector. However, in other segments 3D image

  3. 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

  4. [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.

  5. Intraoperative irradiation: precision medicine for quality cancer control promotion.

    PubMed

    Calvo, Felipe A

    2017-02-02

    Intraoperative irradiation was implemented 4 decades ago, pioneering the efforts to improve precision in local cancer therapy by combining real-time surgical exploration/resection with high single dose radiotherapy (Gunderson et al., Intraoperative irradiation: techniques and results, 2011). Clinical and technical developments have led to very precise radiation dose deposit. The ability to deliver a very precise dose of radiation is an essential element of contemporary multidisciplinary individualized oncology.This issue of Radiation Oncology contains a collection of expert review articles and updates with relevant data regarding intraoperative radiotherapy. Technology, physics, biology of single dose and clinical results in a variety of cancer sites and histologies are described and analyzed. The state of the art for advanced cancer care through medical innovation opens a significant opportunity for individualize cancer management across a broad spectrum of clinical practice. The advantage for tailoring diagnostic and treatment decisions in an individualized fashion will translate into precise medical treatment.

  6. 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.

  7. Intra-operative neurophysiology during microvascular decompression for hemifacial spasm.

    PubMed

    Fernández-Conejero, I; Ulkatan, S; Sen, C; Deletis, V

    2012-01-01

    There is evidence that primary hemifacial spasm (HFS) in the majority of patients is related to a vascular compression of the facial nerve at its root exit zone (REZ). As a consequence, the hyperexcitability of facial nerve generates spasms of the facial muscles. Microvascular decompression (MVD) of the facial nerve near its REZ has been established as an effective treatment of HFS. Intra-operative disappearance of abnormal muscle responses (lateral spread) elicited by stimulating one of the facial nerve branches has been used as a method to predict MVD effectiveness. Other neurophysiologic techniques, such as facial F-wave, blink reflex and facial corticobulbar motor evoked potentials (FCoMEP), are feasible to intra-operatively study changes in excitability of the facial nerve and its nucleus during MVDs. Intra-operative neuromonitoring with the mentioned techniques allows a better understanding of HFS pathophysiology and helps to optimise the MVD.

  8. Intraoperative Hypothermia During Surgical Fixation of Hip Fractures.

    PubMed

    Frisch, Nicholas B; Pepper, Andrew M; Jildeh, Toufic R; Shaw, Jonathan; Guthrie, Trent; Silverton, Craig

    2016-11-01

    Hip fractures are common orthopedic injuries and are associated with significant morbidity/mortality. Intraoperative normothermia is recommended by national guidelines to minimize additional morbidity/mortality, but limited evidence exists regarding hypothermia's effect on orthopedic patients. The purpose of this study was to determine the incidence of intraoperative hypothermia in patients with operatively treated hip fractures and evaluate its effect on complications and outcomes. Retrospective chart review was performed on clinical records from 1541 consecutive patients who sustained a hip fracture and underwent operative fixation at the authors' institution between January 2005 and October 2013. A total of 1525 patients were included for analysis, excluding those with injuries requiring additional surgical intervention. Patient demographic data, surgery-specific data, postoperative complications, length of stay, and 30-day readmission were recorded. Patients with a mean intraoperative temperature less than 36°C were identified as hypothermic. Statistical analysis with univariate and multivariate logistic regression modeling evaluated associations with hypothermia and effect on complications/outcomes. The incidence of intraoperative hypothermia in operatively treated hip fractures was 17.0%. Hypothermia was associated with an increase in the rate of deep surgical-site infection (odds ratio, 3.30; 95% confidence interval, 1.19-9.14; P=.022). Lower body mass index and increasing age demonstrated increased association with hypothermia (P=.004 and P=.005, respectively). To the authors' knowledge, this is the first and largest study analyzing the effect of intraoperative hypothermia in orthopedic patients. In patients with hip fractures, the study's findings confirm evidence found in other surgical specialties that hypothermia may be associated with an increased risk of deep surgical-site infection and that lower body mass index and increasing age are risk factors

  9. 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

  10. 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.

  11. Roles of real-time three-dimensional transesophageal echocardiography in peri-operation of transcatheter left atrial appendage closure

    PubMed Central

    Zhou, Qing; Song, Hongning; Zhang, Lan; Deng, Qing; Chen, Jinling; Hu, Bo; Wang, Yijia; Guo, Ruiqiang

    2017-01-01

    Abstract Left atrial appendage (LAA) closure is a new treatment option for the prevention of stroke in patients with nonvalvular atrial fibrillation (AF). Conventional 2-dimensional transesophageal echocardiography (2D TEE) has some limitations in the imaging assessment of LAA closure. Real-time 3-dimensional transesophageal echocardiography (RT-3D TEE) allows for detailed morphologic assessment of the LAA. In this study, we aim to determine the clinical values of RT-3D TEE in the periprocedure of LAA closure. Thirty-eight persistent or paroxysmal AF patients with indications for LAA closure were enrolled in this study. RT-3D TEE full volume data of the LAA were recorded before operation to evaluate the anatomic feature, the landing zone dimension, and the depth of the LAA. On this basis, selection of LAA closure device was carried out. During the procedure, RT-3D TEE was applied to guide the interatrial septal puncture, device operation, and evaluate the occlusion effects. The patients were follow-up 1 month and 3 months postclosure. Twenty-eight (73.7%) patients with AF received placement of LAA occlusion device under RT-3D TEE. Eleven cases with single-lobe LAAs were identified using RT-3D TEE, among which 4 showed limited depth. Seventeen cases showed bilobed or multilobed LAA. Seven cases received LAA closure using Lefort and 21 using LAmbre based on the 3D TEE and radiography. The landing zone dimension of the LAA measured by RT-3D TEE Flexi Slice mode was better correlated with the device size used for occlusion (r = 0.90) than 2D TEE (r = 0.88). The interatial septal puncture, the exchange of the sheath, as well as the release of the device were executed under the guidance of RT-3D TEE during the procedure. The average number of closure devices utilized for optimal plugging was (1.11 ± 0.31). There were no clinically unacceptable residual shunts, pericardial effusion, or tamponade right after occlusion. All the patients had the device well

  12. Cardiac angiosarcoma diagnosed by transvenous endomyocardial biopsy with the aid of transesophageal echocardiography and intra-procedural consultation.

    PubMed

    Hosokawa, Yusuke; Kodani, Eitaro; Kusama, Yoshiki; Kamiya, Masataka; Yoshikawa, Masatomo; Hirasawa, Yasuhiro; Nakagomi, Akihiro; Atarashi, Hirotsugu; Maeda, Shotaro; Mizuno, Kyoichi

    2010-01-01

    We report a case who had confirmed tumor cells in the biopsy specimens by transvenous endomyocardial biopsy with intra-procedural consultation and fast smear cytology. A 57-year-old female was admitted to our hospital because of shortness of breath and left back pain. Transthoracic echocardiography (TTE) and contrast-enhanced computed tomography (CT) scans demonstrated a large mass in the right atrium and multiple liver tumors thought to be due to spread of the disease. Coronary angiography showed the right coronary artery was involved in the mass. In order to confirm the histological diagnosis, we attempted transvenous endomyocardial tumor biopsy under fluoroscopic guidance. However, we failed to obtain adequate tissue material. Due to several risks associated with a surgical procedure such as an open surgical biopsy, transvenous endomyocardial tumor biopsy was again attempted with the aid of transesophageal echocardiography (TEE). Intra-procedural consultation and fast smear cytology enabled us to finish the procedure. Hematoxylin-eosin stained sections demonstrated spindle-shaped cells. Immunohistochemical stains of these cells were positive for anti-factor VIII antigen, CD31, and CD34. These findings indicated a definite diagnosis of angiosarcoma. Since there was no surgical indication for this tumor, the patient underwent chemotherapy with docetaxel and radiotherapy. Three months later, CT scans showed a reduction in the size of the cardiac tumor.

  13. Role of transthoracic and transesophageal echocardiography in right-sided endocarditis: one echocardiographic modality does not fit all.

    PubMed

    San Román, José Alberto; Vilacosta, Isidre; López, Javier; Revilla, Ana; Arnold, Roman; Sevilla, Teresa; Rollán, María J

    2012-08-01

    The added value of transesophageal echocardiography (TEE) over transthoracic echocardiography in the assessment of left-sided infective endocarditis has been extensively validated in the literature. Little research has dealt with the role of echocardiography in right-sided infective endocarditis (RSE), however. In this review, the differences between RSE and left-sided endocarditis and the different types of RSE according to the types of patients who have the disease are described. Both issues have important implications for echocardiographic workup. Moreover, a systematic echocardiographic protocol to avoid missing right-sided vegetations and several specific morphologic aspects of RSE are reviewed. Normal right-sided structures, which may mimic vegetations, particularly when the clinical picture is compatible, are described. Finally, the value of transthoracic echocardiography and TEE in RSE is reviewed according to the publications available. The diagnostic yield of transthoracic echocardiography is comparable with that of TEE in intravenous drug users. On the contrary, TEE is mandatory in patients with cardiac devices. A Bayesian-based diagnostic approach is proposed for a third poorly characterized group of patients with RSE who are not drug addicts, have no cardiac devices, and have no left-sided endocarditis (the "three no's" endocarditis group).

  14. 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.

  15. Pseudomonas aeruginosa respiratory tract infections associated with contaminated ultrasound gel used for transesophageal echocardiography - Michigan, December 2011-January 2012.

    PubMed

    2012-04-20

    In late December 2011, the Department of Epidemiology at Beaumont Health System (BHS) in Royal Oak, Michigan, noted an increase in the number of positive respiratory cultures in one surgical intensive-care unit (ICU), prompting further investigation. The increase in positive cultures was attributed entirely to Pseudomonas aeruginosa. Investigation by BHS staff members found that all of these positive cultures were related to use of ultrasound transmission gel from a single manufacturer during transesophageal echocardiography. Seven patients were infected with P. aeruginosa based on National Healthcare Safety Network (NHSN) criteria, and nine were colonized. Cultures from one open and one unopened bottle of the gel grew P. aeruginosa closely related to the outbreak strain based on molecular typing via repetitive extragenic palindromic polymerase chain reaction (rep-PCR). The Oakland County Health Department, the Michigan Department of Community Health, and the Food and Drug Administration (FDA) were notified of the findings. On January 23, all implicated ultrasound gel in multiuse bottles was removed from BHS facilities and replaced with a single-use, sterile ultrasound gel for all potentially invasive procedures. On April 18, FDA issued a Safety Communication* advising health-care professionals and facilities not to use certain lot numbers of the ultrasound transmission gel and further advising that the only ultrasound gel that is sterile is unopened gel in containers labeled as sterile. To date, no further respiratory cultures have been positive for P. aeruginosa.

  16. Low-molecular-weight heparins in patients with atrial fibrillation.

    PubMed

    Calvo Romero, J M

    2016-10-27

    In clinical practice, low-molecular-weight heparins are used relatively frequently in patients with atrial fibrillation to prevent embolic events. In this article, it is revised the available evidence in the following clinical situations: rapid onset of anticoagulation, bridging therapy (replacing long-term oral anticoagulant therapy around an invasive procedure) and transesophageal echocardiography-guided cardioversion.

  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. Intraoperative in situ radial artery conduit flow assessment.

    PubMed

    Canver, Charles C; Yousafzai, Sajjad M

    2008-01-01

    A technique is described for simple flow assessment of the in situ radial artery conduit during coronary bypass via a small incision. This technique allows morphologic and physiologic direct intraoperative assessment of radial artery quality and expands the use of radial artery during coronary artery surgery.

  19. Intraoperative sonography-guided removal of radiolucent foreign bodies.

    PubMed

    Leung, A; Patton, A; Navoy, J; Cummings, R J

    1998-01-01

    This article reports our use of intraoperative sonography to guide in real time, the removal of radiolucent foreign bodies from five patients. Two of these patients had undergone previous unsuccessful attempts at surgical removal in the operating room. The technique is cost effective, readily available, and can be very helpful in locating difficult-to-find radiolucent foreign bodies at the time of surgery.

  20. Intraoperative monitoring of flash visual evoked potential under general anesthesia.

    PubMed

    Hayashi, Hironobu; Kawaguchi, Masahiko

    2017-04-01

    In neurosurgical procedures that may cause visual impairment in the intraoperative period, the monitoring of flash visual evoked potential (VEP) is clinically used to evaluate visual function. Patients are unconscious during surgery under general anesthesia, making flash VEP monitoring useful as it can objectively evaluate visual function. The flash stimulus input to the retina is transmitted to the optic nerve, optic chiasm, optic tract, lateral geniculate body, optic radiation (geniculocalcarine tract), and visual cortical area, and the VEP waveform is recorded from the occipital region. Intraoperative flash VEP monitoring allows detection of dysfunction arising anywhere in the optic pathway, from the retina to the visual cortex. Particularly important steps to obtain reproducible intraoperative flash VEP waveforms under general anesthesia are total intravenous anesthesia with propofol, use of retinal flash stimulation devices using high-intensity light-emitting diodes, and a combination of electroretinography to confirm that the flash stimulus has reached the retina. Relatively major postoperative visual impairment can be detected by intraoperative decreases in the flash VEP amplitude.

  1. 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.

  2. [Minimally invasive intraoperative CT-guided correction of calcaneal osteosynthesis].

    PubMed

    Mayr, E; Häuser, H; Rüter, A; Bohndorf, K

    1999-03-01

    This article describes the CT-guided osteosynthesis of calcaneus fractures. This procedure is minimal invasive and offers the opportunity to reduce and to stabilize such fractures very exactly under intraoperative CT-controll only by stab-incisions. A running study will define the ranking of this method.

  3. Intraoperative monitoring of flash visual evoked potential under general anesthesia

    PubMed Central

    Hayashi, Hironobu

    2017-01-01

    In neurosurgical procedures that may cause visual impairment in the intraoperative period, the monitoring of flash visual evoked potential (VEP) is clinically used to evaluate visual function. Patients are unconscious during surgery under general anesthesia, making flash VEP monitoring useful as it can objectively evaluate visual function. The flash stimulus input to the retina is transmitted to the optic nerve, optic chiasm, optic tract, lateral geniculate body, optic radiation (geniculocalcarine tract), and visual cortical area, and the VEP waveform is recorded from the occipital region. Intraoperative flash VEP monitoring allows detection of dysfunction arising anywhere in the optic pathway, from the retina to the visual cortex. Particularly important steps to obtain reproducible intraoperative flash VEP waveforms under general anesthesia are total intravenous anesthesia with propofol, use of retinal flash stimulation devices using high-intensity light-emitting diodes, and a combination of electroretinography to confirm that the flash stimulus has reached the retina. Relatively major postoperative visual impairment can be detected by intraoperative decreases in the flash VEP amplitude. PMID:28367282

  4. 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

  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. 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

  7. Approach to the intraoperative consultation for neurosurgical specimens.

    PubMed

    Somerset, Hilary Lynch; Kleinschmidt-DeMasters, Bette Kay

    2011-11-01

    Intraoperative consultation remains an invaluable tool in the initial evaluation of surgically excised specimens. Good communication is required between the pathologist and surgeon to obtain the best care for their mutual patient. Intraoperative consultation (frozen section, FS) provides a preliminary diagnosis for the surgeon and aids in guiding his/her subsequent surgical approach. For the pathologist, it serves to assess tissue adequacy in the context of the clinical and imaging features of the patient. FS can guarantee that the surgeon is in the desired anatomic location, but most often serves to ensure that adequate amounts of abnormal, and likely diagnostic, tissue will be available to the pathologist to render a final diagnosis on permanent sections. The preliminary evaluation of tissue at the time of intraoperative FS also guides the pathologist in the ordering of ancillary studies, some of which need to be performed on fresh or frozen tissues and must be sent at the time of the intraoperative consultation. This brief review will specifically focus on the role of the pathologist who is called to perform a FS for a neurosurgical specimen. We will discuss (1) the goals of the neurosurgeon for the intraoperative consultation, (2) how to achieve optimal communication between neurosurgeon and pathologist at the time of the FS, (3) what constitutes reasonable and unreasonable expectations by the neurosurgeon for the FS, (4) choices of techniques that can be used by the pathologist, (5) what tissue should be triaged, and (6) common discrepancies between FS and permanent section diagnoses in central nervous system disorders. The published literature on FS and permanent section discrepancies will be briefly reviewed so that pathologists will understand that some difficulties are inherent in neurosurgical specimens and are not specific to their practice, or to a given pathologist. Hopefully, this knowledge will enhance pathologists' confidence as they negotiate how

  8. 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.

  9. The influence of lidocaine topical anesthesia during transesophageal echocardiography on blood methemoglobin level and risk of methemoglobinemia.

    PubMed

    Filipiak-Strzecka, Dominika; Kasprzak, Jarosław D; Wiszniewska, Marta; Walusiak-Skorupa, Jolanta; Lipiec, Piotr

    2015-04-01

    Methemoglobinemia is a relatively rare, but potentially life-threating medical condition, which may be induced by application of topical anaesthetic agents commonly used during endoscopic procedure. The aim of our study was to assess the influence of lidocaine used prior to transesophageal echocardiography (TEE) on the blood level of methemoglobin in vivo. Additionally we attempted to establish the occurrence rate of clinically evident lidocaine-induced methemoglobinemia on the basis of data collected in our institution. We retrospectively analyzed patient records from 3,354 TEEs performed in our echocardiographic laboratory over the course of 13 years in search for clinically evident methemoglobinemia cases. Additionally, 18 consecutive patients referred for TEE were included in the prospective part of our analysis. Blood samples were tested before and 60 min after pre-TEE lidocaine anesthesia application. Information concerning concomitant conditions and pharmacotherapy were also obtained. In 3,354 patients who underwent TEE in our institution no cases of clinically evident methemoglobinemia occurred. In the prospective part of the study, none of 18 patients [16 (89 %) men, mean age 63 ± 13] was diagnosed with either clinical symptoms of methemoglobinemia or exceeded normal blood concentration of methemoglobin. Initial mean methemoglobin level was 0.5 ± 0.1 % with mild, statistically (but not clinically) significant rise to 0.6 ± 0.1 % after 60 min (p = 0.02). Among the analyzed factors only the relation between the proton pump inhibitors intake and methemoglobin blood level rise was identified as statistically relevant (p = 0.03). In adults, pre-TEE lidocaine anesthesia with recommended dosage results in significant increase in methemoglobin blood level, which however does not exceed normal values and does not result in clinically evident methemoglobinemia.

  10. Towards patient-specific modeling of mitral valve repair: 3D transesophageal echocardiography-derived parameter estimation.

    PubMed

    Zhang, Fan; Kanik, Jingjing; Mansi, Tommaso; Voigt, Ingmar; Sharma, Puneet; Ionasec, Razvan Ioan; Subrahmanyan, Lakshman; Lin, Ben A; Sugeng, Lissa; Yuh, David; Comaniciu, Dorin; Duncan, James

    2017-01-01

    Transesophageal echocardiography (TEE) is routinely used to provide important qualitative and quantitative information regarding mitral regurgitation. Contemporary planning of surgical mitral valve repair, however, still relies heavily upon subjective predictions based on experience and intuition. While patient-specific mitral valve modeling holds promise, its effectiveness is limited by assumptions that must be made about constitutive material properties. In this paper, we propose and develop a semi-automated framework that combines machine learning image analysis with geometrical and biomechanical models to build a patient-specific mitral valve representation that incorporates image-derived material properties. We use our computational framework, along with 3D TEE images of the open and closed mitral valve, to estimate values for chordae rest lengths and leaflet material properties. These parameters are initialized using generic values and optimized to match the visualized deformation of mitral valve geometry between the open and closed states. Optimization is achieved by minimizing the summed Euclidean distances between the estimated and image-derived closed mitral valve geometry. The spatially varying material parameters of the mitral leaflets are estimated using an extended Kalman filter to take advantage of the temporal information available from TEE. This semi-automated and patient-specific modeling framework was tested on 15 TEE image acquisitions from 14 patients. Simulated mitral valve closures yielded average errors (measured by point-to-point Euclidean distances) of 1.86 ± 1.24 mm. The estimated material parameters suggest that the anterior leaflet is stiffer than the posterior leaflet and that these properties vary between individuals, consistent with experimental observations described in the literature.

  11. 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.

  12. [Value of transesophageal auricular stimulation for evaluating the accessory pathway and effect of treatment in Wolf-Parkinson-White syndrome].

    PubMed

    Kieny, J R; Kraenner, C; Facello, A; Roul, G; Mossard, J M; Bareiss, P; Sacrez, A

    1989-09-01

    In order to assess the value of the various atrial pacing techniques employed to evaluate the anterograde conduction of the accessory pathway and the effect of antiarrhythmic agents in Wolff-Parkinson-White syndrome, transesophageal atrial pacing was performed in 12 patients before and during treatment with oral flecainide acetate in doses of 200 mg per day. Before treatment, the shortest interval conducted with a 1/1 atrioventricular conduction by the accessory pathway ranged from 225 to 600 ms (mean 311 +/- 98 ms), and the effective refractory period of the accessory pathway, measured by the extrastimulus method in 11 patients, varied from 240 to 320 ms (mean 273 +/- 22 ms). These two values were very close in each patient and correlated well with each other (r = 0.90; p less than 0.001). Atrial fibrillation could be induced in 3 patients. Three patients were considered "at risk" since their effective refractory period or minimal R-R interval in atrial fibrillation was 250 ms or less. Tachycardia was induced in 8 patients, and it was possible to induce arrhythmias in the 6 patients for whom we had recordings in spontaneous tachycardia. Under treatment with flecainide acetate, an anterograde conduction block appeared in 3 patients. In the remaining 9 patients the shortest interval conducted with a 1/1 atrioventricular conduction by the accessory pathway was longer in every case: it ranged from 270 to 540 ms (mean 407 +/- 84 ms; p less than 0.001), which corresponded to a 20 to 240 ms prolongation (mean 133 +/- 78 ms).(ABSTRACT TRUNCATED AT 250 WORDS)

  13. 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.

  14. 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.

  15. 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.

  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. 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.

  18. The usefulness of intraoperative drip infusion cholangiography during laparoscopic cholecystectomy.

    PubMed

    Nagai, K; Matsumoto, S; Kanemaki, T; Ooshima, T; Mori, K; Funabiki, T

    1992-12-01

    Intraoperative cholangiography during laparoscopic cholecystectomy has been considered to be a necessary examination because incidental injury to the common bile duct must be avoided. We performed 93 intraoperative drip infusion cholangiographies among 103 laparoscopic cholecystectomized patients as simple examinations by using iotroxic acid. The best drip infusion time was determined to be 20 min and good pictures were obtained from 10 to 60 min after the end of the drip. Nine patients with liver dysfunction and a poor radiograph had poor cholangiograms. Clear cholangiograms were obtained in 79 patients: four had a long remnant cystic duct and, in one case, a common bile duct stenosis was found by endoclip. The findings in these five cases helped us to correct failures during operation.

  19. 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.

  20. 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

  1. Macular Surgery Using Intraoperative Spectral Domain Optical Coherence Tomography

    PubMed Central

    Riazi-Esfahani, Mohammad; Khademi, Mohammad Reza; Mazloumi, Mehdi; Khodabandeh, Alireza; Riazi-Esfahani, Hamid

    2015-01-01

    Purpose: To report the use of intraoperative spectral domain optical coherence tomography (SD-OCT) for detecting anatomical changes during macular surgery. Methods: In a consecutive case series, 32 eyes of 32 patients undergoing concurrent pars plana vitrectomy and intraoperative SD-OCT for macular hole (MH), epiretinal membrane (ERM) and vitreomacular traction (VMT) were enrolled. Intraoperative changes in retinal thickness and dimensions of the macular hole were measured in patients with ERM and VMT following surgical manipulation using a hand-held SD-OCT device (iVue, Optovue Inc., Fremont, CA, USA). Results: SD-OCT images of sixteen eyes with macular hole were subjected to quantitative and qualitative analysis. All MH dimensions remained stable during consecutive stages of surgery except for MH apex diameter, which showed a significant decrease after internal limiting membrane (ILM) peeling (P=0.025). Quantitative analysis of ten patients with ERM showed a significant decrease in retinal thickness after membrane removal (P=0.018) which did not remain significant until the end of the procedure (P=0.8). In three cases, subretinal fluid was formed after ILM peeling. Quantitative analysis of five patients with VMT showed a decrease in retinal thickness during consecutive steps of the surgery, although these changes were not significant. In two cases, subretinal fluid was formed after ILM peeling. Conclusion: Intraoperative SD-OCT is a useful imaging technique which provides vitreoretinal surgeons with rapid awareness of changes in macular anatomy during surgery and may therefore result in better anatomical and visual outcomes. PMID:26730318

  2. Conservative management of intraoperative tracheal injury during cardiac operations.

    PubMed

    Kayatta, Michael O; Vasquez, Julio C; DeLaRosa, Jacob

    2014-04-01

    Iatrogenic intraoperative tracheal injuries are rare in cardiac operations. Management of this complication is not well described because of the low incidence and lack of reported cases. We present an 82-year-old woman who sustained a tracheal injury during aortic valve replacement. Soft tissue coverage of the trachea was obtained, the original cardiac operation was completed, and she was otherwise managed conservatively. She recovered without further complication and was discharged home 1 week after the surgical procedure.

  3. Intraoperative Manipulation for Flexion Contracture During Total Knee Arthroplasty.

    PubMed

    Matsui, Yoshio; Minoda, Yukihide; Fumiaki, Inori; Nakagawa, Sigeru; Okajima, Yoshiaki; Kobayashi, Akio

    2016-11-01

    Joint gap balancing during total knee arthroplasty (TKA) is important for ensuring postoperative joint stability and range of motion. Although the joint gap should be balanced to ensure joint stability, it is not easy to achieve perfect balancing during TKA. In particular, relative extension gap shortening can induce flexion contracture. Intraoperative manipulation is often empirically performed. This study evaluated the tension required for this manipulation and investigated the influence of intraoperative manipulation on the joint gap in cadaveric knees. Total knee arthroplasty was performed in 6 cadaveric knees from whole body cadavers. Flexion contracture was induced using an insert that was 4 mm thicker than the extension gap, and intraoperative manipulation was performed. Study measurements included the changes in the joint gap after manipulation at 6 positions, with the knee bending from extension to 120° flexion, and the manipulation tension that was required to create a 4-mm increase in the gap. The manipulation tension needed to create a 4-mm increase in the extension gap was 303±17 N. The changes in the joint gap after manipulation were 0.4 mm, 0.6 mm, 0.2 mm, -0.2 mm, -0.4 mm, and -0.6 mm at 0°, 30°, 45°, 60°, 90°, and 120° flexion, respectively. Therefore, the joint gap was not significantly changed by the manipulation. Intraoperative manipulation does not resolve flexion contracture. Therefore, if flexion contracture occurs during TKA, treatment with additional bone cutting and soft tissue release is likely more appropriate than manipulation. [Orthopedics. 2016; 39(6):e1070-e1074.].

  4. 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

  5. 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.

  6. 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

  7. 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

  8. Protocol for intraoperative assessment of the human cerebrovascular glycocalyx

    PubMed Central

    Haeren, R H L; Vink, H; Staals, J; van Zandvoort, M A M J; Dings, J; van Overbeeke, J J; Hoogland, G; Rijkers, K; Schijns, O E M G

    2017-01-01

    Introduction Adequate functioning of the blood–brain barrier (BBB) is important for brain homoeostasis and normal neuronal function. Disruption of the BBB has been described in several neurological diseases. Recent reports suggest that an increased permeability of the BBB also contributes to increased seizure susceptibility in patients with epilepsy. The endothelial glycocalyx is coating the luminal side of the endothelium and can be considered as the first barrier of the BBB. We hypothesise that an altered glycocalyx thickness plays a role in the aetiology of temporal lobe epilepsy (TLE), the most common type of epilepsy. Here, we propose a protocol that allows intraoperative assessment of the cerebrovascular glycocalyx thickness in patients with TLE and assess whether its thickness is decreased in patients with TLE when compared with controls. Methods and analysis This protocol is designed as a prospective observational case–control study in patients who undergo resective brain surgery as treatment for TLE. Control subjects are patients without a history of epileptic seizures, who undergo a craniotomy or burr hole surgery for other indications. Intraoperative glycocalyx thickness measurements of sublingual, cortical and hippocampal microcirculation are performed by video microscopy using sidestream dark-field imaging. Demographic details, seizure characteristics, epilepsy risk factors, intraoperative haemodynamic parameters and histopathological evaluation are additionally recorded. Ethics and dissemination This protocol has been ethically approved by the local medical ethical committee (ID: NL51594.068.14) and complies with the Declaration of Helsinki and principles of Good Clinical Practice. Informed consent is obtained before study enrolment and only coded data will be stored in a secured database, enabling an audit trail. Results will be submitted to international peer-reviewed journals and presented at international conferences. Trial registration number

  9. Intraoperative Hypothermia in Total Hip and Knee Arthroplasty.

    PubMed

    Frisch, Nicholas B; Pepper, Andrew M; Rooney, Edward; Silverton, Craig

    2016-10-25

    Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are common and successful orthopedic procedures, and as their frequency continues to increase substantially, the focus on limiting perioperative complications heightens. Intraoperative normothermia is recommended to minimize additional complications, but limited evidence exists regarding the effect of hypothermia on orthopedic patients. The purpose of this retrospective study was to determine the incidence of perioperative hypothermia in the setting of TKA and THA, and to evaluate its impact on complications and outcomes. The clinical records of 2580 consecutive patients who underwent TKA or THA at a single institution between January 1, 2011, and December 31, 2013 were reviewed. After excluding patients with complex or revision procedures, a total of 2397 patients comprised the study population. Patient demographic data, surgery-specific data, postoperative complications, length of hospital stay, and 30-day readmission were recorded. Patients with a mean intraoperative temperature less than 36°C were identified as hypothermic. Statistical analysis evaluated associations with hypothermia and the effect on complications and outcomes. The incidence of mean intraoperative hypothermia was 37%, 43.9%, and 32.6% for arthroplasty, THA, and TKA, respectively. General anesthesia was significantly associated with hypothermia (P<.001). Women and THA patients were at higher risk for hypothermia. In the arthroplasty and THA cohorts, longer operating room time and re-warmer use were associated with hypothermia (P=.010). Overall, hypothermia was associated with increased estimated blood loss, but no increase in associated transfusion was demonstrated (P=.006). Hypothermia was not associated with postoperative complications. [Orthopedics. 201x; xx(x):xx-xx.].

  10. Pediatric awake craniotomy and intra-operative stimulation mapping.

    PubMed

    Balogun, James A; Khan, Osaama H; Taylor, Michael; Dirks, Peter; Der, Tara; Carter Snead Iii, O; Weiss, Shelly; Ochi, Ayako; Drake, James; Rutka, James T

    2014-11-01

    The indications for operating on lesions in or near areas of cortical eloquence balance the benefit of resection with the risk of permanent neurological deficit. In adults, awake craniotomy has become a versatile tool in tumor, epilepsy and functional neurosurgery, permitting intra-operative stimulation mapping particularly for language, sensory and motor cortical pathways. This allows for maximal tumor resection with considerable reduction in the risk of post-operative speech and motor deficits. We report our experience of awake craniotomy and cortical stimulation for epilepsy and supratentorial tumors located in and around eloquent areas in a pediatric population (n=10, five females). The presenting symptom was mainly seizures and all children had normal neurological examinations. Neuroimaging showed lesions in the left opercular (n=4) and precentral or peri-sylvian regions (n=6). Three right-sided and seven left-sided awake craniotomies were performed. Two patients had a history of prior craniotomy. All patients had intra-operative mapping for either speech or motor or both using cortical stimulation. The surgical goal for tumor patients was gross total resection, while for all epilepsy procedures, focal cortical resections were completed without any difficulty. None of the patients had permanent post-operative neurologic deficits. The patient with an epileptic focus over the speech area in the left frontal lobe had a mild word finding difficulty post-operatively but this improved progressively. Follow-up ranged from 6 to 27 months. Pediatric awake craniotomy with intra-operative mapping is a precise, safe and reliable method allowing for resection of lesions in eloquent areas. Further validations on larger number of patients will be needed to verify the utility of this technique in the pediatric population.

  11. Diffuse large B-cell lymphoma diagnosed by intracardiac echocardiography-guided cardiac tumor biopsy.

    PubMed

    Kamiya, Kiwamu; Sakakibara, Mamoru; Yamada, Shiro; Tan, Michinao; Furihata, Takaaki; Kubota, Kanako; Tsutsui, Hiroyuki

    2012-01-01

    A 44-year-old man presented with exertional dyspnea. Transthoracic echocardiography (TTE) revealed a large tumor protruding into the right atrium and extending into the left ventricle. Cardiac magnetic resonance imaging and contrast enhanced computed tomography also confirmed the intracardiac tumor detected by TTE. An endomyocardial biopsy was performed under the intracardiac echocardiography (ICE) guidance, and he was diagnosed to have diffuse large B-cell lymphoma following the histological analysis. ICE-guided cardiac tumor biopsy is expected to be a useful diagnostic strategy that can minimize the risk of procedural complications.

  12. Intracardiac Echocardiography Guided Transeptal Catheter Injection of Microspheres for Assessment of Cerebral Microcirculation in Experimental Models

    PubMed Central

    Bellapart, Judith; Dunster, Kimble R.; Diab, Sara; Platts, David G.; Raffel, Christopher; 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

  13. 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

  14. Intracavernosal metaraminol for treatment of intraoperative penile erection.

    PubMed Central

    Tsai, S. K.; Hong, C. Y.

    1990-01-01

    Four patients developed penile erection when regional anaesthesia was induced with spinal block. In another patient, penile erection developed during fentanyl-induced general anaesthesia. Injection of metaraminol into corpus cavernosum successfully achieved detumescence in all these patients. The dose of metaraminol ranged from 10 to 25 micrograms, much less than that required for the treatment of vasodilator-induced priapism. Intracavernosal injection of metaraminol is a simple, effective and safe method for immediate relief of intraoperative penile erection. It is most useful when urogenital operation would be delayed by penile tumescence. PMID:2099422

  15. 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

  16. 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.

  17. Effectivity of intraoperative adjustable suture technique in horizontal strabismus

    PubMed Central

    Altintas, Ayse Gul Kocak; Arifoglu, Hasan Basri; Midillioglu, Inci Kocak; Gungor, Elif Damar; Simsek, Saban

    2013-01-01

    AIM To compare the long-term effectivity of intraoperative adjustable suture technique with traditional non-adjustable strabismus surgery. METHODS Two hundred and thirty-three patients, who underwent strabismus surgery either with traditional procedures or one-stage intraoperative adjustable suture technique, were included in our long-term follow-up study. One hundred and eighteen patients were evaluated in traditional surgery group (TSG) and 115 who underwent adjustable suture were in the one-stage intraoperative adjustable surgery group (ASG). In this group 9 patients had paralytic strabismus and 16 had reoperations, 2 patients had restrictive strabismus related to thyroid eye disease. The mean follow up in the TSG was 26.2 months and it was 24.8 months in the ASG group. RESULTS In patients with exotropia (XT) the mean correction of deviation for near fixation in ASG (32.4±13.2PD) and in TSG (26.4±8.2PD) were similar (P=0.112). The correction for distant fixation in ASG (33.2±11.4PD) and TSG (30.9±7.2PD) were not significantly different (P=0.321). In patients with esotropia (ET) even the mean correction of deviation for both near (31±12PD) and distant (30.6±12.8PD) fixations were higher in ASG than in TSG, for both near (28.27±14.2PD) and distant (28.9±12.9PD) fixations, the differences were not significant (P=0.346, 0.824 respectively). The overall success rate of XT patient was 78.9% in TSG and 78.78% in ASG, the difference was not significant (P=0.629). The success rates were 78.75% in TSG and 75.51% in ASG in ET patient, which was also not significantly different (P=0.821). CONCLUSION Although patients in ASG had more complex deviation such as paralysis, reoperations and restrictive strabismus, success rates of this tecnique was as high as TSG which did not contain complicated deviation. One-stage intraoperative adjustable suture technique is a safe and effective method for cooperative patient who has complex deviation. PMID:23991385

  18. Dense deformation field estimation for brain intraoperative images registration

    NASA Astrophysics Data System (ADS)

    De Craene, Mathieu S.; du Bois d'Aische, Aloys; Talos, Ion-Florin; Ferrant, Matthieu; Black, Peter M.; Jolesz, Ferenc; Kikinis, Ron; Macq, Benoit; Warfield, Simon K.

    2004-05-01

    A new fast non rigid registration algorithm is presented. The algorithm estimates a dense deformation field by optimizing a criterion that measures image similarity by mutual information and regularizes with a linear elastic energy term. The optimal deformation field is found using a Simultaneous Perturbation Stochastic Approximation to the gradient. The implementation is parallelized for symmetric multi-processor architectures. This algorithm was applied to capture non-rigid brain deformations that occur during neurosurgery. Segmentation of the intra-operative data is not required but preoperative segmentation of the brain allows the algorithm to be robust to artifacts due to the craniotomy.

  19. Intraoperative passive knee kinematics during total knee arthroplasty surgery.

    PubMed

    Young, Kathryn L; Dunbar, Michael J; Richardson, Glen; Astephen Wilson, Janie L

    2015-11-01

    Surgical navigation systems for total knee arthroplasty (TKA) surgery are capable of capturing passive three-dimensional (3D) angular joint movement patterns intraoperatively. Improved understanding of patient-specific knee kinematic changes between pre and post-implant states and their relationship with post-operative function may be important in optimizing TKA outcomes. However, a comprehensive characterization of the variability among patients has yet to be investigated. The objective of this study was to characterize the variability within frontal plane joint movement patterns intraoperatively during a passive knee flexion exercise. Three hundred and forty patients with severe knee osteoarthritis (OA) received a primary TKA using a navigation system. Passive kinematics were captured prior to (pre-implant), and after prosthesis insertion (post-implant). Principal component analysis (PCA) was used to capture characteristic patterns of knee angle kinematics among patients, to identify potential patient subgroups based on these patterns, and to examine the subgroup-specific changes in these patterns between pre- and post-implant states. The first four extracted patterns explained 99.9% of the diversity within the frontal plane angle patterns among the patients. Post-implant, the magnitude of the frontal plane angle shifted toward a neutral mechanical axis in all phenotypes, yet subtle pattern (shape of curvature) features of the pre-implant state persisted.

  20. Mini gamma cameras for intra-operative nuclear tomographic reconstruction.

    PubMed

    Matthies, Philipp; Gardiazabal, José; Okur, Aslı; Vogel, Jakob; Lasser, Tobias; Navab, Nassir

    2014-12-01

    Nuclear imaging modalities like PET or SPECT are in extensive use in medical diagnostics. In a move towards personalized therapy, we present a flexible nuclear tomographic imaging system to enable intra-operative SPECT-like 3D imaging. The system consists of a miniaturized gamma camera mounted on a robot arm for flexible positioning, while spatio-temporal localization is provided by an optical tracking system. To facilitate statistical tomographic reconstruction of the radiotracer distribution using a maximum likelihood approach, a precise model of the mini gamma camera is generated by measurements. The entire system is evaluated in a series of experiments using a hot spot phantom, with a focus on criteria relevant for the intra-operative workflow, namely the number of required imaging positions as well as the required imaging time. The results show that high quality reconstructed images of simple hot spot configurations with positional errors of less than one millimeter are possible within acquisition times as short as 15s.

  1. 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.

  2. Intra-operative implantation errors during Austin Moore Hemiarthroplasty.

    PubMed

    Naqvi, Zohaib Gulzar; Markhand, Javed Ali; Ahmed, Syed Kamran; Chinoy, Amin; Khan, Mansoor Ali

    2016-10-01

    Austin Moore hemiarthroplasty is an established treatment in elderly patients with neck of femur fractures. Being commonly performed, it is also associated with several technical errors of implantation which results in complications and failure requiring revision surgery. This retrospective pre- and post-operative radiographic study to determine the frequency of technical errors was conducted at the Indus Hospital, Karachi, and comprised data of 50 patients who underwent Austin Moore hemiarthroplasty between January and November 2016. Of the total, 29(58%%) patients had no error of implantation. Overhanging of prosthesis was observed in 21(42%) patients, followed by inadequate length of the neck remnant in 18(36%). Moreover, 8(16%) patients sustained intra-operative periprosthetic fractures managed with cerclage wire. Also, 33(66%) patients had a Dorr type-Afemur morphologic pattern. Hemiarthroplasty was found to be a technically demanding procedure associated with avoidable intra-operative implantation errors by proper preoperative planning, careful patient selection, proper training of surgeons, hence avoiding failure.

  3. 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.

  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. Risk factors for intraoperative floppy iris syndrome: a prospective study.

    PubMed

    Chatziralli, I P; Peponis, V; Parikakis, E; Maniatea, A; Patsea, E; Mitropoulos, P

    2016-08-01

    PurposeTo evaluate risk factors for intraoperative floppy iris syndrome (IFIS) in patients undergoing phacoemulsification.MethodsParticipants in the study were 1274 consecutive patients, who underwent routine phacoemulsification cataract surgery. The following data were recorded and evaluated as possible risk factors: ophthalmological conditions, axial length of the eye, sociodemographic features, clinical data (hypertension and diabetes mellitus), medications being taken at the time of surgery, and duration of their intake. Cases were characterized intraoperatively as IFIS and non-IFIS. Univariate and multivariate logistic regression analysis were performed.ResultsIFIS was observed in 63/1274 eyes (4.9%, 95% CI: 3.9-6.7%). Current use of tamsulosin, alfuzosin, terazosin, benzodiazepines, quetiapine, and finasteride, as well as hypertension, were all independently associated with IFIS. Significant associations were noted for male sex, rivastigmine, and short axial length, which did not reach significance at the multivariate analysis. Duration of α-blockers intake was not found to be associated with IFIS.ConclusionApart from the well-established associations with α-blockers, this prospective study points to benzodiazepines, quetiapine, finasteride, and hypertension as potential risk factors for IFIS. Short axial length and rivastigmine were significantly associated with IFIS only at the univariate analysis.

  6. 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.

  7. Intraoperative esophageal Doppler hemodynamic monitoring in free perforator flap surgery.

    PubMed

    Figus, Andrea; Wade, Ryckie G; Oakey, Stephen; Ramakrishnan, Venkat V

    2013-03-01

    Goal-directed fluid therapy optimizes cardiac output and flap perfusion during anesthesia. Intraoperative esophageal Doppler (ED) monitoring has been reported as more accurate and reliable, demonstrating improved surgical outcomes compared with central venous pressure and arterial catheter monitoring. A prospective study of patients undergoing free perforator (deep inferior epigastric artery perforator/anterolateral thigh) flap surgery with intraoperative ED monitoring (51 patients) or central venous pressure monitoring (53 patients) was undertaken. Fluid input included crystalloids, colloids, or blood products. Fluid output included urine, blood, or suctioned fluid. Postoperative fluid balance was calculated as fluid input - output. Fluid input between groups was not different. Fluid output was greater in the ED group (P = 0.008). The ED group showed less fluid balance (P = 0.023), less anesthetic time (P = 0.001), less hospital stay (mean 1.9 days; P = 0.147), less monitoring and flap complications (P = 0.062). ED monitoring demonstrated no monitoring complications, provides a favorable postoperative fluid balance, and may reduce flap complications and hospital stay.

  8. Intraoperative multi-exposure speckle imaging of cerebral blood flow.

    PubMed

    Richards, Lisa M; Kazmi, Sm Shams; Olin, Katherine E; Waldron, James S; Fox, Douglas J; Dunn, Andrew K

    2017-01-01

    Multiple studies have demonstrated that laser speckle contrast imaging (LSCI) has high potential to be a valuable cerebral blood flow monitoring technique during neurosurgery. However, the quantitative accuracy and sensitivity of LSCI is limited, and highly dependent on the exposure time. An extension to LSCI called multi-exposure speckle imaging (MESI) overcomes these limitations, and was evaluated intraoperatively in patients undergoing brain tumor resection. This clinical study ( n = 8) recorded multiple exposure times from the same cortical tissue area spanning 0.5-20 ms, and evaluated images individually as single-exposure LSCI and jointly using the MESI model. This study demonstrated that the MESI estimates provided the broadest flow sensitivity for sampling the flow magnitude in the human brain, closely followed by the shorter exposure times. Conservation of flow analysis on vascular bifurcations was used to validate physiological accuracy, with highly conserved flow estimates (<10%) from both MESI and 1 ms LSCI ( n = 14 branches). The MESI model had high goodness-of-fit with proper image calibration and acquisition, and was used to monitor blood flow changes after tissue cautery. Results from this study demonstrate that intraoperative MESI can be performed with high quantitative accuracy and sensitivity for cerebral blood flow monitoring.

  9. 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.

  10. Transesophageal Echocardiography in Healthy Young Adult Male Baboons (Papio hamadryas anubis): Normal Cardiac Anatomy and Function in Subhuman Primates Compared to Humans.

    PubMed

    Bert, Arthur A; Drake, William B; Quinn, Rachael W; Brasky, Kathleen M; O'Brien, James E; Lofland, Gary K; Hopkins, Richard A

    2013-08-01

    Implantable, viable tissue engineered cardiovascular constructs are rapidly approaching clinical translation. Species typically utilized as preclinical large animal models are food stock ungulates for which cross species biological and genomic differences with humans are great. Multiple authorities have recommended developing subhuman primate models for testing regenerative surgical strategies to mitigate xenotransplant inflammation. However, there is a lack of specific quantitative cardiac imaging comparisons between humans and the genomically similar baboons (Papio hamadryas anubis). This study was undertaken to translate to baboons transesophageal echocardiographic functional and dimensional criteria defined as necessary for defining cardiac anatomy and function in the perioperative setting. Seventeen young, healthy baboons (approximately 30 kg, similar to 5 year old children) were studied to determine whether the requisite 11 views and 52 measurement parameters could be reliably acquired by transesophageal echocardiography (TEE). The obtained measurements were compared to human adult normative literature values and to a large relational database of pediatric "normal heart" echo measurements. Comparisons to humans, when normalized to BSA, revealed a trend in baboons toward larger mitral and aortic valve effective orifice areas and much larger left ventricular muscle mass and wall thickness, but similar pulmonary and tricuspid valves. By modifying probe positioning relative to human techniques, all recommended TEE views except transgastric could be replicated. To supplement, two transthoracic apical views were discovered that in baboons could reliably replace the transgastric TEE view. Thus, all requisite echo views could be obtained for a complete cardiac evaluation in Papio hamadryas anubis to noninvasively quantify cardiac structural anatomy, physiology, and dimensions. Despite similarities between the species, there are subtle and important physiologic and

  11. Intraoperative image updating for brain shift following dural opening.

    PubMed

    Fan, Xiaoyao; Roberts, David W; Schaewe, Timothy J; Ji, Songbai; Holton, Leslie H; Simon, David A; Paulsen, Keith D

    2016-09-09

    OBJECTIVE Preoperative magnetic resonance images (pMR) are typically coregistered to provide intraoperative navigation, the accuracy of which can be significantly compromised by brain deformation. In this study, the authors generated updated MR images (uMR) in the operating room (OR) to compensate for brain shift due to dural opening, and evaluated the accuracy and computational efficiency of the process. METHODS In 20 open cranial neurosurgical cases, a pair of intraoperative stereovision (iSV) images was acquired after dural opening to reconstruct a 3D profile of the exposed cortical surface. The iSV surface was registered with pMR to detect cortical displacements that were assimilated by a biomechanical model to estimate whole-brain nonrigid deformation and produce uMR in the OR. The uMR views were displayed on a commercial navigation system and compared side by side with the corresponding coregistered pMR. A tracked stylus was used to acquire coordinate locations of features on the cortical surface that served as independent positions for calculating target registration errors (TREs) for the coregistered uMR and pMR image volumes. RESULTS The uMR views were visually more accurate and well aligned with the iSV surface in terms of both geometry and texture compared with pMR where misalignment was evident. The average misfit between model estimates and measured displacements was 1.80 ± 0.35 mm, compared with the average initial misfit of 7.10 ± 2.78 mm between iSV and pMR, and the average TRE was 1.60 ± 0.43 mm across the 20 patients in the uMR image volume, compared with 7.31 ± 2.82 mm on average in the pMR cases. The iSV also proved to be accurate with an average error of 1.20 ± 0.37 mm. The overall computational time required to generate the uMR views was 7-8 minutes. CONCLUSIONS This study compensated for brain deformation caused by intraoperative dural opening using computational model-based assimilation of iSV cortical surface displacements. The u

  12. Intraoperative near-infrared fluorescent imaging during robotic operations.

    PubMed

    Macedo, Antonio Luiz de Vasconcellos; Schraibman, Vladimir

    2016-01-01

    The intraoperative identification of certain anatomical structures because they are small or visually occult may be challenging. The development of minimally invasive surgery brought additional difficulties to identify these structures due to the lack of complete tactile sensitivity. A number of different forms of intraoperative mapping have been tried. Recently, the near-infrared fluorescence imaging technology with indocyanine green has been added to robotic platforms. In addition, this technology has been tested in several types of operations, and has advantages such as safety, low cost and good results. Disadvantages are linked to contrast distribution in certain clinical scenarios. The intraoperative near-infrared fluorescent imaging is new and promising addition to robotic surgery. Several reports show the utility of this technology in several different procedures. The ideal dose, time and site for dye injection are not well defined. No high quality evidence-based comparative studies and long-term follow-up outcomes have been published so far. Initial results, however, are good and safe. RESUMO A identificação intraoperatória de certas estruturas anatômicas, por seu tamanho ou por elas serem ocultas à visão, pode ser desafiadora. O desenvolvimento da cirurgia minimamente invasiva trouxe dificuldades adicionais, pela falta da sensibilidade tátil completa. Diversas formas de detecção intraoperatória destas estruturas têm sido tentadas. Recentemente, a tecnologia de fluorescência infravermelha com verde de indocianina foi associada às plataformas robóticas. Além disso, essa tecnologia tem sido testada em uma variedade de cirurgias, e suas vantagens parecem estar ligadas a baixo custo, segurança e bons resultados. As desvantagens estão associadas à má distribuição do contraste em determinados cenários. A imagem intraoperatória por fluorescência infravermelha é uma nova e promissora adição à cirurgia robótica. Diversas séries mostram

  13. Intraoperative electron beam radiation therapy (IOEBRT) for carcinoma of the exocrine pancreas

    SciTech Connect

    Dobelbower, R.R. Jr.; Konski, A.A.; Merrick, H.W. III; Bronn, D.G.; Schifeling, D.; Kamen, C. )

    1991-01-01

    The abdominal cavities of 50 patients were explored in a specially constructed intraoperative radiotherapy operating amphitheater at the Medical College of Ohio. Twenty-six patients were treated with intraoperative and postoperative precision high dose external beam therapy, 12 with intraoperative irradiation but no external beam therapy, and 12 with palliative surgery alone. All but two patients completed the postoperative external beam radiation therapy as initially prescribed. The median survival time for patients treated with palliative surgery alone was 4 months, and that for patients treated with intraoperative radiotherapy without external beam therapy was 3.5 months. Patients undergoing intraoperative irradiation and external beam radiation therapy had a median survival time of 10.5 months. Four patients died within 30 days of surgery and two patients died of gastrointestinal hemorrhage 5 months posttreatment.

  14. Cytology of bone lesions by intraoperative sampling during fracture treatment.

    PubMed

    Kinias, Ioannis S; Rammou-Kinia, Rea

    2002-03-01

    Cytology was performed on 314 patients who were treated by surgery for hip joint fracture, to determine and evaluate the role, accuracy, and perspective of intraoperative bone sampling. Specimens were collected from bone lesions during surgery by imprints or driller washing in normal saline. The results were compared with those of subsequent biopsies or clinical follow-up. All 13 neoplastic cases (malignant or benign) were identified by cytology. An accuracy rate of 69.2% was achieved by this method when the type and origin of the neoplasms were to be conclusive. There were no false-positive diagnoses, and all benign conditions showed negative results on cytology (specificity and sensitivity of 100%). Cytology can play a valuable role in the diagnosis of bone lesions. The morphologic diagnostic criteria allow for a high level of diagnostic accuracy of cytologic assessments in most cases of bone lesions, no matter the sampling technique.

  15. Computerized intraoperative calculation of instantaneous prosthetic aortic valve area.

    PubMed

    DiSesa, V J; Lachman, P; Collins, J J; Cohn, L H

    1988-01-01

    Improved assessment of valve area is essential to understanding the performance of prosthetic valves. The authors studied six patients undergoing aortic valve replacement using mechanical (ME) or porcine (PO) prostheses. Instantaneous cardiac output (CO) (L/min) was measured in the aorta using an ultrasonic flow probe. Left ventricular and aortic pressures (mmHg) were measured using Millar catheters. Data were analyzed using an IBM PC-AT. Valve area (cm2) was determined using Gorlin's formula (AG) and a new formula for instantaneous area derived mathematically and using a theoretic constant. AG, mean (AI) and peak (Apk) instantaneous areas were compared to geometric measures of area (Aactual) in vitro. Peak instantaneous area correlates best with measured area. Intraoperative assessment using the ultrasonic flow probe and computer analysis is helpful in understanding the dynamic properties of prosthetic valves in vivo.

  16. Intraoperative Proximal Femoral Fracture in Primary Cementless Total Hip Arthroplasty.

    PubMed

    Ponzio, Danielle Y; Shahi, Alisina; Park, Andrew G; Purtill, James J

    2015-08-01

    Intraoperative proximal femoral fracture is a complication of primary cementless total hip arthroplasty (THA) at rates of 2.95-27.8%. A retrospective review of 2423 consecutive primary cementless THA cases identified 102 hips (96 patients) with fracture. Multivariate analysis compared fracture incidences between implants, Accolade (Stryker Orthopaedics) and Tri-Lock (DePuy Orthopaedics, Inc.), and evaluated potential risk factors using a randomized control group of 1150 cases without fracture. The fracture incidence was 4.4% (102/2423), 3.7% (36/1019) using Accolade and 4.9% using Tri-Lock (66/1404) (P=0.18). Female gender (OR=1.96; 95% CI 1.19-3.23; P=0.008) and smaller stem size (OR=1.64; 95% CI 1.04-2.63; P=0.03) predicted increased odds of fracture. No revisions of the femoral component were required in the fracture cohort.

  17. Intraoperative raster photogrammetry--the PAR Corneal Topography System.

    PubMed

    Belin, M W

    1993-01-01

    The PAR Corneal Topography System (CTS) is a computer-driven corneal imaging system that uses close-range raster photogrammetry to measure and produce a topographic map of the corneal surface. The CTS determines distortion in a projected two-dimensional grid. Unlike Placido-disc-based videokeratoscopes, the PAR CTS produces a true topographic map (elevation map) and requires neither a smooth reflective surface nor precise spatial alignment for accurate imaging. Because the system uses two noncoaxial optical paths, it can be integrated into other optical devices. A modified CTS was integrated into an experimental erbium: YAG photoablative laser. The CTS successfully imaged corneas before, after, and during laser photoablation. Its ability to image nonreflective surfaces and to be integrated into other optical systems may make it suitable for intraoperative refractive monitoring.

  18. 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.

  19. Intraoperative hypertensive crisis due to a catecholamine-secreting esthesioneuroblastoma

    PubMed Central

    Salmasi, Vafi; Schiavi, Adam; Binder, Zev A.; Ruzevick, Jacob; Orr, Brent A.; Burger, Peter C.; Ball, Douglas W.; Blitz, Ari M.; Koch, Wayne M.; Ishii, Masaru; Gallia, Gary L.

    2015-01-01

    Background Although uncommon, esthesioneuroblastomas may produce clinically significant amounts of catecholamines. Methods We report a patient with a catecholamine-secreting esthesioneuroblastoma who developed intraoperative hypertensive crisis. Results A patient with history of hypertension was referred to our skull base center for management of a residual esthesioneuroblastoma. A staged endonasal endoscopic approach was planned. At the conclusion of the first stage, a hypertensive crisis occurred. Work-up revealed elevated levels of serum and urinary catecholamines. The patient was treated with alpha adrenoceptor blockade prior to the second stage. Serum catecholamine levels following this second stage were normal. On immunohistochemical analysis, the tumor cells were found to be positive for tyrosine hydroxylase, the rate limiting enzyme in cathecholamine synthesis, and achaete-scute homologue 1, a transcription factor essential in the development of olfactory and sympathetic neurons. Conclusion Catecholamine production should be considered in the differential of unexpected extreme hypertension during surgical resection of esthesioneuroblastoma. PMID:25352487

  20. Modified Surgical Techniques for Managing Intraoperative Floppy Iris Syndrome

    PubMed Central

    Charukamnoetkanok, Puwat

    2016-01-01

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

  1. 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.

  2. Is current clinical practice modified about intraoperative breast irradiation?

    PubMed

    Massa, Michela; Franchelli, Simonetta; Panizza, Renzo; Massa, Tiberio

    2016-04-01

    After the results obtained in the two randomized clinical trial, the ELIOT trial and the TARGIT-A trial, a heated debate is going on concerning the question of applying intraoperative radiotherapy (IORT) instead of postoperative whole breast irradiation (WBI) after breast conservative treatment. Currently, many centers are applying the IORT following the strict selection criteria dictated by the working groups American Society for Radiation Oncology (ASTRO) and Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) and monitoring the oncological outcome together with radiation toxicity on breast tissue. The clinical experience of the Geneva University Hospital regarding the use of the Intrabeam system is evaluated and compared with current evidences.

  3. Is current clinical practice modified about intraoperative breast irradiation?

    PubMed Central

    Massa, Michela; Franchelli, Simonetta; Panizza, Renzo; Massa, Tiberio

    2016-01-01

    After the results obtained in the two randomized clinical trial, the ELIOT trial and the TARGIT-A trial, a heated debate is going on concerning the question of applying intraoperative radiotherapy (IORT) instead of postoperative whole breast irradiation (WBI) after breast conservative treatment. Currently, many centers are applying the IORT following the strict selection criteria dictated by the working groups American Society for Radiation Oncology (ASTRO) and Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) and monitoring the oncological outcome together with radiation toxicity on breast tissue. The clinical experience of the Geneva University Hospital regarding the use of the Intrabeam system is evaluated and compared with current evidences. PMID:27199511

  4. Fatal intraoperative hemorrhage during spinal fusion surgery for osteogenesis imperfecta.

    PubMed

    Sperry, K

    1989-03-01

    Osteogenesis imperfecta (OI) is an uncommon inherited systemic disorder of the connective tissues characterized primarily by varying degrees of bony fragility. Consequently, individuals affected by this condition frequently suffer severe skeletal injuries from otherwise innocuous traumatic events. This syndrome has other associated abnormalities, including hydrocephalus and brain stem compression on the basis of cranial developmental defects (platybasia), cardiac and vascular problems, respiratory disease from spinal deformities, vascular fragility, a bleeding disorder caused by an apparent platelet function abnormality, and anesthesia-related hyperpyrexia. A case is presented here of a young girl with advanced OI in whom intraoperative death occurred as a consequence of inadvertent rib fractures, with subsequent uncontrollable hemorrhage. OI may also potentially be mistaken for child abuse by an inexperienced examiner.

  5. Intraoperative blood loss and gestational age at pregnancy termination.

    PubMed

    Marchiano; Thomas; Lapinski; Balwan; Patel

    1998-07-01

    Objective: To establish the relationship of measured intraoperative blood loss to gestational age at pregnancy termination, and to determine which factors, if any, affect the risk of bleeding.Methods: A single-operator series of 363 consecutive women undergoing pregnancy termination between 5 and 24 weeks gestational age, as dated by ultrasound, was prospectively evaluated. All pregnancies under 13 weeks gestation were terminated by mechanical dilation and suction curettage without preoperative cervical ripening. All pregnancies between 13 and 24 weeks gestation were terminated by preoperative osmotic cervical dilation with laminaria tents and subsequent uterine evacuation by a combination of suction curettage, sharp curettage, and Bierer forceps extraction. All patients over 12 weeks gestation received a postoperative oxytocin infusion. Whenever possible, amniotic fluid and blood were collected and measured separately. Patients were excluded from the data analysis for pregnancy demise, PPROM, Potter's syndrome, or inability to separate blood establish their relationship. After adjustment for gestational age, the results were analyzed to determine if blood loss was related to maternal age, smoking history, body habitus, or operative indication.Results: A curvilinear relationship between blood loss and gestational age was observed. Mean blood loss at 24 weeks exceeded 800 mL. After adjustment for gestational age, no factors significantly affected blood loss at dilation and aspiration of first trimester pregnancies. In those patients undergoing dilation and evacuation in the second trimester, both simple and stepwise regression analyses showed obesity (BMI >/=32.3) to be significantly associated with increased blood loss (P <.05). Neither age, parity, previous cesarean section, nor smoking history were significantly associated with increased blood loss at dilation and evacuation.Conclusions: With advancing gestational age, intraoperative blood loss increases in

  6. Intraoperative measurement of limb lengthening during total hip arthroplasty

    PubMed Central

    Papadopoulos, Dimitrios Vasileiou; Koulouvaris, Panagiotis; Aggelidakis, Georgios Charalambos; Tsantes, Andreas Georgios; Lykissas, Marios Georgios; Mavrodontidis, Alexandros

    2017-01-01

    Background: Limb length discrepancy (LLD) after total hip arthroplasty (THA) is a common problem which cannot be completely resolved. Many techniques have been described in order to minimize postoperative LLD, but most of these techniques are difficult to apply. Ideal technique must be simple and accurate. The most simple technique using a suture tied on the skin has well-known limitations, but its accuracy has not been evaluated before. Materials and Methods: Sixty THAs in sixty patients (mean age 71 years, 1:1 male to female ratio) with hip osteoarthritis (37 cases in the right, and 23 cases in the left side) were studied in this prospective study. In all surgeries, the intraoperataive measurement of limb lengthening was performed using a suture tied on the skin of the lateral pelvis. The accuracy of this technique and correlation between intraoperative and postoperative radiological measurements of lengthening were evaluated. Results: The mean preoperative LLD was –7.5 mm while the mean postoperative LLD was 1.58 mm. The accuracy of this technique, defined as the mean difference between the intraoperative and postoperative measurements was 1.8 mm. A strong correlation between these two measurements was noticed (r = 0.86). Conclusion: The accuracy and correlation index of this simple technique were similar to those of other techniques. The studied technique is quite accurate when attention is given to certain details, such as the amount of tension applied on the suture, the position of the tied point on the skin, and the position of the leg during measurements.

  7. 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.

  8. Intraoperative ultrasound control of surgical margins during partial nephrectomy

    PubMed Central

    Alharbi, Feras M.; Chahwan, Charles K.; Le Gal, Sophie G.; Guleryuz, Kerem M.; Tillou, Xavier P.; Doerfler, Arnaud P.

    2016-01-01

    Aims: To evaluate a simple and fast technique to ensure negative surgical margins on partial nephrectomies, while correlating margin statuses with the final pathology report. Subjects and Methods: This study was conducted for patients undergoing partial nephrectomy (PN) with T1–T2 renal tumors from January 2010 to the end of December 2015. Before tumor removal, intraoperative ultrasound (US) localization was performed. After tumor removal and before performing hemostasis of the kidney, the specimens were placed in a saline solution and a US was performed to evaluate if the tumor's capsule were intact, and then compared to the final pathology results. Results: In 177 PN(s) (147 open procedures and 30 laparoscopic procedures) were performed on 147 patients. Arterial clamping was done for 32 patients and the mean warm ischemia time was 19 ± 6 min. The mean US examination time was 41 ± 7 s. The US analysis of surgical margins was negative in 172 cases, positive in four, and in only one case it was not possible to conclude. The final pathology results revealed one false positive surgical margin and one false negative surgical margin, while all other margins were in concert with US results. The mean tumor size was 3.53 ± 1.43 cm, and the mean surgical margin was 2.8 ± 1.5 mm. Conclusions: The intraoperative US control of resection margins in PN is a simple, efficient, and effective method for ensuring negative surgical margins with a small increase in warm ischemia time and can be conducted by the operating urologist. PMID:28057986

  9. Intraoperative Imaging Guidance for Sentinel Node Biopsy in Melanoma Using a Mobile Gamma Camera

    SciTech Connect

    Dengel, Lynn T; Judy, Patricia G; Petroni, Gina R; Smolkin, Mark E; Rehm, Patrice K; Majewski, Stan; Williams, Mark B; Slingluff Jr., Craig L

    2011-04-01

    The objective is to evaluate the sensitivity and clinical utility of intraoperative mobile gamma camera (MGC) imaging in sentinel lymph node biopsy (SLNB) in melanoma. The false-negative rate for SLNB for melanoma is approximately 17%, for which failure to identify the sentinel lymph node (SLN) is a major cause. Intraoperative imaging may aid in detection of SLN near the primary site, in ambiguous locations, and after excision of each SLN. The present pilot study reports outcomes with a prototype MGC designed for rapid intraoperative image acquisition. We hypothesized that intraoperative use of the MGC would be feasible and that sensitivity would be at least 90%. From April to September 2008, 20 patients underwent Tc99 sulfur colloid lymphoscintigraphy, and SLNB was performed with use of a conventional fixed gamma camera (FGC), and gamma probe followed by intraoperative MGC imaging. Sensitivity was calculated for each detection method. Intraoperative logistical challenges were scored. Cases in which MGC provided clinical benefit were recorded. Sensitivity for detecting SLN basins was 97% for the FGC and 90% for the MGC. A total of 46 SLN were identified: 32 (70%) were identified as distinct hot spots by preoperative FGC imaging, 31 (67%) by preoperative MGC imaging, and 43 (93%) by MGC imaging pre- or intraoperatively. The gamma probe identified 44 (96%) independent of MGC imaging. The MGC provided defined clinical benefit as an addition to standard practice in 5 (25%) of 20 patients. Mean score for MGC logistic feasibility was 2 on a scale of 1-9 (1 = best). Intraoperative MGC imaging provides additional information when standard techniques fail or are ambiguous. Sensitivity is 90% and can be increased. This pilot study has identified ways to improve the usefulness of an MGC for intraoperative imaging, which holds promise for reducing false negatives of SLNB for melanoma.

  10. 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.

  11. Intraoperative methods to stage and localize pancreatic and duodenal tumors.

    PubMed

    Norton, J A

    1999-01-01

    Intraoperative methods to stage and localize tumors have dramatically improved. Advances include less invasive methods to obtain comparable results and precise localization of previously occult tumors. The use of new technology including laparoscopy and ultrasound has provided some of these advances, while improved operative techniques have provided others. Laparoscopy with ultrasound has allowed for improved staging of patients with pancreatic cancer and exclusion of patients who are not resectable for cure. We performed laparoscopy with ultrasound on 50 consecutive patients with adenocarcinoma of the pancreas or liver who appeared to have resectable tumors based on preoperative computed tomography. 22 patients (44%) were found to be unresectable because of tumor nodules on the liver and/or peritoneal surfaces or unsuspected distant nodal or liver metastases. The site of disease making the patient unresectable was confirmed by biopsy in each case. Of the 28 remaining patients in whom laparoscopic ultrasound predicted to be resectable for cure, 26 (93%) had all tumor removed. Thus laparoscopy with ultrasound was the best method to select patients for curative surgery. Intraoperative ultrasound (IOUS) has been a critical method to identify insulinomas that are not palpable. Nonpalpable tumors are most commonly in the pancreatic head. Because the pancreatic head is thick and insulinomas are small, of 9 pancreatic head insulinomas only 3 (33%) were palpable. However, IOUS precisely identified each (100%). Others have recommended blind distal pancreatectomy for individuals with insulinoma in whom no tumor can be identified. However, our data suggest that this procedure is contraindicated as these occult tumors are usually within the pancreatic head. Recent series suggest that previously missed gastrinomas are commonly in the duodenum. IOUS is not able to identify these tumors, but other methods can. Of 27 patients with 31 duodenal gastrinomas, palpation identified 19

  12. Intraoperative surgical photoacoustic microscopy (IS-PAM) using augmented reality

    NASA Astrophysics Data System (ADS)

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

    2014-03-01

    We have developed an intraoperative surgical photoacoustic microscopy (IS-PAM) system by integrating an optical resolution photoacoustic microscopy (OR-PAM) and conventional surgical microscope. Based on the common optical path in the OR-PAM and microscope system, we can acquire the PAM and microscope images at the same time. Furthermore, by utilizing a mini-sized beam projector, 2D PAM images are back-projected onto the microscope view plane as augmented reality. Thus, both the conventional microscopic and 2D cross-sectional PAM images are displayed on the plane through an eyepiece lens of the microscope. In our method, additional image display tool is not required to show the PAM image. Therefore, it potentially offers significant convenience to surgeons without movement of their sights during surgeries. In order to demonstrate the performance of our IS-PAM system, first, we successfully monitored needle intervention in phantoms. Moreover, we successfully guided needle insertion into mice skins in vivo by visualizing surrounding blood vessels from the PAM images and the magnified skin surfaces from the conventional microscopic images simultaneously.

  13. Intraoperative radiation therapy (IORT) in head and neck cancer

    PubMed Central

    Kyrgias, George; Hajiioannou, Jiannis; Tolia, Maria; Kouloulias, Vassilios; Lachanas, Vasileios; Skoulakis, Charalambos; Skarlatos, Ioannis; Rapidis, Alexandros; Bizakis, Ioannis

    2016-01-01

    Abstract Background: Multimodality therapy constitutes the standard treatment of advanced and recurrent head and neck cancer. Since locoregional recurrence comprises a major obstacle in attaining cure, the role of intraoperative radiation therapy (IORT) as an add-on in improving survival and local control of the disease has been investigated. IORT allows delivery of a single tumoricidal dose of radiation to areas of potential residual microscopic disease while minimizing doses to normal tissues. Advantages of IORT include the conformal delivery of a large dose of radiation in an exposed and precisely defined tumor bed, minimizing the risk of a geographic miss creating the potential for subsequent dose reduction of external beam radiation therapy (EBRT). This strategy allows for shortening overall treatment time and dose escalation. The aim of this review is to summarize recent published work on the use of IORT as an adjuvant modality to treat common head and neck cancer in the primary or recurrent setting. Methods: We searched the Medline, Scopus, Ovid, Cochrane, Embase, and ISI Web of Science databases for articles published from 1980 up to March 2016. Results: Based on relevant publications it appears that including IORT in the multimodal treatment may contribute to improved local control. However, the benefit in overall survival is not so clear. Conclusion: IORT seems to be a safe, promising adjunct in the management of head and neck cancer and yet further well organized clinical trials are required to determine its role more precisely. PMID:27977569

  14. Intraoperative visualization and assessment of electromagnetic tracking error

    NASA Astrophysics Data System (ADS)

    Harish, Vinyas; Ungi, Tamas; Lasso, Andras; MacDonald, Andrew; Nanji, Sulaiman; Fichtinger, Gabor

    2015-03-01

    Electromagnetic tracking allows for increased flexibility in designing image-guided interventions, however it is well understood that electromagnetic tracking is prone to error. Visualization and assessment of the tracking error should take place in the operating room with minimal interference with the clinical procedure. The goal was to achieve this ideal in an open-source software implementation in a plug and play manner, without requiring programming from the user. We use optical tracking as a ground truth. An electromagnetic sensor and optical markers are mounted onto a stylus device, pivot calibrated for both trackers. Electromagnetic tracking error is defined as difference of tool tip position between electromagnetic and optical readings. Multiple measurements are interpolated into the thin-plate B-spline transform visualized in real time using 3D Slicer. All tracked devices are used in a plug and play manner through the open-source SlicerIGT and PLUS extensions of the 3D Slicer platform. Tracking error was measured multiple times to assess reproducibility of the method, both with and without placing ferromagnetic objects in the workspace. Results from exhaustive grid sampling and freehand sampling were similar, indicating that a quick freehand sampling is sufficient to detect unexpected or excessive field distortion in the operating room. The software is available as a plug-in for the 3D Slicer platforms. Results demonstrate potential for visualizing electromagnetic tracking error in real time for intraoperative environments in feasibility clinical trials in image-guided interventions.

  15. 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.

  16. Echocardiographic detection and treatment of intraoperative air embolism.

    PubMed

    Sato, S; Toya, S; Ohira, T; Mine, T; Greig, N H

    1986-03-01

    A real-time two-dimensional echocardiogram was used to detect the presence of an air embolism in patients undergoing neurosurgical procedures in the sitting position. The technique could with good sensitivity detect the appearance of a single air bubble intraoperatively, thus allowing early intervention to prevent development of further air emboli. Two types of air embolism could be differentiated; the single-bubble type and the "stormy-bubble" type. The single-bubble type was observed during skin and muscle incisions, craniotomy, and brain lesion excision. Further embolism development was prevented by electrocoagulation and application of bone wax. The stormy-bubble type occurred during dura and muscle incisions and was prevented by electrocoagulation, reflection of the dura, or suturing the affected muscle. The routine use of a Swan-Ganz catheter for removal of air embolism by suction proved effective for the treatment of the stormy-bubble type of air embolism. Masking the operative field with saline-soaked cotton strips was of moderate benefit in the stabilization of the single-bubble type of air influx, but proved to be of little value in controlling the entrance of the stormy-bubble type.

  17. Intra-operative probe for brain cancer: feasibility study

    NASA Astrophysics Data System (ADS)

    Vu Thi, M. H.; Charon, Y.; Duval, M. A.; Lefebvre, F.; Menard, L.; Pitre, S.; Pinot, L.; Siebert, R.

    2007-07-01

    The present work aims a new medical probe for surgeons devoted to brain cancers, in particular glioblastoma multiforme. Within the last years, our group has started the development of a new intra-operative beta imaging probe. More recently, we took an alternative approach for the same application: a fluorescence probe. In both cases the purpose is to differentiate normal from tumor brain tissue. In a first step, we developed set-ups capable to measure autofluorescence. They are based on a dedicated epi-fluorescence design and on specific fiber optic probes. Relative signal amplitude, spectral shape and fluorescence lifetime measurements are foreseen to distinguish normal and cancer tissue by analyzing fluorophores like NADH, lipopigments and porphyrines. The autofluorescence spectra are recorded in the 460-640 nm range with a low resolution spectrometer. For lifetime measurements a fast detector (APD) is used together with a TCSPC-carte. Intrinsic wavelength- and time-resolutions are a few nm and 200 ps, respectively. Different samples have been analyzed to validate our new detection system and to allow a first configuration of our medical fluorescence probe. First results from the tissue measurements are shown.

  18. Intraoperative use of a tablet computer to aid rhinoplasty.

    PubMed

    Tsounis, M; Papadopoulou, D; Faris, C

    2017-01-01

    Open septorhinoplasty enables excellent exposure to the structural components of the nasal tip. Nevertheless, it runs the risk of weakening its support mechanisms, which can lead to notable changes to tip projection and rotation as well as to the nasolabial angle. It is therefore paramount that the surgeon reconstructs the nose to the desired endpoint at the end of the operation. Currently, the gold standard of care in rhinoplasty uses preoperative photographs with the patient sitting or standing. However, this is not a true representation of the face in the operative position as the patient is placed supine and so gravity affects the appearance of the nose in a different way. Other factors such as head drapes and traction on the endotracheal tube can also cause subtle changes. We therefore advocate additional intraoperative profile view photographs to improve the accuracy of nasal tip positioning. In our department, in addition to standard preoperative photographs, immediate preoperative profile photos are taken with the patient supine, intubated and draped. Images are captured using a tablet computer at a distance of 1 meter from the patient. We ensure that the Frankfort plane is perpendicular to the floor. The picture is enlarged so that the image is full scale and the tablet is subsequently placed immediately behind the patient for direct comparison. This is then used during the procedure to check tip projection and rotation as well as at the end of the procedure following closure of the columellar incision to ensure correct placement of the nasal tip.

  19. 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.

  20. 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.

  1. 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.

  2. Importance of a arteriography for intraoperative quality control during carotid artery surgery.

    PubMed

    Sala, Florent; Hassen-Khodja, Reda; Bouillanne, Pierre Jean; Hussein, Hassan; Semlali, Chakir; Planchard, Pierre; Declemy, Serge; Batt, Michel

    2002-11-01

    The purpose of this study was to determine the impact of intraoperative quality control using arteriography on the conduct and immediate outcome of carotid artery surgery. This retrospective study included 623 carotid artery repair procedures performed between January 1993 and January 2000. There were 427 men and 159 women (37 bilateral procedures) with a mean age of 71.6 years. The repair technique consisted of conventional endarterectomy alone in 353 cases, conventional endarterectomy with patch closure in 95 cases, eversion in 44 cases, and vein (n = 105) or prosthetic (n = 26) grafting in 131 cases. Findings of intraoperative arteriography, which is used routinely in our department, were reviewed and analyzed in all cases. Our findings indicate that intraoperative quality control with arteriography is an important part of carotid artery surgery. In 11.7% of cases in this study, intraoperative arteriography revealed significant defects that are the main cause of postoperative neurological complications.

  3. Intraoperative squash cytology and histology of giant cell ependymoma: A diagnostic dilemma

    PubMed Central

    Cakir, Ebru; Kucuk, Ulku; Ersen, Ayca; Pala, Emel E; Senoglu, Mehmet; Binatli, Ali O; Yildirim, Zubeyde

    2017-01-01

    Giant cell ependymomas (GCE) are extremely rare tumors, with 24 cases described in the literature. Squash cytology is a rapid, reliable, simple technique for intraoperative consultation in neurosurgical practice. We describe a rare case of GCE arising at level of L4-L5 in a 66-year-old woman and discuss the cytologic/histologic features. Intraoperative smears were highly cellular with a prominent fibrillary background and exhibited papillary structures and sheets composed of highly atypical and bizarre cells. Some of the cells showed nuclear pseudoinclusions and rarely formed pseudorosette-like arrays. Intraoperative diagnosis was high grade glial tumor. On paraffin sections, besides extensive polymorphism, there were no microvascular proliferation, necrosis, and mitosis and the final diagnosis was WHO grade II GCE. GCE may be a diagnostic challenge on intraoperative smears, frozen, and paraffin sections. It must be kept in mind in the differential diagnosis of giant cell exhibiting benign and malignant tumors of brain. PMID:28182061

  4. Repeated sugammadex reversal of muscle relaxation during lumbar spine surgery with intraoperative neurophysiological multimodal monitoring.

    PubMed

    Errando, C L; Blanco, T; Díaz-Cambronero, Ó

    2016-11-01

    Intraoperative neurophysiological monitoring during spine surgery is usually acomplished avoiding muscle relaxants. A case of intraoperative sugammadex partial reversal of the neuromuscular blockade allowing adequate monitoring during spine surgery is presented. A 38 year-old man was scheduled for discectomy and vertebral arthrodesis throughout anterior and posterior approaches. Anesthesia consisted of total intravenous anesthesia plus rocuronium. Intraoperatively monitoring was needed, and the muscle relaxant reverted twice with low dose sugammadex in order to obtain adequate responses. The doses of sugammadex used were conservatively selected (0.1mg/kg boluses increases, total dose needed 0.4mg/kg). Both motor evoqued potentials, and electromyographic responses were deemed adequate by the neurophysiologist. If muscle relaxation was needed in the context described, this approach could be useful to prevent neurological sequelae. This is the first study using very low dose sugammadex to reverse rocuronium intraoperatively and to re-establish the neuromuscular blockade.

  5. Threshold dose for peripheral neuropathy following intraoperative radiotherapy (IORT) in a large animal model

    SciTech Connect

    Kinsella, T.J.; DeLuca, A.M.; Barnes, M.; Anderson, W.; Terrill, R.; Sindelar, W.F. )

    1991-04-01

    Radiation injury to peripheral nerve is a dose-limiting toxicity in the clinical application of intraoperative radiotherapy, particularly for pelvic and retroperitoneal tumors. Intraoperative radiotherapy-related peripheral neuropathy in humans receiving doses of 20-25 Gy is manifested as a mixed motor-sensory deficit beginning 6-9 months following treatment. In a previous experimental study of intraoperative radiotherapy-related neuropathy of the lumbro-sacral plexus, an approximate inverse linear relationship was reported between the intraoperative dose (20-75 Gy range) and the time to onset of hind limb paresis (1-12 mos following intraoperative radiotherapy). The principal histological lesion in irradiated nerve was loss of large nerve fibers and perineural fibrosis without significant vascular injury. Similar histological changes in irradiated nerves were found in humans. To assess peripheral nerve injury to lower doses of intraoperative radiotherapy in this same large animal model, groups of four adult American Foxhounds received doses of 10, 15, or 20 Gy to the right lumbro-sacral plexus and sciatic nerve using 9 MeV electrons. The left lumbro-sacral plexus and sciatic nerve were excluded from the intraoperative field to allow each animal to serve as its own control. Following treatment, a complete neurological exam, electromyogram, and nerve conduction studies were performed monthly for 1 year. Monthly neurological exams were performed in years 2 and 3 whereas electromyogram and nerve conduction studies were performed every 3 months during this follow-up period. With follow-up of greater than or equal to 42 months, no dog receiving 10 or 15 Gy IORT shows any clinical or laboratory evidence of peripheral nerve injury. However, all four dogs receiving 20 Gy developed right hind limb paresis at 8, 9, 9, and 12 mos following intraoperative radiotherapy.

  6. Transumbilical approach to intraoperative enteroscopy in a child with intussusception and Peutz-Jeghers syndrome.

    PubMed

    Chui, Chan Hon; Jacobsen, Anette Sundfor

    2006-10-01

    Intraoperative enteroscopy has been known to reduce reoperation rates in complicated Peutz- Jeghers polyposis. It is usually performed during a laparotomy. This case report illustrates the feasibility of performing intraoperative transenterotomy enteroscopy together with extracorporeal ileal resection using the transumbilical approach after successfully reducing an intussusception laparoscopically in a 10-year-old child with Peutz-Jeghers syndrome. This technique obviates the need for a laparotomy.

  7. Intraoperative magnetic resonance imaging during surgery for pituitary adenomas: pros and cons.

    PubMed

    Buchfelder, Michael; Schlaffer, Sven-Martin

    2012-12-01

    Surgery for pituitary adenomas still remains a mainstay in their treatment, despite all advances in sophisticated medical treatments and radiotherapy. Total tumor excision is often attempted, but there are limitations in the intraoperative assessment of the radicalism of tumor resection by the neurosurgeon. Standard postoperative imaging is usually performed with a few months delay from the surgical intervention. The purpose of this report is to review briefly the facilities and kinds of intraoperative magnetic resonance imaging for all physician and surgeons involved in the management of pituitary adenomas on the basis of current literature. To date, there are several low- and high-field magnetic resonance imaging systems available for intraoperative use and depiction of the extent of tumor removal during surgery. Recovery of vision and the morphological result of surgery can be largely predicted from the intraoperative images. A variety of studies document that depiction of residual tumor allows targeted attack of the remnant and extent the resection. Intraoperative magnetic resonance imaging offers an immediate feedback to the surgeon and is a perfect quality control for pituitary surgery. It is also used as a basis of datasets for intraoperative navigation which is particularly useful in any kind of anatomical variations and repeat operations in which primary surgery has distorted the normal anatomy. However, setting up the technology is expensive and some systems even require extensive remodeling of the operation theatre. Intraoperative imaging prolongs the operation, but may also depict evolving problems, such as hematomas in the tumor cavity. There are several artifacts in intraoperative MR images possible that must be considered. The procedures are not associated with an increased complication rate.

  8. 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

  9. Intraoperative Mapping of Expressive Language Cortex Using Passive Real-Time Electrocorticography

    DTIC Science & Technology

    2016-08-26

    Epilepsy & Behavior Case Reports 5 (2016) 46–51 Contents lists available at ScienceDirect Epilepsy & Behavior Case Reports j ourna l homepage: www.e...lsev ie r .com/ locate /ebcrCase ReportIntraoperative mapping of expressive language cortex using passive real-time electrocorticographyAmiLyn M...case report, we investigated the utility and practicality of passive intraoperative functional mapping of expressive language cortex using high

  10. Method for quantitative validation of image-based correction for intraoperative brain shift

    NASA Astrophysics Data System (ADS)

    Bates, Lisa M.; Goerss, Stephan J.; Robb, Richard A.

    2000-04-01

    Stereotactic neuronavigational systems use pre-operatively acquired 3D images for procedural planning and also are employed in intraoperative navigations to help localize and resect brain lesions. Intraoperatively, multiple factors contribute to anatomic changes that limit the accuracy of navigation based solely on pre-operative images. Loss of CSF, cortical swelling, and the effect of gravity relative to the craniotomy locations are some of the factors that contribute to errors in navigation.

  11. Custom-made, 3D, intraoperative surgical guides for nasal reconstruction.

    PubMed

    Sultan, Babar; Byrne, Patrick J

    2011-11-01

    This article presents the use of an intraoperative surgical guide created by 3D laser surface scanning and rapid prototyping. The authors present outcomes of 3 patients in whom the nasal surgical guide was used intraoperatively for reconstruction of full-thickness, complex nasal defects. This effort highlights the multidisciplinary approach involving a surgeon and anaplastologist integrated with the latest technology to provide patients with the best possible outcomes.

  12. Intraoperative Clinical Decision Support for Anesthesia: A Narrative Review of Available Systems.

    PubMed

    Nair, Bala G; Gabel, Eilon; Hofer, Ira; Schwid, Howard A; Cannesson, Maxime

    2017-02-01

    With increasing adoption of anesthesia information management systems (AIMS), there is growing interest in utilizing AIMS data for intraoperative clinical decision support (CDS). CDS for anesthesia has the potential for improving quality of care, patient safety, billing, and compliance. Intraoperative CDS can range from passive and post hoc systems to active real-time systems that can detect ongoing clinical issues and deviations from best practice care. Real-time CDS holds the most promise because real-time alerts and guidance can drive provider behavior toward evidence-based standardized care during the ongoing case. In this review, we describe the different types of intraoperative CDS systems with specific emphasis on real-time systems. The technical considerations in developing and implementing real-time CDS are systematically covered. This includes the functional modules of a CDS system, development and execution of decision rules, and modalities to alert anesthesia providers concerning clinical issues. We also describe the regulatory aspects that affect development, implementation, and use of intraoperative CDS. Methods and measures to assess the effectiveness of intraoperative CDS are discussed. Last, we outline areas of future development of intraoperative CDS, particularly the possibility of providing predictive and prescriptive decision support.

  13. Utility of Intraoperative Neuromonitoring during Minimally Invasive Fusion of the Sacroiliac Joint.

    PubMed

    Woods, Michael; Birkholz, Denise; MacBarb, Regina; Capobianco, Robyn; Woods, Adam

    2014-01-01

    Study Design. Retrospective case series. Objective. To document the clinical utility of intraoperative neuromonitoring during minimally invasive surgical sacroiliac joint fusion for patients diagnosed with sacroiliac joint dysfunction (as a direct result of sacroiliac joint disruptions or degenerative sacroiliitis) and determine stimulated electromyography thresholds reflective of favorable implant position. Summary of Background Data. Intraoperative neuromonitoring is a well-accepted adjunct to minimally invasive pedicle screw placement. The utility of intraoperative neuromonitoring during minimally invasive surgical sacroiliac joint fusion using a series of triangular, titanium porous plasma coated implants has not been evaluated. Methods. A medical chart review of consecutive patients treated with minimally invasive surgical sacroiliac joint fusion was undertaken at a single center. Baseline patient demographics and medical history, intraoperative electromyography thresholds, and perioperative adverse events were collected after obtaining IRB approval. Results. 111 implants were placed in 37 patients. Sensitivity of EMG was 80% and specificity was 97%. Intraoperative neuromonitoring potentially avoided neurologic sequelae as a result of improper positioning in 7% of implants. Conclusions. The results of this study suggest that intraoperative neuromonitoring may be a useful adjunct to minimally invasive surgical sacroiliac joint fusion in avoiding nerve injury during implant placement.

  14. Utility of Intraoperative Neuromonitoring during Minimally Invasive Fusion of the Sacroiliac Joint

    PubMed Central

    Woods, Michael; Birkholz, Denise; MacBarb, Regina; Capobianco, Robyn; Woods, Adam

    2014-01-01

    Study Design. Retrospective case series. Objective. To document the clinical utility of intraoperative neuromonitoring during minimally invasive surgical sacroiliac joint fusion for patients diagnosed with sacroiliac joint dysfunction (as a direct result of sacroiliac joint disruptions or degenerative sacroiliitis) and determine stimulated electromyography thresholds reflective of favorable implant position. Summary of Background Data. Intraoperative neuromonitoring is a well-accepted adjunct to minimally invasive pedicle screw placement. The utility of intraoperative neuromonitoring during minimally invasive surgical sacroiliac joint fusion using a series of triangular, titanium porous plasma coated implants has not been evaluated. Methods. A medical chart review of consecutive patients treated with minimally invasive surgical sacroiliac joint fusion was undertaken at a single center. Baseline patient demographics and medical history, intraoperative electromyography thresholds, and perioperative adverse events were collected after obtaining IRB approval. Results. 111 implants were placed in 37 patients. Sensitivity of EMG was 80% and specificity was 97%. Intraoperative neuromonitoring potentially avoided neurologic sequelae as a result of improper positioning in 7% of implants. Conclusions. The results of this study suggest that intraoperative neuromonitoring may be a useful adjunct to minimally invasive surgical sacroiliac joint fusion in avoiding nerve injury during implant placement. PMID:25544898

  15. Fully automatic segmentation of the mitral leaflets in 3D transesophageal echocardiographic images using multi-atlas joint label fusion and deformable medial modeling.

    PubMed

    Pouch, A M; Wang, H; Takabe, M; Jackson, B M; Gorman, J H; Gorman, R C; Yushkevich, P A; Sehgal, C M

    2014-01-01

    Comprehensive visual and quantitative analysis of in vivo human mitral valve morphology is central to the diagnosis and surgical treatment of mitral valve disease. Real-time 3D transesophageal echocardiography (3D TEE) is a practical, highly informative imaging modality for examining the mitral valve in a clinical setting. To facilitate visual and quantitative 3D TEE image analysis, we describe a fully automated method for segmenting the mitral leaflets in 3D TEE image data. The algorithm integrates complementary probabilistic segmentation and shape modeling techniques (multi-atlas joint label fusion and deformable modeling with continuous medial representation) to automatically generate 3D geometric models of the mitral leaflets from 3D TEE image data. These models are unique in that they establish a shape-based coordinate system on the valves of different subjects and represent the leaflets volumetrically, as structures with locally varying thickness. In this work, expert image analysis is the gold standard for evaluating automatic segmentation. Without any user interaction, we demonstrate that the automatic segmentation method accurately captures patient-specific leaflet geometry at both systole and diastole in 3D TEE data acquired from a mixed population of subjects with normal valve morphology and mitral valve disease.

  16. Effect of acute pericardial tamponade on the relative contributions of systolic and diastolic pulmonary venous return: a transesophageal pulsed Doppler study.

    PubMed

    Louie, E K; Hariman, R J; Wang, Y; Hwang, M H; Loeb, H S; Scanlon, P J

    1995-01-01

    The effect of acute pericardial tamponade on pulmonary venous return was assessed by transesophageal pulsed Doppler echocardiography. In 14 open-chest anesthetized dogs peak pulmonary venous flow velocities in systole (VJ) and in diastole (VK) were measured during apnea and atrial pacing while acute tamponade was induced by intrapericardial instillation of 0.9% sodium chloride solution. Before intravascular volume expansion, induction of acute tamponade resulted in a significant decline in VK (43 +/- 17 to 19 +/- 8 cm/sec; p < 0.05) but no change in VJ or the ratio VJ/VK. After intravascular volume expansion, induction of acute tamponade resulted in significant reductions in VJ (43 +/- 9 to 29 +/- 10 cm/sec; p < 0.001) and VK (37 +/- 19 to 15 +/- 11 cm/sec; p < 0.001). The effect was disproportionately greater on VK, however, resulting in a significant increase in VJ/VK (1.51 +/- 0.84 to 2.58 +/- 1.41; p < 0.001). The disproportionate effect of acute tamponade on VK suggests that increased pericardial pressure directly constrains diastolic filling of the left atrium as a conduit to the left ventricle and that it does not decrease the systolic and diastolic phases of pulmonary venous return uniformly. Intravascular volume expansion increases cardiac output before acute tamponade, but during acute tamponade it amplifies the disproportionate impact of increased pericardial pressure on left ventricular diastolic filling as the left ventricle is constrained within the fluid-filled pericardial sac.

  17. Guidelines of the Indian Association of Cardiovascular and Thoracic Anaesthesiologists and Indian College of Cardiac Anaesthesia for perioperative transesophageal echocardiography fellowship examination.

    PubMed

    Muralidhar, Kanchi; Tempe, Deepak; Mehta, Yatin; Kapoor, Poonam Malhotra; Mukherjee, Chirojit; Koshy, Thomas; Tewari, Prabhat; Shastri, Naman; Misra, Satyajeet; Belani, Kumar

    2016-10-01

    During current medical care, perioperative transesophageal echocardiography (TEE) has become a vital component of patient management, especially in cardiac operating rooms and in critical care medicine. Information derived from echocardiography has an important bearing on the patient's outcome. The Indian Association of Cardiovascular and Thoracic Anaesthesiologists (IACTA) has promoted the use of TEE during routine clinical care of patients undergoing cardiac surgery. An important mission of IACTA is to oversee training and certify anesthesiologists in the perioperative and intensive care use of TEE. The provision of "Fellowship" is by way of conducting IACTA - TEE fellowship (F-TEE) examination. This has been done annually for the past 7 years using well-established curriculums by accredited national and international societies. Now, with the transformation and reconstitution of IACTA education and research cell into the newly formed Indian College of Cardiac Anaesthesia, F-TEE is bound to meet international standards. To ensure that the examinations are conducted in a transparent and foolproof manner, the guideline committee (formulated in 2010) of IACTA has taken the onus of formulating the guidelines for the same. These guidelines have been formally reviewed and updated since 2010 and are detailed here to serve as a guide to both the examinee and examiner ensuring standardization, efficiency, and competency of the IACTA F-TEE certification process.

  18. Intraoperative hemodialysis during liver transplantation: a decade of experience.

    PubMed

    Nadim, Mitra K; Annanthapanyasut, Wanwarat; Matsuoka, Lea; Appachu, Kari; Boyajian, Mark; Ji, Lingyun; Sedra, Ashraf; Genyk, Yuri S

    2014-07-01

    Liver transplantation (LT) for patients with renal dysfunction is frequently complicated by major fluid shifts, acidosis, and electrolyte and coagulation abnormalities. Continuous renal replacement therapy (CRRT) has been previously shown to ameliorate these problems. We describe the safety and clinical outcomes of intraoperative hemodialysis (IOHD) during LT for a group of patients with high Model for End-Stage Liver Disease (MELD) scores. We performed a retrospective study at our institution of patients who underwent IOHD from 2002 to 2012. Seven hundred thirty-seven patients underwent transplantation, and 32% received IOHD. The mean calculated MELD score was 37, with 38% having a MELD score ≥ 40. Preoperatively, 61% were in the intensive care unit, 19% were mechanically ventilated, 43% required vasopressor support, and 80% were on some form of renal replacement therapy at the time of transplantation, the majority being on CRRT. Patients on average received 35 U of blood products and 4.8 L of crystalloids without significant changes in hemodynamics or electrolytes. The average urine output was 450 ml, and the average amount of fluid removal with dialysis was 1.8 L. The 90-day patient and dialysis-free survival rates were 90% and 99%, respectively. One-year patient survival rates based on the pretransplant renal replacement status and the MELD status were not statistically different. This is the first large study to demonstrate the safety and feasibility of IOHD in a cohort of critically ill patients with high MELD scores undergoing LT with good patient and renal outcomes.

  19. 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.

  20. Intraoperative bleeding control by uniportal video-assisted thoracoscopic surgery†.

    PubMed

    Gonzalez-Rivas, Diego; Stupnik, Tomaz; Fernandez, Ricardo; de la Torre, Mercedes; Velasco, Carlos; Yang, Yang; Lee, Wentao; Jiang, Gening

    2016-01-01

    Owing to advances in video-assisted thoracic surgery (VATS), the majority of pulmonary resections can currently be performed by VATS in a safe manner with a low level of morbidity and mortality. The majority of the complications that occur during VATS can be minimized with correct preoperative planning of the case as well as careful pulmonary dissection. Coordination of the whole surgical team is essential when confronting an emergency such as major bleeding. This is particularly important during the VATS learning curve, where the occurrence of intraoperative complications, particularly significant bleeding, usually ends in a conversion to open surgery. However, conversion should not be considered as a failure of the VATS approach, but as a resource to maintain the patient's safety. The correct assessment of any bleeding is of paramount importance during major thoracoscopic procedures. Inadequate management of the source of bleeding may result in major vessel injury and massive bleeding. If bleeding occurs, a sponge stick should be readily available to apply pressure immediately to control the haemorrhage. It is always important to remain calm and not to panic. With the bleeding temporarily controlled, a decision must be made promptly as to whether a thoracotomy is needed or if the bleeding can be solved through the VATS approach. This will depend primarily on the surgeon's experience. The operative vision provided with high-definition cameras, specially designed or adapted instruments and the new sealants are factors that facilitate the surgeon's control. After experience has been acquired with conventional or uniportal VATS, the rate of complications diminishes and the majority of bleeding events are controlled without the need for conversion to thoracotomy.

  1. Intra-Operative Vertebroplasty Combined with Posterior Cord Decompression

    PubMed Central

    Allegretti, Luca; Mavilio, Nicola; Fiaschi, Pietro; Bragazzi, Roberto; Pacetti, Mattia; Castelletti, Lara; Saitta, Laura; Castellan, Lucio

    2014-01-01

    Summary Percutaneous vertebroplasty (VP) is a minimally invasive technique for the treatment of vertebral pathology providing early vertebral stabilization and pain relief. In cases of vertebral pathology complicated by spinal cord compression with associated neurological deficits, VP alone cannot be performed free of risks. We describe a combined approach in which decompressive laminectomy and intra-operative vertebroplasty (IVP) are performed during a single session. Among the 252 VP performed in our centre in the past three years, 12 patients (12 vertebral levels) with different pathologies (six symptomatic haemangiomas, two metastatic fractures, four osteoporotic fractures) were treated with an open procedure combined with surgery. All cases were treated with decompressive laminectomy and IVP (mono/bipeduncular or median-posterior trans-somatic access). Five patients with symptomatic haemangiomas were treated with endovascular embolization prior to the combined approach. A visual analogue scale (VAS) was applied to assess pain intensity before and after surgery. The neurological deficits were evaluated with an ASIA impairment scale. In all cases benefit from pain and neurological deficits was observed. The mean VAS score decreased from 7.8 to 2.5 after surgery. The ASIA score improved in all cases (five cases from D to E and five cases from C to D). No clinical complications were observed. In one case a CT scan performed after the procedure showed a foraminal accumulation of PMMA, but the patient referred no symptoms. IVP can be successfully applied in different pathologies affecting the vertebrae. In our limited series this approach proved safe and efficient to provide decompression of spinal cord and dural sac and vertebral body stabilization in a single session. PMID:25363261

  2. Radical Pleurectomy and Intraoperative Photodynamic Therapy for Malignant Pleural Mesothelioma

    PubMed Central

    Friedberg, Joseph S.; Culligan, Melissa J.; Mick, Rosemarie; Stevenson, James; Hahn, Stephen M.; Sterman, Daniel; Punekar, Salman; Glatstein, Eli; Cengel, Keith

    2015-01-01

    Background Radical pleurectomy (RP) for mesothelioma is often considered either technically infeasible or an operation limited to patients who would not tolerate a pneumonectomy. The purpose of this study was to review our experience using RP and intraoperative photodynamic therapy (PDT) for mesothelioma. Methods 38 patients (42–81 years) underwent RP-PDT. 35/38 (92%) patients also received systemic therapy. Standard statistical techniques were employed for analysis. Results 37/38 (97%) patients had Stage III/IV (AJCC) cancer and 7/38 (18%) patients had nonepithelial subtypes. Macroscopic complete resection was achieved in 37/38 (97%) patients. There was one postoperative mortality (stroke). At a median follow-up of 34.4 months, the median survival was 31.7 months for all 38 patients, 41.2 months for the 31/38 (82%) epithelial patients and 6.8 months for the 7/38 (18%) nonepithelial patients. The median progression free survivals were 9.6, 15.1 and 4.8 months, respectively. The median and progression free survivals for the 20/31 (64%) epithelial patients with N2 disease were 31.7 and 15.1 months, respectively. Conclusions It was possible to achieve a macroscopic complete resection utilizing lung-sparing surgery in 97% of these stage III/IV patients. The survival we observed with this approach was unusually long for the epithelial subtype patients but, interestingly, the progression free survival was not. The reason for this prolonged survival in spite of recurrence is not clear, but is potentially related to preservation of the lung and/or some PDT-induced effect. We conclude that the results of this lung-sparing approach are safe, encouraging and warrant further investigation. PMID:22541196

  3. 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

  4. 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.

  5. Intraoperative electron beam irradiation for patients with unresectable pancreatic carcinoma

    SciTech Connect

    Shipley, W.U.; Wood, W.C.; Tepper, J.E.; Warshaw, A.L.; Orlow, E.L.; Kaufman, S.D.; Battit, G.E.; Nardi, G.L.

    1984-09-01

    Since 1978 we have used electron beam intraoperative radiation therapy (IORT) to deliver higher radiation doses to pancreatic tumors than are possible with external beam techniques while minimizing the dose to the surrounding normal tissues. Twenty-nine patients with localized, unresectable, pancreatic carcinoma were treated by electron beam IORT in combination with conventional external radiation therapy (XRT). The primary tumor was located in the head of the pancreas in 20 patients, in the head and body in six patients, and in the body and tail in three. Adjuvant chemotherapy was given in 23 of the 29 patients. The last 13 patients have received misonidazole (3.5 mg/M2) just prior to IORT (20 Gy). At present 14 patients are alive and 11 are without evidence of disease from 3 to 41 months after IORT. The median survival is 16.5 months. Eight patients have failed locally in the IORT field and two others failed regionally. Twelve patients have developed distant metastases, including five who failed locally or regionally. We have seen no local recurrences in the 12 patients who have been treated with misonidazole and have completed IORT and XRT while 10 of 15 patients treated without misonidazole have recurred locally. Because of the shorter follow-up in the misonidazole group, this apparent improvement is not statistically significant. Fifteen patients (52%) have not had pain following treatment and 22 (76%) have had no upper gastrointestinal or biliary obstruction subsequent to their initial surgical bypasses and radiation treatments. Based on the good palliation generally obtained, the 16.5-month median survival, and the possible added benefit from misonidazole, we are encouraged to continue this approach.

  6. 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.

  7. 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.

  8. 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.

  9. 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

  10. Preoperative characteristics predicting intraoperative hypotension and hypertension among hypertensives and diabetics undergoing noncardiac surgery.

    PubMed Central

    Charlson, M E; MacKenzie, C R; Gold, J P; Ales, K L; Topkins, M; Shires, G T

    1990-01-01

    We prospectively studied patients with hypertension and diabetes undergoing elective noncardiac surgery with general anesthesia to test the hypothesis that patients at high risk for prognostically significant intraoperative hemodynamic instability could be identified by their preoperative characteristics. Specifically we hypothesized that patients with a low functional capacity, decreased plasma volume, or significant cardiac comorbidity would be at high risk for intraoperative hypotension and those with a history of severe hypertension would be at risk for intraoperative hypertension. Patients who had a preoperative mean arterial pressure (MAP) greater than or equal to 110, a walking distance of less than 400 m, or a plasma volume less than 3000 cc were at increased risk of intraoperative hypotension (i.e., more than 1 hour of greater than or equal to 20 mmHg decreases in the MAP). Hypotension was also more common among patients having intra-abdominal or vascular surgery, and among those who had operations longer than 2 hours. Patients older than 70 years or with a decreased plasma volume were at increased risk of having more than 15 minutes of intraoperative elevations of greater than or equal to 20 mmHg over the preoperative MAP in combination with intraoperative hypotension; this was also more common when surgery lasted more than 2 hours. Patients who had intraoperative hypotension tended to have an immediate decrease in MAP at the onset of anesthesia and were often purposefully maintained at MAPs less than their usual level during surgery with fentanyl and neuromuscular blocking agents. Patients who had intraoperative hyper/hypotension tended to have repeated elevations in MAP above their preoperative levels during the course of surgery, and such elevations precipitated interventions with neuromuscular blocking agents and/or fentanyl. Neither pattern was more common among patients who developed net intraoperative negative fluid balances. Both hypotension and

  11. 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.

  12. 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

  13. Variability of intraoperative electrostimulation parameters in conscious individuals: language cortex.

    PubMed

    Roux, Franck-Emmanuel; Durand, Jean-Baptiste; Djidjeli, Imène; Moyse, Emmanuel; Giussani, Carlo

    2016-07-15

    OBJECTIVE Electrostimulation in awake brain mapping is widely used to guide tumor removal, but methodologies can differ substantially across institutions. The authors studied electrostimulation brain mapping data to characterize the variability of the current intensity threshold across patients and the effect of its variations on the number, type, and surface area of the essential language areas detected. METHODS Over 7 years, the authors prospectively studied 100 adult patients who were undergoing intraoperative brain mapping during resection of left hemisphere tumors. In all 100 cases, the same protocol of electrostimulation brain mapping (a controlled naming task-bipolar stimulation with biphasic square wave pulses of 1-msec duration and 60-Hz trains, maximum train duration 6 sec) and electrocorticography was used to detect essential language areas. RESULTS The minimum positive thresholds of stimulation varied from patient to patient; the mean minimum intensity required to detect interference was 4.46 mA (range 1.5-9 mA), and in a substantial proportion of sites (13.5%) interference was detected only at intensities above 6 mA. The threshold varied within a given patient for different naming areas in 22% of cases. Stimulation of the same naming area with greater intensities led to slight changes in the type of response in 19% of cases and different types of responses in 4.5%. Naming sites detected were located in subcentimeter cortical areas (50% were less than 20 mm(2)), but their extent varied with the intensity of stimulation. During a brain mapping session, the same intensity of stimulation reproduced the same type of interference in 94% of the cases. There was no statistically significant difference between the mean stimulation intensities required to produce interfereince in the left inferior frontal lobe (Broca's area), the supramarginal gyri, and the posterior temporal region. CONCLUSIONS Intrasubject and intersubject variations of the minimum thresholds

  14. Electrical Noise in the Intraoperative Magnetic Resonance Imaging Setting

    PubMed Central

    Dzwonczyk, Roger; Fujii, Jeffrey T; Simonetti, Orlando; Nieves-Ramos, Ricardo; Bergese, Sergio D

    2013-01-01

    Background Intraoperative magnetic resonance imaging (iMRI) is a tool now commonly used in neurosurgery. Safe and reliable patient care in this (or any other) operating room setting depends on an environment where electrical noise (EN) does not interfere with the operation of the electronic monitoring or imaging equipment. In this investigation, we evaluated the EN generated by the iMRI system and the anesthesia patient monitor used at this institution that impacts the performance of these 2 devices. Methods We measured the EN generated by our iMRI-compatible anesthesia patient monitor as detected by the EN analysis algorithm in our iMRI system. We measured the EN generated by our iMRI system during scanning as detected in the electrocardiogram (ECG) waveform of our patient monitor. We analyzed the effects on EN reduction and signal quality of the ECG noise filters provided in our iMRI-compatible anesthesia patient monitor. Results Our patient monitor generated EN that was detectable by the iMRI EN analysis algorithm; however, this interference was within the iMRI manufacturer’s acceptable limits for an iMRI scan (<10% more than background system level noise). In the clinical case analyzed, the iMRI generated a narrow-band low-frequency (20Hz) relatively high-energy EN that interfered with the ECG signal of our patient monitor during an iMRI scan. This EN was correlated with the acoustic noise from the iMRI system during the scan and was associated with the radio frequency and magnetic gradient pulsations of the iMRI system. The integrity of the ECG waveform was nearly entirely lost during a scan. The filters of the ECG monitor diminished but did not entirely eliminate this 20Hz interference. We found that the filters alter the morphology of the ECG signal, which may make it difficult to identify clinically relevant ECG changes. Conclusion The EN generated by our anesthesia patient monitor is within acceptable limits for the iMRI system. The iMRI generates EN

  15. Bone necrosis and tumor induction following experimental intraoperative irradiation.

    PubMed

    Powers, B E; Gillette, E L; McChesney, S L; LeCouteur, R A; Withrow, S J

    1989-09-01

    The bone of the lumbar vertebrae of 153 dogs was examined 2 and 5 years after intraoperative irradiation (IORT), fractionated external beam irradiation (EBRT), or the combination. Groups of dogs received 15 to 55 Gy IORT only, 10 to 47.5 Gy IORT combined with 50 Gy EBRT in 2 Gy fractions or 60 to 80 Gy EBRT in 30 fractions. Six MeV electrons were used for IORT, and EBRT was done using photons from a 6 MV linear accelerator. The paraaortic region was irradiated and the ventral part of the lumbar vertebrae was in the 90% isodose level. Two years after irradiation, the dose causing significant bone necrosis as determined by at least 50% empty lacunae in the vertebral cortex was 38.2 Gy IORT alone and 32.5 Gy IORT combined with EBRT. Five years after irradiation, the dose causing 50% empty lacunae was 28.5 Gy IORT only and 14.4 Gy IORT combined with EBRT. The ED50 for lesions of the ventral vertebral artery was 21.7 Gy IORT only and 20.1 Gy IORT combined with 50 Gy EBRT 2 years after irradiation and 27.0 Gy IORT only and 20.0 Gy IORT combined with 50 Gy EBRT 5 years after irradiation. All lesions after EBRT only were mild. Eight dogs developed osteosarcomas 4 to 5 years after irradiation, one at 47.5 Gy IORT only and the remainder at 25.0 Gy IORT and above combined with 50 Gy EBRT. In conclusion, the extent of empty lacunae, indicating bone necrosis, was more severe 5 years after irradiation than after 2 years. The effect of 50 Gy EBRT in 2 Gy fractions was equivalent to about 6 Gy IORT 2 years after irradiation and to about 14 Gy 5 years after irradiation. Based on these estimates, IORT doses of 10 to 15 Gy have an effect 5 times or greater than the amount given in 2 Gy fractions. Osteosarcomas occurred in 21% of dogs which received doses greater than 25 Gy IORT. Doses of 15 to 20 Gy IORT in combination with 50 Gy EBRT in 2 Gy fractions may be near the tolerance level for late developing bone injury.

  16. Relation between Birth Weight and Intraoperative Hemorrhage during Cesarean Section in Pregnancy with Placenta Previa

    PubMed Central

    Ishibashi, Hiroki; Takano, Masashi; Sasa, Hidenori; Furuya, Kenichi

    2016-01-01

    Background Placenta previa, one of the most severe obstetric complications, carries an increased risk of intraoperative massive hemorrhage. Several risk factors for intraoperative hemorrhage have been identified to date. However, the correlation between birth weight and intraoperative hemorrhage has not been investigated. Here we estimate the correlation between birth weight and the occurrence of intraoperative massive hemorrhage in placenta previa. Materials and Methods We included all 256 singleton pregnancies delivered via cesarean section at our hospital because of placenta previa between 2003 and 2015. We calculated not only measured birth weights but also standard deviation values according to the Japanese standard growth curve to adjust for differences in gestational age. We assessed the correlation between birth weight and the occurrence of intraoperative massive hemorrhage (>1500 mL blood loss). Receiver operating characteristic curves were constructed to determine the cutoff value of intraoperative massive hemorrhage. Results Of 256 pregnant women with placenta previa, 96 (38%) developed intraoperative massive hemorrhage. Receiver-operating characteristic curves revealed that the area under the curve of the combination variables between the standard deviation of birth weight and intraoperative massive hemorrhage was 0.71. The cutoff value with a sensitivity of 81.3% and specificity of 55.6% was −0.33 standard deviation. The multivariate analysis revealed that a standard deviation of >−0.33 (odds ratio, 5.88; 95% confidence interval, 3.04–12.00), need for hemostatic procedures (odds ratio, 3.31; 95% confidence interval, 1.79–6.25), and placental adhesion (odds ratio, 12.68; 95% confidence interval, 2.85–92.13) were independent risk of intraoperative massive hemorrhage. Conclusion In patients with placenta previa, a birth weight >−0.33 standard deviation was a significant risk indicator of massive hemorrhage during cesarean section. Based on

  17. Intraoperative cholangiography. A review of indications and analysis of age-sex groups.

    PubMed Central

    Levine, S B; Lerner, H J; Leifer, E D; Lindheim, S R

    1983-01-01

    A retrospective review was performed of patients who had biliary tract stone formation as the primary diagnosis for hospitalization and indication for surgery. Five hundred and eighty-nine consecutive charts were reviewed of patients admitted between 1975 and 1979. Intraoperative cholangiography was performed in 166 patients of whom 22 had common duct exploration. Choledochotomy in this series was performed in 63 cases without utilizing pre-exploratory cholangiography. A normal intraoperative cholangiogram was found to be 100% accurate; however, an abnormal cholangiogram was associated with a 16% false positive rate of exploration of the common duct. The incidence of unsuspected common duct stones detected only by intraoperative cholangiography was 2.3%. Age-sex analysis confirms a 10-year mean age difference between men and women within the population of this study (p less than 0.001). This age-sex difference is maintained in patients without common duct pathology as well as in patients with sterile bile. However, the mean age difference between male and female patients with either demonstrable common duct obstruction by stones or infected bile as determined by routine intraoperative culture is not statistically significant. A review of the role of intraoperative cholangiography, and the experience at Northeastern Hospital is discussed. PMID:6639173

  18. Model-Updated Image-Guided Neurosurgery: Preliminary Analysis Using Intraoperative MR.

    PubMed

    Miga, Michael I; Staubert, Andreas; Paulsen, Keith D; Kennedy, Francis E; Tronnier, Volker M; Roberts, David W; Hartov, Alex; Platenik, Leah A; Lunn, Karen E

    2000-10-01

    In this paper, initial clinical data from an intraoperative MR system are compared to calculations made by a three-dimensional finite element model of brain deformation. The preoperative and intraoperative MR data was collected on a patient undergoing a resection of an astrocytoma, grade 3 with non-enhancing and enhancing regions. The image volumes were co-registered and cortical displacements as well as subsurface structure movements were measured retrospectively. These data were then compared to model predictions undergoing intraoperative conditions of gravity and simulated tumor decompression. Computed results demonstrate that gravity and decompression effects account for approximately 40% and 30%, respectively, totaling a 70% recovery of shifting structures with the model. The results also suggest that a non-uniform decompressive stress distribution may be present during tumor resection. Based on this preliminary experience, model predictions constrained by intraoperative surface data appear to be a promising avenue for correcting brain shift during surgery. However, additional clinical cases where volumetric intraoperative MR data is available are needed to improve the understanding of tissue mechanics during resection.

  19. Intraoperative culture positive allograft bone and subsequent postoperative infections: a retrospective review

    PubMed Central

    Sims, Laura; Kulyk, Paul; Woo, Allan

    2017-01-01

    Background Obtaining intraoperative cultures of allograft bone just before use in orthopedic procedures is standard practice in many centres; however, the association between positive cultures and subsequent surgical infections is unknown. Our study had 3 goals: to determine the prevalence of positive intraoperative allograft culture and subsequent infection; to determine if, in cases of subsequent infection, organisms isolated at reoperation were the same as those cultured from the allograft at the time of the index procedure; and to assess the costs associated with performing intraoperative allograft cultures. Methods In this retrospective case series, we obtained data on patients receiving allograft bone between 2009 and 2012. Patients receiving allograft with positive cultures were reviewed to identify cases of significant infection. Organisms isolated at reoperation were compared with the allograft culture taken at the time of implantation, and we performed a cost assessment. Results Of the 996 allograft bone grafts used, 43 (4.3%) had positive intraoperative cultures and significant postoperative infections developed in 2, requiring reoperation. Antibiotics based on culture results were prescribed in 24% of cases. Organisms cultured at the time of reoperation differed from those isolated initially. The cost of performing 996 allograft cultures was $169 320. Conclusion This series suggests that rates of positive intraoperative bone allograft culture are low, and subsequent infection is rare. In cases of postoperative infection, primary allograft culture and secondary tissue cultures isolated different organisms. Costs associated with performing cultures are high. Eliminating initial culture testing could save $42 500 per year in our health region. PMID:28234217

  20. Analysis of real-time three dimensional transesophageal echocardiography in the assessment of left atrial appendage function in patients with atrial fibrillation

    PubMed Central

    Gan, Lin; Yu, Lan; Xie, Manying; Feng, Wei; Yin, Jiabao

    2016-01-01

    The aim of the study was to examine changes in left atrial appendage volume (LAA-V) in patients with non-valvular atrial fibrillation (AF) using real-time three-dimensional transesophageal echocardiography (RT3D-TEE) and evaluate the prediction value on the high risk of thrombosis of LAA. Using RT3D-TEE we measured: i) LAA peak empty velocity (LAA-PEV), ii) LAA-V including LAA end-diastolic volume (LAA-EDV) and end-systolic volume (LAA-ESV). We also calculated LAA ejection fraction (LAA-EF). RT3D-TEE was applied in 20 control cases and 74 patients with non-valvular AF. According to the presence of thrombosis, 74 patients were divided into the no thrombosis group (NTH group, n=52) and thrombosis group (TH group, n=22). Our results showed that there were significant differences in LAA-V and LAA-EF values in different groups (P<0.05). LAA-EDV moderately correlated with LAA-PEV (r=−0.531, P<0.001) while LAA-ESV demonstrated a strong correlation with LAA-PEV (r=−0.741, P<0.001). LAA-EF also showed a strong correlation with LAA-PEV (r=0.693, P<0.001). Through receiver operating characteristic (ROC) curves, the cut-off values of LAA-EDV and LAA-ESV in thrombosis of LAA were 18.45 and 9.69 ml, respectively. RT3D-TEE effectively evaluated the LAA-V, LAA-PEV and LAA-EF parameters, and proved to be valuable in the process of evaluation of thrombosis of LAA. PMID:27882157

  1. Estimation of intra-operative brain shift using a tracked laser range scanner.

    PubMed

    Ding, Siyi; Miga, Michael I; Thompson, Reid C; Dumpuri, Prashanth; Cao, Aize; Dawant, Benoit M

    2007-01-01

    Intra-operative brain shift limits the usefulness of image-guided neurosurgery systems (IGNS), which are based on pre-operative images. Methods that are being developed to address this problem need intra-operative measurements as input. In this work, we present an intra-operative surface shift measurement technique that relies on a tracked 3D laser range scanner. This scanner acquires both 3D range data and 2D images, which are co-registered. We compare two methods to derive displacements at every point in the field of view. The first one relies on the registration of the 2D images; the second relies on the direct 3D registration of the 3D range data. Our results, based on five data sets, show that the 2D method is preferable.

  2. Treatment of cancer of the pancreas by intraoperative electron beam therapy: physical and biological aspects

    SciTech Connect

    Bagne, F.R.; Dobelbower, R.R. Jr.; Milligan, A.J.; Bronn, D.G.

    1989-01-01

    Radiation therapy has had a significant and an expanded role in the management of cancer of the pancreas during the last decade. In particular, for locally advanced disease, radiation therapy has improved the median survival of patients to 1 year. Intraoperative electron beam therapy has been applied to unresectable and resectable pancreatic cancer in an attempt to enhance local control of disease and to improve patient survival. This paper presents a survey of the role of radiation therapy in treatment of cancer of the pancreas, provides information on the radiobiological aspects of this treatment modality and details the physical and dosimetric characteristics of intraoperative radiation therapy with electrons. Presented are the design specifics of an applicator system, central axis beam data, applicator parameters, dose distribution data, shielding, treatment planning and means of verification. Emphasis is placed on the collaboration and cooperation necessary for all members of the intraoperative radiation therapy team including surgeons, radiation therapists, medical physicists, anesthesiologists, technologists, and nurses.29 references.

  3. 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

  4. Intraoperative transillumination with water-filling of lumen for localizing lesions in occult small bowel bleeding

    PubMed Central

    Kong, Xiangheng; Cao, Yuning; Yang, Daogui; Li, Senlin

    2017-01-01

    Abstract Rationale: Occult small bowel bleeding is always difficult to locate by either radiological examination or endoscopy. When the site of bleeding cannot be found by nonsurgical measures, exploratory laparotomy becomes necessary. Patient concerns: A 63-year-old woman with a half-month history of occult gastrointestinal bleeding failed to many conservative therapies. Interventions: Intraoperative transillumination with water-filling of lumen was performed. Diagnoses: Small bowel bleeding was diagnosed intraoperatively. Outcomes: Segmental resection of the diseased small bowel with side-to-side anastomosis was performed while the histology showed no significant abnormality. Lessons: The technique of intraoperative transillumination with water-filling of lumen allows simple, accurate, and rapid localization of lesions in occult small bowel bleeding and facilitates precise and definitive surgery. PMID:28151907

  5. Intra-operative femoral neck fracture during attempted dislocation of a reduced hemi-arthroplasty.

    PubMed

    Ling, Samuel Ka Kin; Ma, Chun Man; Lui, Tun Hing

    2015-05-01

    Fragility hip fractures are increasingly common and hemiarthroplasty is one of the standard treatments. Although a common surgery, it should be performed with great caution because of the poor premorbid and bone quality in this demographic. Intra-operative fractures can occur while attempting press fit of the femoral implant. However; vigilance often steps down once the implant is secured and the hip reduced. This case report reminds surgeons that a large amount of torque can be transmitted during intra-operative positioning, such as during an attempt of hip dislocation. This torque, in addition to the risk factor of osteoporotic bone, can result in iatrogenic fractures. Published literature regarding management of an intra-operative fracture while the prosthetic hip is still reduced is lacking. The authors propose that temporary prophylactic cerclage wiring is a prudent and safe procedure prior to hip dislocation.

  6. Intraoperative neurophysiologic monitoring in spine surgery. Developments and state of the art in France in 2011.

    PubMed

    Gavaret, M; Jouve, J L; Péréon, Y; Accadbled, F; André-Obadia, N; Azabou, E; Blondel, B; Bollini, G; Delécrin, J; Farcy, J-P; Fournet-Fayard, J; Garin, C; Henry, P; Manel, V; Mutschler, V; Perrin, G; Sales de Gauzy, J

    2013-10-01

    Intraoperative spinal cord monitoring consists in a subcontinuous evaluation of spinal cord sensory-motor functions and allows the reduction the incidence of neurological complications resulting from spinal surgery. A combination of techniques is used: somatosensory evoked potentials (SSEP), motor evoked potentials (MEP), neurogenic motor evoked potentials (NMEP), D waves, and pedicular screw testing. In absence of intraoperative neurophysiological testing, the intraoperative wake-up test is a true form of monitoring even if its latency long and its precision variable. A 2011 survey of 117 French spinal surgeons showed that only 36% had neurophysiological monitoring available (public healthcare facilities, 42%; private facilities, 27%). Monitoring can be performed by a neurophysiologist in the operating room, remotely using a network, or directly by the surgeon. Intraoperative alerts allow real-time diagnosis of impending neurological injury. Use of spinal electrodes, moved along the medullary canal, can determine the lesion level (NMEP, D waves). The response to a monitoring alert should take into account the phase of the surgical intervention and does not systematically lead to interruption of the intervention. Multimodal intraoperative monitoring, in presence of a neurophysiologist, in collaboration with the anesthesiologist, is the most reliable technique available. However, no monitoring technique can predict a delayed-onset paraplegia that appears after the end of surgery. In cases of preexisting neurological deficit, monitoring contributes little. Monitoring of the L1-L4 spinal roots also shows low reliability. Therefore, monitoring has no indication in discal and degenerative surgery of the spinal surgery. However, testing pedicular screws can be useful. All in all, thoracic and thoracolumbar vertebral deviations, with normal preoperative neurological examination are currently the essential indication for spinal cord monitoring. Its absence in this

  7. 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.

  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. An evaluation of liquid-crystal thermometry as a screening device for intraoperative hyperthermia.

    PubMed

    Lees, D E; Schuette, W; Bull, J M; Whang-Peng, J; Atkinson, E R; Macnamara, T E

    1978-01-01

    Disposable liquid-crystal temperature-trend indicators were evaluated under clinical conditions that simulated the development of intraoperative hyperthermia during anesthesia. Comparison was made to forehead thermistors for rapidity, accuracy, and linearity of response as well as correlation with esophageal and rectal thermistor recordings. The liquid-crystal monitors were comparable to the forehead thermistors in both rapidity and linearity or response, but not in accuracy. A linear correlation existed with the esophageal thermistor temperatures. Correlation with the rectal temperatures was not as exact. It is concluded that liquid-crystal thermometers may adequately serve as screening devices for intraoperative hyperthermia.

  10. "Subclinoid" carotid aneurysm with erosion of the anterior clinoid process and fatal intraoperative rupture.

    PubMed

    Korosue, K; Heros, R C

    1992-08-01

    We present the case of a patient with an aneurysm of the right internal carotid artery with subarachnoid hemorrhage. The aneurysm had resulted in erosion of the anterior clinoid process, but this was not recognized preoperatively. Intraoperative rupture during drilling of the clinoid necessitated vigorous packing that led to unintended carotid occlusion with subsequent fatal cerebral infarction. Preoperative recognition of the clinoid erosion may have prevented this catastrophe. To call attention to the potential for intraoperative rupture during exposure, we suggest the term subclinoid aneurysm to refer to aneurysms of the internal carotid artery that grow superolaterally and remain confined under the anterior clinoid process.

  11. [What is the role of intraoperative radiotherapy in breast cancer treatment?].

    PubMed

    Aumont, M

    2016-10-01

    Breast-conserving surgery followed by whole breast postoperative irradiation is considered to be the current standard treatment for patients with early stage breast cancer. It allows an excellent local tumour control with 6% of local recurrence. Over the last years, partial breast radiotherapy has been developed to reduce treatment volume and duration. Intraoperative radiotherapy is one of the techniques. It offers an excellent delineation of the tumour bed and high normal tissue sparing. This purpose of this review is to describe the different intraoperative radiotherapy techniques available, to assess their potential clinical efficiency and tolerance, the recommendations for new practice with a selected population of patients and for future research.

  12. Histopathological effects of intraoperative radiotherapy on pancreas and adjacent tissues: a postmortem analysis

    SciTech Connect

    Hoekstra, H.J.; Restrepo, C.; Kinsella, T.J.; Sindelar, W.F.

    1988-02-01

    Intraoperative radiotherapy (IORT) has been utilized in the treatment of resectable and unresectable pancreatic carcinoma at the National Cancer Institute. Detailed autopsy analyses of the radiation effects on the pancreas and adjacent tissues were performed on 13 patients dying at various times following therapy. IORT can induce a progressive retroperitoneal fibrosis and fibrosis of the porta hepatis in patients with resectable pancreatic carcinoma. In unresectable pancreatic carcinoma, the major expression of intraoperative irradiation with external beam irradiation is a progressive fibrosis of the pancreas with vascular sclerosis, nerve degeneration, atrophy of acinar cells, and atypical changes in the ducts of the pancreas, as well as degenerative changes of the pancreatic tumor.

  13. Utilization of intraoperative 3D navigation for delayed reconstruction of orbitozygomatic complex fractures.

    PubMed

    Morrison, Clinton S; Taylor, Helena O; Sullivan, Stephen R

    2013-05-01

    Reconstructive goals for orbitozygomaticomaxillary complex fractures include restoration of orbital volume, facial projection, and facial width. Delayed reconstruction is made more difficult by malunion, nonunion, bony absorption, loss of the soft tissue envelope, and scar. Three-dimensional intraoperative navigation, widely used in neurosurgery and sinus surgery, can improve the accuracy with which bony reduction is performed. This is particularly useful in the setting of bony absorption and comminution. We report a case of delayed reconstruction of an orbitozygomaticomaxillary complex fracture using intraoperative navigation and review this technology's utility in this setting.

  14. Neurophysiological criteria for intraoperative prediction of pure motor hemiplegia during aneurysm surgery. Case report.

    PubMed

    Szelényi, Andrea; Bueno de Camargo, Adauri; Flamm, Eugene; Deletis, Vedran

    2003-09-01

    The value of motor evoked potentials (MEPs) as an intraoperative neurophysiological monitoring tool for detecting selective subcortical ischemia of the motor pathways during intracerebral aneurysm repair is described and the use of such measures to predict postoperative motor status is discussed. The authors present the case of a 64-year-old woman in whom there was an incidental finding of two right middle cerebral artery (MCA) aneurysms. During the aneurysm clipping procedure, an intraoperative MEP loss in the left abductor pollicis brevis and tibial anterior muscles occurred during an attempt at permanent clip placement. There were no concurrent changes in somatosensory evoked potentials. Postoperatively, the patient demonstrated a left hemiplegia with intact sensation. A computerized tomography scan revealed an infarct in the anterior division of the MCA territory, including the posterior limb of the internal capsule. In this patient, intraoperative neurophysiological monitoring with MEPs has been shown to be a sensitive tool for indicating subcortical ischemia affecting selective motor pathways in the internal capsule. Therefore, intraoperative loss of MEPs can be used to predict postoperative motor deficits.

  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. Intraoperative radioimmunodetection of colorectal tumor with a hand-held radiation detector

    SciTech Connect

    Martin, D.T.; Hinkle, G.H.; Tuttle, S.; Olsen, J.; Nabi, H.; Houchens, D.; Thurston, M.; Martin, E.W. Jr.

    1985-12-01

    A hand-held gamma detection probe was used intraoperatively to localize primary and recurrent colorectal tumors in 28 patients 48 to 72 hours after they received an intravenous injection of 2.2 mCi of iodine-131 labeled anticarcinoembryonic antigen polyclonal baboon antibody. Preoperative evaluation included determination of serum carcinoembryonic antigen, barium enema, colonoscopy, chest film, computerized axial tomography, liver, spleen, and bone scans, and endoscopy when indicated. Preoperative whole-body imaging correctly localized primary tumors in only 33 percent of the patients, whereas it correctly demonstrated tumor in 64 percent of those with recurrent disease. Intraoperative tumor-to-background ratios derived from the detector probe were elevated in all patients, averaging 3.97:1 in primary lesions and 4.18:1 in recurrent tumors. Postoperatively, carcinoembryonic antigen was localized in tissues with the avidin-biotin peroxidase staining technique to confirm intraoperative readings. Variations in stain uptake in a patient could be correlated with variations in radiation detector readings in the same patient. Results support our previous work in nude mice, demonstrating the improved sensitivity and specificity of the hand-held gamma detection device over whole-body imaging for intraoperative localization of immunoradiolabeled tumors.

  17. Proposal of an optimized strategy for intraoperative testing of speech and language during awake mapping.

    PubMed

    Mandonnet, Emmanuel; Sarubbo, Silvio; Duffau, Hugues

    2017-01-01

    In this paper, we review the literature about the definitions of errors observed by direct electrical stimulation during language testing. As a practical application, we propose an optimized strategy for differentiating accurately motor arrest, speech arrest, and anomia in the context of intraoperative mapping. Finally, we also discuss the anatomical correlates of the networks sustaining these different errors, both cortically and axonally.

  18. Intraoperative magnesium infusion during carotid endarterectomy: a double-blind placebo-controlled trial

    PubMed Central

    Mack, William J.; Kellner, Christopher P.; Sahlein, Daniel H.; Ducruet, Andrew F.; Kim, Grace H.; Mocco, J; Zurica, Joseph; Komotar, Ricardo J.; Haque, Raqeeb; Sciacca, Robert; Quest, Donald O.; Solomon, Robert A.; Connolly, E. Sander; Heyer, Eric J.

    2009-01-01

    Object Recent data from both experimental and clinical studies have supported the use of intravenous magnesium as a potential therapy in the setting of cerebral ischemia. This study assessed whether intraoperative magnesium therapy improves neuropsychometric testing (NPT) following carotid endarterectomy (CEA). Methods One hundred eight patients undergoing CEA were randomly assigned to receive placebo infusion or 1 of 3 magnesium-dosing protocols. Neuropsychometric testing was performed 1 day after surgery and compared with baseline performance. Assessment was also performed on a set of 35 patients concurrently undergoing lumbar laminectomy to serve as a control group for NPT. A forward stepwise logistic regression analysis was performed to evaluate the impact of magnesium therapy on NPT. A subgroup analysis was then performed, analyzing the impact of each intraoperative dose on NPT. Results Patients treated with intravenous magnesium infusion demonstrated less postoperative neurocognitive impairment than those treated with placebo (OR 0.27, 95% CI 0.10–0.74, p = 0.01). When stratified according to dosing bolus and intraoperative magnesium level, those who were treated with low-dose magnesium had less cognitive decline than those treated with placebo (OR 0.09, 95% CI 0.02-0.50, p < 0.01). Those in the high-dose magnesium group demonstrated no difference from the placebo-treated group. Conclusions Low-dose intraoperative magnesium therapy protects against neurocognitive decline following CEA. PMID:19199498

  19. Virtual slide telepathology with scanner systems for intraoperative frozen-section consultation.

    PubMed

    Ribback, Silvia; Flessa, Steffen; Gromoll-Bergmann, Katrin; Evert, Matthias; Dombrowski, Frank

    2014-06-01

    Telepathology provides pathology services over a distance using digital imaging and telecommunication for primary diagnostic practice, including intraoperative frozen sections. Virtual slide technology provides digitizing of histological slides by scanner systems and improved remote assessment substantially. In this retrospective study, diagnostic accuracy of intraoperative frozen sections assessed as virtual slide was determined. Tissue assessment was mainly requested for urological, gynecological and dermatological resections. Issues of time consumption, cost and cost effectiveness of this diagnostic method are discussed. 1204 intraoperative frozen sections were conducted in the course of this study at our department over a period of 2.5 years. 98.59% of all intraoperative frozen sections were accurately diagnosed in the initial telepathological assessment. Tumor affection was present in 15.6% of frozen sections, in 174 instances already assessed in the initial slides (sensitivity 92.6%). Discrepant diagnoses compared to the final diagnosis occurred in 1.41%. Our determined averaged time for virtual slide technology of 10.58±8.19min can be ranged in well. Our study did not allow a full economic assessment, but some preliminary insights are pointed out. The quality of services is highly acceptable and the investment costs and the labor cost of virtual slide technology are lower than those of robotic microscopy.

  20. Effect of different types of anesthesia on intraoperative blood glucose of diabetic patients

    PubMed Central

    Li, Xueqiong; Wang, Jinjing; Chen, Kang; Li, Yijun; Wang, Haibin; Mu, Yiming; Chen, Yaolong

    2017-01-01

    Abstract Background: Systematic review which analyzes the impact of different anesthesia on intraoperative blood glucose levels of diabetes patients. Methods: We searched Medline (via PubMed), Embase, Cochrane Library, Web of Science, Wangfang, CNKI, and CBM database through June 2016, included in randomized controlled trial (RCT), about different anesthesia on intraoperative blood glucose levels in patients with diabetes. Two researchers in 1 group independently screened literatures with eligibility criteria, extracted information, and used RevMan5.3 software to perform meta-analysis. Results: We included 11 trials and performed the meta-analysis with 10 trials. The meta-analysis results suggested that compared with general anesthesia, the combined general-epidural anesthesia has a better glycemic control in intraoperative blood glucose levels (WMD −1.26, 95% confidence interval [CI] −1.77 to 0.76), the epidural anesthesia had no significant effects compared with general anesthesia (WMD −0.74, 95% CI 4.41–2.92), and the combined spinal-epidural anesthesia had no significant effects compared with epidural anesthesia (WMD −0.28, 95% CI −1.02 to 0.46). One study suggested that compared with epidural anesthesia, the combined general-epidural anesthesia can lower blood glucose levels Conclusion: Existing evidence showed that compared with general anesthesia, the combined general-epidural anesthesia has a better glycemic control in intraoperative blood glucose levels. PMID:28353577

  1. Risk factors for intraoperative perforation during endoscopic submucosal dissection of superficial esophageal squamous cell carcinoma

    PubMed Central

    Noguchi, Masaaki; Yano, Tomonori; Kato, Tomoji; Kadota, Tomohiro; Imajoh, Maomi; Morimoto, Hiroyuki; Osera, Shozo; Yagishita, Atsushi; Odagaki, Tomoyuki; Yoda, Yusuke; Oono, Yasuhiro; Ikematsu, Hiroaki; Kaneko, Kazuhiro

    2017-01-01

    AIM To identify the risk factors and clarify the subsequent clinical courses. METHODS This study retrospectively analyzed consecutive patients with esophageal squamous cell carcinoma (ESCC) treated using endoscopic submucosal dissection (ESD) between April 2008 and October 2012. We divided the ESCC lesions into perforation cases and non-perforation cases, and compared characteristics and endoscopic findings between the two groups. "Intraoperative perforation" was defined as the detection of a perforation site during ESD and the presence of mediastinal emphysema. RESULTS In total, 147 patients with 156 ESCC lesions were treated by ESD. Intraoperative perforation was recorded for nine lesions (5.8%) from nine patients. Multivariate analysis identified mucosal deficiency larger than 75% of the circumference of the esophagus as an independent risk factor for intraoperative perforation (OR = 7.37, 95%CI: 1.45-37.4, P = 0.016). The predominant site of perforation was the left wall [6/9 (67%)]. Six of nine perforation sites were successfully closed by clips during the procedures. Two of nine cases required drainage for pleural effusions; however, all nine cases recovered with conservative treatment and without surgical intervention. At the median follow up of 42 mo after ESD, no cases of local recurrence or distant organ metastasis had been observed. CONCLUSION This study suggests that mucosal deficiency larger than 75% of the luminal circumference is a risk factor for intraoperative perforation during ESD for ESCC. PMID:28210084

  2. The use of an intraoperative molding device for the reconstruction of a female breast after mastectomy.

    PubMed

    Dirnberger, F; Bruck, H G

    1980-09-01

    A temporary intraoperative molding device for the reconstruction of a breast after mastectomy is presented. It is a low-cost, throw-away Silastic rubber product. It follows the principle of a tailor's wooden model, to allow an easier forming of a breast.

  3. 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

  4. 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…

  5. 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

    2015-03-08

    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.

  6. Intraoperative rapid diagnosis of primary central nervous system lymphomas: advantages and pitfalls.

    PubMed

    Sugita, Yasuo; Terasaki, Mizuhiko; Nakashima, Shinji; Ohshima, Koichi; Morioka, Motohiro; Abe, Hideyuki

    2014-10-01

    To study the advantages and pitfalls of intraoperative rapid diagnosis (IRD) of primary central nervous system lymphomas (PCNSL), pathology reports and frozen sections in our institution were reviewed. We examined 27 cases of PCNSL, one case of anaplastic glioma, and one case of metastatic brain tumor that were diagnosed on neuroimaging. Fifteen cases of intraoperative cytological preparations were also reviewed in a correlative manner. Among the 27 cases initially diagnosed as PCNSL, 18 were also diagnosed as PCNSL by IRD. However, IRD identified four of the 27 cases as gliosis, two as demyelination, one as atypical epithelial cells, one as malignant glioma and anaplastic astrocytoma. In addition, the case identified as metastatic brain tumor on neuroimaging was corrected to a diagnosis of PCNSL based on IRD. The final accuracy of IRD in the present study was 89.6% (26/29). After postoperative definitive diagnosis, two cases of anaplastic astrocytoma and one case of PCNSL by IRD were corrected to PCNSL, anaplastic oligodendroglioma and demyelination, respectively. PCNSL were sometimes histologically indistinguishable from malignant gliomas or demyelinating diseases in the present study, particularly in frozen sections. Notably, all cases for which both intraoperative cytology and frozen section were performed concomitantly were correctly diagnosed in the present study. In particular, lymphoglandular bodies were highly characteristic cytological findings of PCNSL. Both intraoperative cytology and frozen sections should therefore be performed concomitantly when PCNSL are suspected.

  7. Initial experience of using high field strength intraoperative MRI for neurosurgical procedures.

    PubMed

    Raheja, Amol; Tandon, Vivek; Suri, Ashish; Sarat Chandra, P; Kale, Shashank S; Garg, Ajay; Pandey, Ravindra M; Kalaivani, Mani; Mahapatra, Ashok K; Sharma, Bhawani S

    2015-08-01

    We report our initial experience to optimize neurosurgical procedures using high field strength intraoperative magnetic resonance imaging (IOMRI) in 300 consecutive patients as high field strength IOMRI rapidly becomes the standard of care for neurosurgical procedures. Three sequential groups (groups A, B, C; n=100 each) were compared with respect to time management, complications and technical difficulties to assess improvement in these parameters with experience. We observed a reduction in the number of technical difficulties (p<0.001), time to induction (p<0.001) and total anesthesia time (p=0.007) in sequential groups. IOMRI was performed for neuronavigation guidance (n=252) and intraoperative validation of extent of resection (EOR; n=67). Performing IOMRI increased the EOR over and beyond the primary surgical attempt in 20.5% (29/141) and 18% (11/61) of patients undergoing glioma and pituitary surgery, respectively. Overall, EOR improved in 59.7% of patients undergoing IOMRI (40/67). Intraoperative tractography and real time navigation using re-uploaded IOMRI images (accounting for brain shift) helps in intraoperative planning to reduce complications. IOMRI is an asset to neurosurgeons, helping to augment the EOR, especially in glioma and pituitary surgery, with no significant increase in morbidity to the patient.

  8. Intraoperative modification of a supracricoid laryngectomy to a subtotal laryngectomy with tracheohyoidoepiglottopexy.

    PubMed

    Marchese-Ragona, Rosario; Calgaro, Nicola; Tregnaghi, Alberto; Marioni, Gino; Ottaviano, Giancarlo; Staffieri, Claudia; Staffieri, Alberto

    2009-12-01

    In recent decades, with the widespread diffusion of the supracricoid laryngectomy in the treatment of selected advanced laryngeal neoplasm, the indications to non-conservative surgery are less frequent than in past. We report the case of a patient in whom a planned supracricoid laryngectomy was intraoperatively converted in an extended partial laryngectomy with tracheohyoidoepiglottopexy for a tumor involving the cricoid cartilage.

  9. 3D monitoring of the intraoperative brainshift by means of photogrammetry

    NASA Astrophysics Data System (ADS)

    D'Apuzzo, Nicola; Verius, Michael

    2008-02-01

    This paper presents the preliminary results of applying multi image photogrammetric techniques for the three-dimensional monitoring of the intraoperative brainshift. The "brainshift" is the motion of cerebral structures occurring in neurosurgery after the craniotomy (opening of the skull in order to access the brain for surgical repair). The causes of this effect are mainly the changes of pressure and loss of cerebrospinal liquid. The phenomenon of brainshift can influence negatively the planning and execution of neurosurgical intervention. A research project at the Clinic of Neuroradiology and Neurosurgery of the Medical University of Innsbruck, Austria) aims at the quantification of the intraoperative brainshift by means of photogrammetry. The goals of the project are: (i) the development of a multi-image photogrammetric system for the quantitative monitoring of intraoperative brainshift by means of 3D measurements performed on the surface of the brain during neurosurgery after craniotomy, (ii) transformation of the pre-operative performed MR and CT datasets in function of the quantified intra-operative brainshift. This paper presents the proposed multi-image photogrammetric system, as well as, the first results achieved, in collaboration with Hometrica Consulting, for the automatic 3D measurement and tracking of selected points on the surface of the brain.

  10. Persistent and automatic intraoperative 3D digitization of surfaces under dynamic magnifications of an operating microscope.

    PubMed

    Kumar, Ankur N; Miga, Michael I; Pheiffer, Thomas S; Chambless, Lola B; Thompson, Reid C; Dawant, Benoit M

    2015-01-01

    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 1 Hz) 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 h) 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

  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. 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

  13. 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.

  14. Integrated backscatter and intima-media thickness of the thoracic aorta evaluated by transesophageal echocardiography in hypercholesterolemic patients: effect of pitavastatin therapy.

    PubMed

    Ono, Koji; Kawasaki, Masanori; Tanaka, Ryuhei; Segawa, Tomonori; Matsuo, Hitoshi; Watanabe, Sachiro; Takemura, Genzou; Minatoguchi, Shinya

    2009-02-01

    The effect of a strong, lipophilic statin (pitavastatin) on the thoracic aorta has not yet been elucidated. The purpose of the present study was to evaluate the effects of pitavastatin (P) therapy on plaque components and morphology in the thoracic aorta by transesophageal echocardiography (TEE) and clarify the impact of the therapy on media and intima in patients with hypercholesterolemia. Sixty-four media and 64 intima of the thoracic aorta were investigated in 32 patients with hypercholesterolemia. The corrected integrated backscatter (c-IBS) values in the thoracic aortic wall and intima-media thickness (IMT) at the same site were measured before and after P therapy or diet (D) for 7 mo. Moreover, c-IBS values in media were measured in 168 patients without hypercholesterolemia to estimate age-dependent changes. C-IBS values in media were correlated with age (r = 0.84, p < 0.001). C-IBS and IMT of media in the P group significantly decreased from -17.8 +/- 2.4 to -20.1 +/- 3.7 dB and from 1.7 +/- 0.3 to 1.5 +/- 0.3 mm, respectively (p < 0.001), whereas those in the D group significantly increased from -18.3 +/- 2.0 to -16.7 +/- 2.1 dB and from 1.6 +/- 0.3 to 1.7 +/- 0.2 mm, respectively (p < 0.001). IMT in intima in the P group significantly decreased from 3.7 +/- 0.4 to 3.3 +/- 0.4 mm (p < 0.001). C-IBS in intima in the P group significantly increased from -10.2 +/- 2.2 to -6.9 +/- 1.7 dB, which indicated plaque stabilization. Pitavastatin improved the atherosis measured by IMT and sclerosis measured by c-IBS values in the media and induced stabilization and regression of plaques in the intima of the thoracic aorta.

  15. High STOP-BANG questionnaire scores predict intraoperative and early postoperative adverse events

    PubMed Central

    Seet, Edwin; Chua, Maureen; Liaw, Chen Mei

    2015-01-01

    INTRODUCTION Obstructive sleep apnoea (OSA) is the most common sleep-related breathing disorder associated with multisystemic organ involvement. The STOP-BANG questionnaire is a concise, validated questionnaire that is used to screen for OSA. This study aimed to establish the use of the STOP-BANG questionnaire for perioperative patient risk stratification. METHODS In this retrospective cohort study, we extracted the demographic, medical and perioperative outcome data of all patients who underwent elective surgery, excluding ophthalmic surgeries, from January to December 2011. Multivariate regression analysis was used to predict independent risk factors for intraoperative and early postoperative adverse events. RESULTS Of the 5,432 patients analysed, 7.4% had unexpected intraoperative and early postoperative adverse events. We found that the risk of unexpected intraoperative and early postoperative adverse events was greater in patients with STOP-BANG scores ≥ 3 compared to those with a STOP-BANG score of 0 (score 3: odds ratio [OR] 3.6, 95% confidence interval [CI] 2.1–6.3, p < 0.001; score 4: OR 3.4, 95% CI 1.8–6.5, p < 0.001; score 5: OR 6.4, 95% CI 2.7–15.0, p < 0.001; score ≥ 6: OR 5.6, 95% CI 2.1–15.4, p < 0.001). Patients with STOP-BANG scores ≥ 5 had a fivefold increased risk of unexpected intraoperative and early postoperative adverse events, while patients with STOP-BANG scores ≥ 3 had a ‘one in four’ chance of having an adverse event. Other independent predictors included older age (p < 0.001), American Society of Anesthesiologists class ≥ 2 (p < 0.003) and uncontrolled hypertension (p = 0.028). CONCLUSION STOP-BANG score may be used as a preoperative risk stratification tool to predict the risk of intraoperative and early postoperative adverse events. PMID:25917473

  16. Intraoperative Spectroscopy with Ultrahigh Sensitivity for Image-Guided Surgery of Malignant Brain Tumors.

    PubMed

    Kairdolf, Brad A; Bouras, Alexandros; Kaluzova, Milota; Sharma, Abhinav K; Wang, May Dongmei; Hadjipanayis, Constantinos G; Nie, Shuming

    2016-01-05

    Intraoperative cancer imaging and fluorescence-guided surgery have attracted considerable interest because fluorescence signals can provide real-time guidance to assist a surgeon in differentiating cancerous and normal tissues. Recent advances have led to the clinical use of a natural fluorophore called protoporphyrin IX (PpIX) for image-guided surgical resection of high-grade brain tumors (glioblastomas). However, traditional fluorescence imaging methods have only limited detection sensitivity and identification accuracy and are unable to detect low-grade or diffuse infiltrating gliomas (DIGs). Here we report a low-cost hand-held spectroscopic device that is capable of ultrasensitive detection of protoporphyrin IX fluorescence in vivo, together with intraoperative spectroscopic data obtained from both animal xenografts and human brain tumor specimens. The results indicate that intraoperative spectroscopy is at least 3 orders of magnitude more sensitive than the current surgical microscopes, allowing ultrasensitive detection of as few as 1000 tumor cells. For detection specificity, intraoperative spectroscopy allows the differentiation of brain tumor cells from normal brain cells with a contrast signal ratio over 100. In vivo animal studies reveal that protoporphyrin IX fluorescence is strongly correlated with both MRI and histological staining, confirming that the fluorescence signals are highly specific to tumor cells. Furthermore, ex vivo spectroscopic studies of excised brain tissues demonstrate that the hand-held spectroscopic device is capable of detecting diffuse tumor margins with low fluorescence contrast that are not detectable with current systems in the operating room. These results open new opportunities for intraoperative detection and fluorescence-guided resection of microscopic and low-grade glioma brain tumors with invasive or diffusive margins.

  17. Detection and identification of oral anaerobes in intraoperative bronchial fluids of patients with pulmonary carcinoma.

    PubMed

    Hasegawa, Ayako; Sato, Takuichi; Hoshikawa, Yasushi; Ishida, Naoko; Tanda, Naoko; Kawamura, Yoshiaki; Kondo, Takashi; Takahashi, Nobuhiro

    2014-07-01

    Postoperative pneumonia may occur when upper respiratory tract protective reflexes such as cough and/or swallowing reflexes are impaired; thus, silent aspiration of oral bacteria may be a causative factor in postoperative pneumonia. This study aimed to quantify and identify bacteria in intraoperative bronchial fluids and to evaluate the relationship between impairment of cough/swallowing reflexes and silent aspiration of oral bacteria in elderly patients. After obtaining informed consent, cough and swallowing reflexes were assessed using an ultrasonic nebulizer and a nasal catheter, respectively. Using a micro-sampling probe, intraoperative bronchial fluids were collected from nine subjects with pulmonary carcinoma and cultured anaerobically on blood agar plates. After 7 days, CFUs were counted and isolated bacteria were identified by 16S rRNA gene sequencing. Four subjects (aged 71.0 ± 8.4 years) had impaired swallowing reflexes with normal cough reflexes, whereas five subjects (73.6 ± 6.5 years) had normal cough and swallowing reflexes. The bacterial counts (mean CFU ± SD) tended to be higher in intraoperative bronchial fluids of subjects with impaired swallowing reflexes ([5.1 ± 7.7] × 10(5)) than in those of subjects with normal reflexes ([1.2 ± 1.9] × 10(5)); however, this difference was not statistically significant. Predominant isolates from intraoperative bronchial fluids were Streptococcus (41.8%), Veillonella (11.4%), Gemella (8.9%), Porphyromonas (7.6%), Olsenella (6.3%) and Eikenella (6.3%). These findings indicate that intraoperative bronchial fluids contain bacteria, probably derived from the oral microbiota, and suggest that silent aspiration of oral bacteria occurs in elderly patients irrespective of impairment of swallowing reflex.

  18. A Smart Tool for Intraoperative Leg Length Targeting in Total Hip Arthroplasty: A Retrospective Cohort Study

    PubMed Central

    Grosso, Paul; Snider, Matthew; Muir, Jeffrey M.

    2016-01-01

    Background: Leg length discrepancies following total hip arthroplasty (THA) may necessitate subsequent interventions, from heel lifts to revision surgery. Current intraoperative methods of determining leg length are either inaccurate or expensive and invasive. Objective: The objective of the current study was to investigate the ability of a novel, intraoperative smart tool (Intellijoint HIP®, Intellijoint Surgical®, Inc., Waterloo, ON) to provide accurate, real-time leg length measurements during THA. Methods: We retrospectively reviewed the medical records of 25 patients who underwent THA utilizing the Intellijoint HIP smart tool between February and August 2014. Intraoperative leg length data was compared with radiographic leg length calculations. Two observers blinded to the Intellijoint HIP findings independently assessed all post-procedure radiographs. Results: The mean difference between smart tool and radiographic measurements was 1.3 mm [CI: -0.1, 2.7]. 88% (22/25) of intraoperative measurements were within 5 mm of radiographic measurements; 100% (25/25) were within 10 mm. A Bland-Altman analysis showed excellent agreement, with 96% (24/25) of measurements within the statistical limit for acceptable agreement, and 84% (21/25) within the clinically acceptable range (± 5 mm). Removal of the first 13 procedures (surgeon training) decreased the mean difference between methods to 0.6 mm [-0.6, 1.9]. All post-training procedures were associated with a difference of <5 mm. There were no reported adverse events related to the use of the smart tool. Conclusion: The Intellijoint HIP smart tool is a safe and accurate tool for providing intraoperative measurements of leg length in real-time. PMID:27843511

  19. Tailoring Adjuvant Radiation Therapy by Intraoperative Imaging to Detect Residual Cancer

    PubMed Central

    Whitley, Melodi J.; Weissleder, Ralph; Kirsch, David G.

    2015-01-01

    For many solid cancers, radiation therapy is offered as an adjuvant to surgical resection in order to lower rates of local recurrence and improve survival. However, a subset of patients treated with surgery alone will not have a local recurrence. Currently, there is no way to accurately determine which patients have microscopic residual disease in the tumor bed after surgery and therefore are most likely to benefit from adjuvant radiation therapy. To address this problem, a number of technologies have been developed to try to improve margin assessment of resected tissue and to detect residual cancer in the tumor bed. Moreover, some of these approaches have been translated from the preclinical arena into clinical trials. Here, we review different types of intraoperative molecular imaging systems for cancer. Optical imaging techniques like epi-illumination, fluorescence molecular tomography and optoacoustic imaging can be coupled with exogenous fluorescent imaging probes that accumulate in tumors passively via the enhanced permeability and retention effect or are targeted to tumor tissues based on affinity or enzyme activity. In these approaches, detection of fluorescence in the tumor bed may indicate residual disease. Protease activated probes have generated great interest because of their potential for leading to high tumor to normal contrast. Recently, the first Phase I clinical trial to assess the safety and activation of a protease activated probe was conducted. Spectroscopic methods like radiofrequency spectroscopy and Raman spectroscopy, which are based on energy absorption and scattering respectively, have also been tested in humans and are able to distinguish between normal and tumors tissues intraoperatively. Most recently, multi-modal contrast agents have been developed that target tumors and contain both fluorescent dyes and MRI contrast agents, allowing for preoperative planning and intraoperative margin assessment with a single contrast agent. Further

  20. 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

  1. 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

  2. Progression to macula-off tractional retinal detachment after a contralateral intraoperative intravitreal bevacizumab injection for proliferative diabetic retinopathy.

    PubMed

    Zlotcavitch, Leonid; Flynn, Harry W; Avery, Robert L; Rachitskaya, Aleksandra

    2015-01-01

    We report a patient with progression to a macula-off tractional retinal detachment in a fellow eye after a contralateral intraoperative intravitreal bevacizumab injection. A 32-year-old diabetic man noted decreased vision in his left eye 1 week following 25 gauge pars plana vitrectomy, gas tamponade, and intraoperative injection of bevacizumab in his right eye. Left eye visual acuity decreased from 20/80 to 20/200, and macula-off tractional retinal detachment was seen on clinical exam and imaging. Progression of tractional retinal detachment associated with proliferative diabetic retinopathy in a fellow eye after a contralateral intraoperative intravitreal bevacizumab injection may occur.

  3. Incidence, influencing factors, and prognostic impact of intraoperative massive blood loss in adolescents with neuromuscular scoliosis

    PubMed Central

    Jia, Rui; Li, Na; Xu, Bi-Yun; Zhang, Wei; Gu, Xiao-ping; Ma, Zheng-Liang

    2017-01-01

    Abstract Factors influencing massive blood loss for neuromuscular scoliosis (NMS) patients. Despite advances in surgical and anesthetic techniques, scoliosis surgery is still associated with intraoperative massive blood loss, which can result in postoperative mortality and morbidity. The aim of this study was to assess the incidence, influencing factors, and prognostic impact of intraoperative massive blood loss in adolescents with NMS. A retrospective review of adolescents who underwent posterior spinal instrumentation and fusion for NMS was performed. Perioperative variables and data were recorded. Massive blood loss was defined as an estimated blood loss that exceeds 30% of total blood volume. We obtained data for 114 patients, of whom 63 (55%) had intraoperative massive blood loss. Compared with those without, patients with massive blood loss were more likely to be older, have lower body mass indexes (BMIs), larger Cobb angles, more fused levels, more osteotomy procedures, and prolonged duration of operation. Logistic regression analysis identified the number of fused levels to be more than 12 (P = 0.003, odds ratio = 6.614, 95% confidence interval [CI]: 1.891–23.131), BMI lower than 16.8 kg/m2 (P = 0.025, odds ratio = 3.293, 95% CI: 1.159–9.357), age greater than 15 years (P = 0.014, odds ratio = 3.505, 95% CI: 1.259–9.761), and duration of operation longer than 4.4 hours (P = 0.016, odds ratio = 3.746, 95% CI: 1.428–9.822) as influencing factors. Patients with massive blood loss are associated with more intraoperative colloids infusion and blood transfusions (red blood cell and fresh frozen plasma), as well as postoperative drainage volume. In adolescents with NMS who underwent posterior spinal instrumentation and fusion operations, intraoperative massive blood loss is common. The number of fused levels, BMI, age, and duration of operation are factors influencing intraoperative massive blood loss. PMID:28296737

  4. 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

  5. A Case of Large Anterior Paraclinoid Aneurysm with Intraoperative Premature Rupture

    PubMed Central

    Ichimura, Shinya; Inaba, Makoto; Kagami, Hiroshi

    2012-01-01

    We report here troubleshooting of intraoperative premature rupture with large anterior paraclinoid aneurysm, which was successfully clipped. A 61-year-old woman with left nasal hemianopia was referred to our institute. Preoperative three-dimensional computed tomography angiography and a left internal carotid artery angiogram showed a large left anterior clinoid aneurysm adjacent to the anterior clinoid process. Aneurysm was ruptured prematurely and tentative clipping of the dome of the aneurysm was done incidentally to stop bleeding and to reduce the volume of the aneurysm. The anterior clinoid process and superior wall of the orbit were drilled out safely, since the tentative clipping had created sufficient space between the aneurysm and the anterior clinoid process to perform the procedure. The proximal neck was observed and tandem clipping was applied to the aneurysm. Intraoperative and postoperative angiography revealed complete disappearance of the aneurysm. PMID:23946926

  6. An extraordinary mechanism causing intraoperative migration of the Kirschner-wire.

    PubMed

    Eroğlu, Mehmet; Özcan, Özal; Şentürk, İhsan; Yücehan, Mehmet

    2016-01-01

    Migration of Kirschner wires (K-wires) postoperatively and with use of cannulated implants intraoperatively is a well-known complication. In this article, we present an extraordinary mechanism causing intraoperative migration of a K-wire. A K-wire which was used for temporary fixation of fracture fragments migrated forwardly due to its contact with the drill bit while drilling a hole for a screw. The interaction between the K-wire and the drill bit simulated a gear wheel effect and thus the rotating K-wire advanced. Although no complications occurred in this case, we believe that the mentioned mechanism may be of importance particularly in osteoporotic patients and may cause damage to vital structures.

  7. Evaluating the effect of intraoperative peritoneal lavage on bacterial culture in dogs with suspected septic peritonitis.

    PubMed

    Swayne, Seanna L; Brisson, Brigitte; Weese, J Scott; Sears, William

    2012-09-01

    This pilot study describes the effect of intraoperative peritoneal lavage (IOPL) on bacterial counts and outcome in clinical cases of septic peritonitis. Intraoperative samples were cultured before and after IOPL. Thirty-three dogs with presumed septic peritonitis on the basis of cytology were managed surgically during the study period. Positive pre-lavage bacterial cultures were found in 14 cases, 13 of which were a result of intestinal leakage. The post-lavage cultures showed fewer isolates in 9 cases and in 1 case became negative. The number of dogs with a decrease in the concentration of bacteria cultured from pre-lavage to post-lavage samples was not statistically significant. There was no significant effect of the change in pre- to post-lavage culture, single versus multiple types of bacteria, selection of an appropriate empiric antimicrobial on survival or the need for subsequent surgery.

  8. Real-time Near-infrared Virtual Intraoperative Surgical Photoacoustic Microscopy.

    PubMed

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

    2015-09-01

    We developed a near infrared (NIR) virtual intraoperative surgical photoacoustic microscopy (NIR-VISPAM) system that combines a conventional surgical microscope and an NIR light photoacoustic microscopy (PAM) system. NIR-VISPAM can simultaneously visualize PA B-scan images at a maximum display rate of 45 Hz and display enlarged microscopic images on a surgeon's view plane through the ocular lenses of the surgical microscope as augmented reality. The use of the invisible NIR light eliminated the disturbance to the surgeon's vision caused by the visible PAM excitation laser in a previous report. Further, the maximum permissible laser pulse energy at this wavelength is approximately 5 times more than that at the visible spectral range. The use of a needle-type ultrasound transducer without any water bath for acoustic coupling can enhance convenience in an intraoperative environment. We successfully guided needle and injected carbon particles in biological tissues ex vivo and in melanoma-bearing mice in vivo.

  9. 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

  10. Wide-field optical coherence micro-elastography for intraoperative assessment of human breast cancer margins

    PubMed Central

    Allen, Wes M.; Chin, Lixin; Wijesinghe, Philip; Kirk, Rodney W.; Latham, Bruce; Sampson, David D.; Saunders, Christobel M.; Kennedy, Brendan F.

    2016-01-01

    Incomplete excision of malignant tissue is a major issue in breast-conserving surgery, with typically 20 - 30% of cases requiring a second surgical procedure arising from postoperative detection of an involved margin. We report advances in the development of a new intraoperative tool, optical coherence micro-elastography, for the assessment of tumor margins on the micro-scale. We demonstrate an important step by conducting whole specimen imaging in intraoperative time frames with a wide-field scanning system acquiring mosaicked elastograms with overall dimensions of ~50 × 50 mm, large enough to image an entire face of most lumpectomy specimens. This capability is enabled by a wide-aperture annular actuator with an internal diameter of 65 mm. We demonstrate feasibility by presenting elastograms recorded from freshly excised human breast tissue, including from a mastectomy, lumpectomies and a cavity shaving. PMID:27867721

  11. Retroperitoneoscopic drainage of bilateral psoas abscesses under intraoperative laparoscopic ultrasound guidance.

    PubMed

    Kodama, Koichi; Takase, Yasukazu; Motoi, Isamu; Mizuno, Hideki; Goshima, Kenichi; Sawaguchi, Takeshi

    2014-05-01

    Despite improved diagnostic modalities for psoas abscesses, the optimum management strategy is not uniform. A 67-year-old man presented with bilateral psoas abscesses secondary to L1-L2 pyogenic discitis. On contrast-enhanced CT, the largest of these abscesses measured 13 × 14 × 33 mm on the right. The patient developed sepsis caused by Klebsiella pneumonia. There were no signs of improvement after 3 weeks of systematic antibiotic administration. We performed surgical drainage of bilateral psoas abscesses by retroperitoneoscopy. Intraoperative laparoscopic ultrasound was useful to determine abscess location in the muscles prior to drainage and confirm no residual abscesses after drainage. The patient was afebrile 3 days later, and his clinical symptoms resolved. Retroperitoneoscopic drainage may represent a feasible minimally invasive therapeutic option for psoas abscess, and intraoperative laparoscopic ultrasound has the potential to increase the safety and efficacy of this surgical procedure.

  12. Descemet membrane endothelial keratoplasty: intraoperative and postoperative imaging spectral-domain optical coherence tomography.

    PubMed

    Ang, Marcus; Dubis, Adam M; Wilkins, Mark R

    2015-01-01

    We describe a case report of using the same handheld spectral-domain anterior segment optical coherence tomography (ASOCT) for rapid intraoperative and postoperative imaging in a case of Descemet membrane endothelial keratoplasty (DMEK). A 67-year-old woman, with Fuchs dystrophy and corneal decompensation, underwent DMEK with intraoperative ASOCT imaging using the handheld Envisu spectral domain ASOCT system (Bioptigen, Inc., Morrisville, NC, USA). We found that this easy-to-use portable system with handheld probe allowed for rapid imaging of the anterior segment during donor manipulation to visualize the orientation of the DMEK donor, as well as to confirm the initial adhesion of the DMEK donor. Moreover, the same system may be used for postoperative monitoring of graft adhesion, corneal thickness, and stromal remodeling in the clinic with very high-definition images.

  13. Three-dimensional Intraoperative Imaging Modalities in Orthopaedic Surgery: A Narrative Review.

    PubMed

    Qureshi, Sheeraz; Lu, Young; McAnany, Steven; Baird, Evan

    2014-12-01

    Intraoperative imaging and navigation systems have revolutionized orthopaedic surgery for the spine, joints, and orthopaedic trauma. Imaging modalities such as the isocentric C-arm, O-arm imaging, and intraoperative MRI or navigation systems allow the visualization of surgical instruments and implants relative to a three-dimensional CT image or MRI. Studies show that these technologies lower the rates of implant misplacement and inadequate fracture reduction, thereby improving surgical outcomes and reducing reoperation rates. An additional benefit is reduced radiation exposure compared with that for conventional fluoroscopy. Concerns surrounding adoption of these technologies include cost and increased operating times, but improvements in design and protocol may improve the integration of these imaging modalities into the operating room.

  14. Intraoperative thermal imaging in esophageal replacement: its use in the assessment of gastric tube viability.

    PubMed

    Nishikawa, Katsunori; Matsudaira, Hideki; Suzuki, Hideyuki; Mizuno, Ryouji; Hanyuu, Nobuyoshi; Iwabuchi, Shuuichi; Yanaga, Katsuhiko

    2006-01-01

    We examined the use of intraoperative thermal imaging to assess the gastric vascularization and gastric tube viability during esophagectomy. The surface temperatures of the intact stomach, devascularized stomach, and gastric tube were measured in 13 patients from the proximal end to the pylorus longitudinally along the greater curvature or along the entire gastric tube during esophagectomy. Thermal images clearly demonstrated a surface temperature decline in the proximal region of the gastric tube. The mean decline rate in the surface temperature in the proximal region of the gastric tube in comparison to the intact stomach was 17.7% (P < 0.001). One patient who developed gastric tube necrosis exhibited a prominent drop in the surface temperature in the proximal region of 20.6% in comparison to that in the distal region, compared to that of 12.5% in other patients. Intraoperative thermal imaging is a noninvasive and reliable technique for the assessment of the gastric tube viability.

  15. A case of large anterior paraclinoid aneurysm with intraoperative premature rupture.

    PubMed

    Ichimura, Shinya; Inaba, Makoto; Kagami, Hiroshi

    2012-10-01

    We report here troubleshooting of intraoperative premature rupture with large anterior paraclinoid aneurysm, which was successfully clipped. A 61-year-old woman with left nasal hemianopia was referred to our institute. Preoperative three-dimensional computed tomography angiography and a left internal carotid artery angiogram showed a large left anterior clinoid aneurysm adjacent to the anterior clinoid process. Aneurysm was ruptured prematurely and tentative clipping of the dome of the aneurysm was done incidentally to stop bleeding and to reduce the volume of the aneurysm. The anterior clinoid process and superior wall of the orbit were drilled out safely, since the tentative clipping had created sufficient space between the aneurysm and the anterior clinoid process to perform the procedure. The proximal neck was observed and tandem clipping was applied to the aneurysm. Intraoperative and postoperative angiography revealed complete disappearance of the aneurysm.

  16. [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.

  17. Intraoperative neural monitoring in thyroid surgery: lessons learned from animal studies

    PubMed Central

    Randolph, Gregory W.; Lu, I-Cheng; Chang, Pi-Ying; Chen, Yi-Ting; Hun, Pao-Chu; Lin, Yi-Chu; Dionigi, Gianlorenzo; Chiang, Feng-Yu

    2016-01-01

    Recurrent laryngeal nerve (RLN) injury remains a significant morbidity associated with thyroid and parathyroid surgery. In the past decade, surgeons have increasingly used intraoperative neural monitoring (IONM) as an adjunct technique for localizing and identifying the RLN, detecting RLN injury, and predicting the outcome of vocal cord function. In recent years, many animal studies have investigated common pitfalls and new applications of IONM. For example, the use of IONM technology in animal models has proven valuable in studies of the electrophysiology of RLN injury. The advent of animal studies has substantially improved understanding of IONM technology. Lessons learned from animal studies have immediate clinical applications in establishing reliable strategies for preventing intraoperative RLN injury. This article gives an overview of the research progress on IONM-relevant animal models. PMID:27867861

  18. A case report of intraoperative endoscopic ultrasound during robotic assisted Heller myotomy for severe esophageal achalasia.

    PubMed

    Abdel Khalek, Mohamed; Abbas, Abbas; Joshi, Virendra; Hariri, Nizar; Kandil, Emad

    2011-01-01

    Esophageal achalasia is the best described primary esophageal motility disorder. Endoscopic ultrasound (EUS) is considered a useful adjunct for grading and establishing the prognosis of these patients. Recent experience using Da Vinci robotic assisted myotomy has demonstrated that this is a safe and effective approach of treatment. The benefit of magnification and three dimensional imaging helps prevent esophageal perforation and identify residual circular muscle fibers. This paper reports the relative efficacy and safety of intraoperative ultrasound during robotic assisted myotomy in a patient with severe achalasia. Intraoperative esophageal endoscopic ultrasound is a safe technique that may improve the success rate of surgery by confirming the adequacy of myotomy, thereby decreasing the likelihood of recurrent symptoms.

  19. Intraoperative β{sup -} detecting probe for radio-guided surgery in tumour resection

    SciTech Connect

    Solfaroli Camillocci, Elena; Bellini, Fabio; Bocciy, Valerio; Collamatiyz, Francesco; Faccini, Riccardo; Paramattiy, Riccardo; Paterayz, Vincenzo; Pinciy, Davide; Recchiay, Luigi; Sciubbayz, Adalberto; Senzacqua, Martina; Voenay, Cecilia; Morgantiy, Silvio; De Luciax, Erika; Matteixk, Ilaria; Sartizx, Alessio; Russomando, Aandrea; Marafiniy, Michela

    2015-07-01

    The development of the β{sup -} based radio-guided surgery aims to extend the technique to those tumours where surgery is the only possible treatment and the assessment of the resection would most profit from the low background around the lesion, as for brain tumours. Feasibility studies on meningioma and gliomas already estimated the potentiality of this new treatment. To validate the technique, a prototype of the intraoperative probe detecting β{sup -} decays and specific phantoms simulating tumour remnant patterns embedded in healthy tissue have been realized. The response of the probe in this simulated environment is tested with dedicated procedures. This document discusses the innovative aspects of the method, the status of the developed intraoperative β{sup -} detecting probe and the results of the preclinical tests. (authors)

  20. [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.

  1. 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.

  2. Intraoperative 16-Channel Electroencephalography and Bilateral Near Infrared Spectroscopy Monitorization in Aortic Surgery

    PubMed Central

    Demir, Aslı; Aydınlı, Bahar; Ünal, Ertekin Utku; Bindal, Mustafa; Koçulu, Rabia; Sarıtaş, Ahmet; Karadeniz, Ümit

    2015-01-01

    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

  3. Functional preoperative and intraoperative mapping and monitoring: increasing safety and efficacy in glioma surgery.

    PubMed

    Ottenhausen, Malte; Krieg, Sandro M; Meyer, Bernhard; Ringel, Florian

    2015-01-01

    Greater extent of resection (EOR) of low-grade gliomas is associated with improved survival. Proximity to eloquent cortical regions often limits resectability and elevates the risk of surgery-related deficits. Therefore, functional localization of eloquent cortex or subcortical fiber tracts can enhance the EOR and functional outcome. Imaging techniques such as functional MRI and diffusion tensor imaging fiber tracking, and neurophysiological methods like navigated transcranial magnetic stimulation and magnetoencephalography, make it possible to identify eloquent areas prior to resective surgery and to tailor indication and surgical approach but also to assess the surgical risk. Intraoperative monitoring with direct cortical stimulation and subcortical stimulation enables surgeons to preserve essential functional tissue during surgery. Through tailored pre- and intraoperative mapping and monitoring the EOR can be maximized, with reduced rates of surgery-related deficits.

  4. 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.

  5. Intraoperative monitoring by imaging and electrophysiological techniques during giant intracranial aneurysm surgery.

    PubMed

    Durand, A; Penchet, G; Thines, L

    2016-02-01

    Difficulties in giant intracranial aneurysm surgery are the consequence of aneurysmal wall histology and the complex angioarchitecture of the vascular tree. In order to reduce complications and risks of those procedures, various imaging and electrophysiological techniques can be implemented perioperatively. The authors review the principles, goals and main results in this context of micro-Doppler and flowmeter techniques, near-infrared spectroscopy, operative microscope-integrated indocyanine green video-angiography, neuro-endoscopy, selective intraoperative angiography and electrophysiological monitoring.

  6. 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

  7. 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.

  8. Anesthetic Complication during Maxillofacial Trauma Surgery: A Case Report of Intraoperative Tension Pneumothorax.

    PubMed

    Al Shetawi, Al Haitham; Golden, Leonard; Turner, Michael

    2016-09-01

    Tension pneumothorax is a life-threatening emergency that requires a high index of suspension and immediate intervention to prevent circulatory collapse and death. Only five cases of pneumothorax were described in the Oral and Maxillofacial Surgery literature. All cases were postoperative complications associated with orthognathic surgery. We report a case of intraoperative tension pneumothorax during a routine facial trauma surgery requiring emergency chest decompression. The possible causes, classification, and reported cases will be presented.

  9. Complications and Cost Analysis of Intraoperative Arterial Complications in Head and Neck Free Flap Reconstruction.

    PubMed

    Chang, Catherine S; Chu, Michael W; Nelson, Jonas A; Basta, Marten; Gerety, Patrick; Kanchwala, Suhail K; Wu, Liza C

    2017-02-25

    Background Microvascular anastomotic patency is fundamental to head and neck free flap reconstructive success. The aims of this study were to identify factors associated with intraoperative arterial anastomotic issues and analyze the impact on subsequent complications and cost in head and neck reconstruction. Methods A retrospective review was performed on all head and neck free flap reconstructions from 2005 to 2013. Patients with intraoperative, arterial anastomotic difficulties were compared with patients without. Postoperative outcomes and costs were analyzed to determine factors associated with microvascular arterial complications. A regression analysis was performed to control for confounders. Results Total 438 head and neck free flaps were performed, with 24 (5.5%) having intraoperative arterial complications. Patient groups and flap survival between the two groups were similar. Free flaps with arterial issues had higher rates of unplanned reoperations (p < 0.001), emergent take-backs (p = 0.034), and major surgical (p = 0.002) and respiratory (p = 0.036) complications. The overall cost of reconstruction was nearly double in patients with arterial issues (p = 0.001). Regression analysis revealed that African American race (OR = 5.5, p < 0.009), use of vasopressors (OR = 6.0, p = 0.024), end-to-side venous anastomosis (OR = 4.0, p = 0.009), and use of internal fixation hardware (OR =3.5, p = 0.013) were significantly associated with arterial complications. Conclusion Intraoperative arterial complications may impact complications and overall cost of free flap head and neck reconstruction. Although some factors are nonmodifiable or unavoidable, microsurgeons should nonetheless be aware of the risk association. We recommend optimizing preoperative comorbidities and avoiding use of vasopressors in head and neck free flap cases to the extent possible.

  10. An MRS- and PET-guided biopsy tool for intraoperative neuronavigational systems.

    PubMed

    Grech-Sollars, Matthew; Vaqas, Babar; Thompson, Gerard; Barwick, Tara; Honeyfield, Lesley; O'Neill, Kevin; Waldman, Adam D

    2017-03-17

    OBJECTIVE Glioma heterogeneity and the limitations of conventional structural MRI for identifying aggressive tumor components can limit the reliability of stereotactic biopsy and, hence, tumor characterization, which is a hurdle for developing and selecting effective treatment strategies. In vivo MR spectroscopy (MRS) and PET enable noninvasive imaging of cellular metabolism relevant to proliferation and can detect regions of more highly active tumor. Here, the authors integrated presurgical PET and MRS with intraoperative neuronavigation to guide surgical biopsy and tumor sampling of brain gliomas with the aim of improving intraoperative tumor-tissue characterization and imaging biomarker validation. METHODS A novel intraoperative neuronavigation tool was developed as part of a study that aimed to sample high-choline tumor components identified by multivoxel MRS and (18)F-methylcholine PET-CT. Spatially coregistered PET and MRS data were integrated into structural data sets and loaded onto an intraoperative neuronavigation system. High and low choline uptake/metabolite regions were represented as color-coded hollow spheres for targeted stereotactic biopsy and tumor sampling. RESULTS The neurosurgeons found the 3D spherical targets readily identifiable on the interactive neuronavigation system. In one case, areas of high mitotic activity were identified on the basis of high (18)F-methylcholine uptake and elevated choline ratios found with MRS in an otherwise low-grade tumor, which revealed the possible use of this technique for tumor characterization. CONCLUSIONS These PET and MRI data can be combined and represented usefully for the surgeon in neuronavigation systems. This method enables neurosurgeons to sample tumor regions based on physiological and molecular imaging markers. The technique was applied for characterizing choline metabolism using MRS and (18)F PET; however, this approach provides proof of principle for using different radionuclide tracers and

  11. An MRS- and PET-guided biopsy tool for intraoperative neuronavigational systems.

    PubMed

    Grech-Sollars, Matthew; Vaqas, Babar; Thompson, Gerard; Barwick, Tara; Honeyfield, Lesley; O'Neill, Kevin; Waldman, Adam D

    2016-11-11

    OBJECTIVE Glioma heterogeneity and the limitations of conventional structural MRI for identifying aggressive tumor components can limit the reliability of stereotactic biopsy and, hence, tumor characterization, which is a hurdle for developing and selecting effective treatment strategies. In vivo MR spectroscopy (MRS) and PET enable noninvasive imaging of cellular metabolism relevant to proliferation and can detect regions of more highly active tumor. Here, the authors integrated presurgical PET and MRS with intraoperative neuronavigation to guide surgical biopsy and tumor sampling of brain gliomas with the aim of improving intraoperative tumor-tissue characterization and imaging biomarker validation. METHODS A novel intraoperative neuronavigation tool was developed as part of a study that aimed to sample high-choline tumor components identified by multivoxel MRS and (18)F-methylcholine PET-CT. Spatially coregistered PET and MRS data were integrated into structural data sets and loaded onto an intraoperative neuronavigation system. High and low choline uptake/metabolite regions were represented as color-coded hollow spheres for targeted stereotactic biopsy and tumor sampling. RESULTS The neurosurgeons found the 3D spherical targets readily identifiable on the interactive neuronavigation system. In one case, areas of high mitotic activity were identified on the basis of high (18)F-methylcholine uptake and elevated choline ratios found with MRS in an otherwise low-grade tumor, which revealed the possible use of this technique for tumor characterization. CONCLUSIONS These PET and MRI data can be combined and represented usefully for the surgeon in neuronavigation systems. This method enables neurosurgeons to sample tumor regions based on physiological and molecular imaging markers. The technique was applied for characterizing choline metabolism using MRS and (18)F PET; however, this approach provides proof of principle for using different radionuclide tracers and

  12. Positron emission tomography-computed tomography coregistration for diagnosis and intraoperative localization in recurrent nelson syndrome.

    PubMed

    Hintz, Eric B; Tomlin, Jeffery M; Chengazi, Vaseem; Vates, G Edward

    2013-06-01

    Recurrent pituitary disease presents unique challenges, including in some cases difficulty localizing a tumor radiographically. Here, we present the case of a patient with recurrent Nelson syndrome whose radiographic work-up was complicated by a significant parasellar metallic artifact. Positron emission tomography ultimately localized the lesion, and coregistration with computed tomography allowed for accurate intraoperative navigation. Additionally, we review a range of imaging techniques available in the evaluation of pituitary disease.

  13. Intraoperative Optical Biopsy During Robotic-Assisted Radical Prostatectomy Using Confocal Endomicroscopy

    PubMed Central

    Mach, Kathleen E.; Bui, Daniel; Liu, Jen-Jane; Rouse, Robert V.; Harris, Theodore; Leppert, John T.; Liao, Joseph C.

    2015-01-01

    Purpose Intraoperative optical biopsy technologies may aid identification of important anatomic landmarks and improve surgical outcomes of robotic-assisted radical prostatectomy (RARP).We sought to evaluate the feasibility of confocal laser endomicroscopy (CLE) during RARP. Materials and Methods Twenty-one patients with biopsy-proven prostate cancer scheduled for RARP were recruited. After intravenous administration of fluorescein, 15 patients underwent in vivo intraoperative CLE of prostatic and periprostatic structures using either a 2.6-mm or 0.85-mm imaging probe. Standard robotic instruments were used to grasp and maneuver the CLE probes for image acquisition. CLE imaging was performed ex vivo on fresh prostate specimens from 20 patients. Confocal video sequences acquired in vivo and ex vivo were reviewed and analyzed, with additional image processing using a mosaicing algorithm. Processed confocal images were compared with standard hematoxylin and eosin analysis of imaged regions. Results CLE was successfully integrated with robotic surgery, including co-registration of confocal video sequences with white light and probe handling with standard robotic instrumentation. Intraoperative CLE imaging of the neurovascular bundle prior to and following nerve-sparing dissection revealed characteristic features including dynamic vascular flow and intact axon fibers. Ex vivo confocal imaging of the prostatic parenchyma demonstrated the normal prostatic glands, stroma, and prostate carcinoma. Conclusions We report the initial feasibility of optical biopsy of prostatic and periprostatic tissue during RARP. Image guidance and tissue interrogation using CLE offers a new intraoperative imaging method that has the potential to improve the functional and oncologic outcomes of prostate cancer surgery. PMID:26626214

  14. Registration-free laparoscope augmentation for intra-operative liver resection planning

    NASA Astrophysics Data System (ADS)

    Feuerstein, Marco; Mussack, Thomas; Heining, Sandro M.; Navab, Nassir

    2007-03-01

    In recent years, an increasing number of liver tumor indications were treated by minimally invasive laparoscopic resection. Besides the restricted view, a major issue in laparoscopic liver resection is the enhanced visualization of (hidden) vessels, which supply the tumorous liver segment and thus need to be divided prior to the resection. To navigate the surgeon to these vessels, pre-operative abdominal imaging data can hardly be used due to intraoperative organ deformations mainly caused by appliance of carbon dioxide pneumoperitoneum and respiratory motion. While regular respiratory motion can be gated and synchronized intra-operatively, motion caused by pneumoperitoneum is individual for every patient and difficult to estimate. Therefore, we propose to use an optically tracked mobile C-arm providing cone-beam CT imaging capability intraoperatively. The C-arm is able to visualize soft tissue by means of its new flat panel detector and is calibrated offline to relate its current position and orientation to the coordinate system of a reconstructed volume. Also the laparoscope is optically tracked and calibrated offline, so both laparoscope and C-arm are registered in the same tracking coordinate system. Intra-operatively, after patient positioning, port placement, and carbon dioxide insufflation, the liver vessels are contrasted and scanned during patient exhalation. Immediately, a three-dimensional volume is reconstructed. Without any further need for patient registration, the volume can be directly augmented on the live laparoscope video, visualizing the contrasted vessels. This augmentation provides the surgeon with advanced visual aid for the localization of veins, arteries, and bile ducts to be divided or sealed.

  15. Intraoperative bradycardia and postoperative hyperkalemia in patients undergoing endoscopic third ventriculostomy.

    PubMed

    Anandh, B; Madhusudan Reddy, K R; Mohanty, A; Umamaheswara Rao, G S; Chandramouli, B A

    2002-09-01

    During our initial experience with endoscopic third ventriculostomies, we observed intraoperative bradycardia and postoperative hyperkalemia. The present study was carried out to verify the consistency of these initial observations. Intraoperative heart rate (HR) changes and postoperative serum K + changes were studied prospectively in 20 patients of endoscopic third ventriculostomy. Another 6 patients who underwent endoscopic procedures other than ventriculostomy acted as controls. The anaesthetic technique and intraoperative and postoperative fluid regimen were similar in all patients. Serum K + concentrations were measured intraoperatively and once a day for the next 5 days. The third ventriculostomy group exhibited a significant slowing of the heart rate during the fenestration of the floor of the third ventricle (112 +/- 26 to 101 +/- 28 bpm, p < 0.001) and also at the time of the reversal of the neuromuscular block at the end of surgery (104 +/- 29 to 96 +/- 33 bpm, p < 0.01). The control group did not exhibit similar changes in the heart rate. The postoperative increase in serum K + values in the ventriculostomy group (0.82 +/- 0.55 mmol/L) was higher than that in the control group (0.10 +/- 0.44 mmol/L) (p < 0.01). Endoscopic third ventriculostomy is associated with a significant bradycardia at the time of fenestration and at the time of reversal of the neuromuscular block. The procedure is also associated with a postoperative increase in serum K + values. We propose a mechanism involving distortion of the posterior hypothalamus, which accounts for the bradycardia and postoperative hyperkalemia.

  16. Accuracy of pedicle screw placement using intraoperative neurophysiological monitoring and computed tomography.

    PubMed

    Mavrogenis, Andreas F; Papagelopoulos, Panayiotis J; Korres, Demetrios S; Papadopoulos, Konstantinos; Sakas, Damianos E; Pneumaticos, Spiros

    2009-01-01

    Fifty consecutive patients with posterior thoracolumbar spine fusion were included in a prospective study to determine the accuracy of intraoperative neurophysiological monitoring (IONM) for safe pedicle screw placement using postoperative computed tomography (CT). The patients were allocated into two equal groups. Pedicle screw placement was evaluated intraoperatively by using the image intensifier. In group A, the integrity of the pedicle wall was evaluated intraoperatively with monopolar stimulation of each screw head with a hand-held single-tip stimulator; the compound muscle action potentials were recorded. A constant current threshold of 7 mA was considered indicative of pedicle breach; < 7 mA was considered as direct contact with neural elements, and > 7mA was considered normal. In group B, pedicle screw placement was performed without IONM. Overall, 306 pedicle screws were inserted in both groups. Postoperatively, all patients underwent CT scans of the spine to evaluate pedicle screw placement. Intraoperatively, five screws in respective group A patients had to be repositioned after IONM (threshold of < 7 mA); in these patients, postoperative CT scans showed proper screw placement. Postoperative CT scans showed eight misdirected screws; two screws (1.26%) in group A patients and six screws (4%) in group B patients. Two screws were misdirected through the medial pedicle wall and six screws were misdirected through the lateral pedicle wall. Both medially misdirected screws were observed in group B patients (1.35%); these patients developed neurologic symptoms postoperatively and underwent revision surgery, with redirection of the misdirected screws and subsequent resolution of the neurologic symptoms. Two of the six laterally misdirected screws were observed in group A patients (1.26%); the remaining four laterally misdirected screws were observed in group B patients (2.7%). None of these patients had neurologic sequelae; no revision surgery was required. The

  17. Use of Intraoperative Temporary Invasive Distraction to Reduce a Chronic Talar Neck Fracture-Dislocation

    DTIC Science & Technology

    2011-04-01

    medial approaches with a medial malleolar osteotomy . The talus was approximately 60° externally rotated in the mortise with the talar head pointing... TYPE N/A 3. DATES COVERED - 4. TITLE AND SUBTITLE Use of intraoperative temporary invasive distraction to reduce a chronic talar neck...if needed (this pin was not available in the external fixator set used in this procedure ). The construct was then assembled using four 4.0-mm

  18. Intraoperative Device Closure of Atrial Septal Defects with Minimal Transthoracic Invasion

    PubMed Central

    Zhu, Peng; Sun, Yong; Yang, Qian; Qiu, Feng

    2013-01-01

    Atrial septal defect is one of the most common congenital heart defects. Open-heart repair via midline sternotomy or right thoracotomy and cardiopulmonary bypass has been considered the standard treatment for the closure of atrial septal defects, but transcatheter closure with the Amplatzer septal occluder has recently become a viable option. We have adopted a 3rd alternative: intraoperative device closure with minimal transthoracic invasion. From May 2007 through June 2011, 250 patients with secundum atrial septal defect underwent cardiac surgery at our institution. Open-heart repair with cardiopulmonary bypass was performed in 72 patients, and intraoperative device closure was performed in 178 patients. This minimally invasive approach, which required a full evaluation of the atrial septal defect by transthoracic echocardiography, was performed by deploying the device through the delivery sheath to occlude the atrial septal defect. The approach was successful in 175 of the 178 patients. The size of the implanted occluder ranged from 12 to 46 mm in diameter. Minor complications included transient arrhythmias (n=7) and pleural effusion (n=25). After complete release, the intraoperative occluder device dislodged in the right atrium in 3 patients, who then underwent immediate surgical repair with cardiopulmonary bypass. All discharged patients were monitored for 2.3 years to 5 years. As monotherapy, intraoperative device closure of atrial septal defect with minimal transthoracic invasion is a safe and feasible technique. It is particularly beneficial for elderly patients or patients with pulmonary hypertension and is associated with better cosmetic results and less trauma than is surgical closure. PMID:23914014

  19. An intraoperative multimodal neurophysiologic approach to successful resection of precentral gyrus epileptogenic lesions.

    PubMed

    Simon, Mirela V; Cole, Andrew J; Chang, Eric C; Buchbinder, Bradley R; Stufflebeam, Steve M; Nozari, Ala; Stemmer-Rachamimov, Anat O; Eskandar, Emad N

    2012-04-01

    Cortical dysplasias (CDs) are highly epileptogenic lesions with a good prognosis of seizure freedom, if totally resected. However, their accurate delineation and resection can be difficult, and depend on the extent of pathology and lesion location. Intraoperative neurophysiologic assessments are valuable in these situations. We present an illustrative case of intractable epilepsy where judicious use of intraoperative neurophysiologic-techniques guided resection of precentral CD, under general anesthesia and in the absence of preoperative electrophysiologic mapping data. Ictal onset was accurately delineated using electrocorticography (ECoG). Phase reversal of the median somatosensory-evoked potentials (MSSEPs) localized the central sulcus (CS). Motor evoked potentials (MEPs) triggered by high-frequency monopolar anodal electrical cortical stimulation at the primary motor cortex (PMC) threshold delineated the PMC. Using this technique, PMC and the corticospinal tract (CST) were continuously monitored during resection. No changes in MEPs from the preresection baseline were seen; no residual abnormal activity was present in the postresection ECoG. The patient emerged from surgery without deficits and has been seizure free during a 10-month follow-up. Staged multimodal intraoperative neurophysiology can be used successfully under general anesthesia to guide resection of epileptogenic lesions within the precentral gyrus, as an add-on or, in certain situations, as a viable alternative to preoperative electrophysiologic mapping.

  20. An intraoperative multimodal neurophysiologic approach to successful resection of precentral gyrus epileptogenic lesions

    PubMed Central

    Simon, Mirela V.; Cole, Andrew J.; Chang, Eric C.; Buchbinder, Bradley R.; Stufflebeam, Steve M.; Nozari, Ala; Stemmer-Rachamimov, Anat O.; Eskandar, Emad N.

    2013-01-01

    Cortical dysplasias (CDs) are highly epileptogenic lesions with a good prognosis of seizure freedom, if totally resected. However, their accurate delineation and resection can be difficult, and depend on the extent of pathology and lesion location. Intraoperative neurophysiologic assessments are valuable in these situations. We present an illustrative case of intractable epilepsy where judicious use of intraoperative neurophysiologic–techniques guided resection of precentral CD, under general anesthesia and in the absence of preoperative electrophysiologic mapping data. Ictal onset was accurately delineated using electrocorticography (ECoG). Phase reversal of the median somatosensory-evoked potentials (MSSEPs) localized the central sulcus (CS). Motor evoked potentials (MEPs) triggered by high-frequency monopolar anodal electrical cortical stimulation at the primary motor cortex (PMC) threshold delineated the PMC. Using this technique, PMC and the corticospinal tract (CST) were continuously monitored during resection. No changes in MEPs from the pre-resection baseline were seen; no residual abnormal activity was present in the postresection ECoG. The patient emerged from surgery without deficits and has been seizure free during a 10-month follow-up. Staged multimodal intraoperative neurophysiology can be used successfully under general anesthesia to guide resection of epileptogenic lesions within the precentral gyrus, as an add-on or, in certain situations, as a viable alternative to preoperative electrophysiologic mapping. PMID:22309192

  1. 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

  2. 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

  3. The First Simultaneous Intraoperative Hyperthermia and Radiotherapy Procedure: Dog Experiment and Technique

    PubMed Central

    Ashayeri, Ebrahim; Halyard, Michele; Goldson, Alfred L.; Cruz, Leon; Nibhanupudy, J. Rao; DeWitty, Robert; Galal, Fathy; Marquis, Bernard; Slaughter, Lynnard; Landes, Fred

    1987-01-01

    The Department of Radiation Therapy of Howard University Hospital was the first to revive (1976) the use of intraoperative radiotherapy, or direct view irradiation, using electron beam (IORTe−) in the United States. Since that time, this pioneering effort has gained both national and international acceptance. Now, many leading centers employ this investigational treatment modality. Recently, a new mode of cancer therapy has been gaining acceptance, namely hyperthermia (the treatment of cancer by heat). Hyperthermia has been shown, both experimentally and clinically, to improve the rate of local control (thermal enchancement ratio [TER]) when combined with radiation therapy in the treatment of cancer. Maximal TER has been observed with simultaneous or immediate application of radiation and hyperthermia for both tumor and normal tissues. Therefore, to achieve maximum therapeutic gain, selective, intraoperative, simultaneous heating and irradiation of the tumor with mechanical retraction of the normal and sensitive structures from the treatment field seems a promising alternative. There have been no published reports, to the authors' knowledge, on the combination of simultaneous IORTe− with intraoperative hyperthermia (IOHT). To employ this combination in human subjects, several questions must be answered first using animal models, including the technical and practical feasibility, the toxicity and morbidity, as well as the pathologic changes that may arise. The technical aspects of the first animal case, using a mongrel dog, applying simultaneous IORTe− and IOHT are presented. PMID:3112416

  4. 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.

  5. 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

  6. 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

  7. Intraoperative imaging of tumors with indo-cyanine green fluorescence with an endoscope

    NASA Astrophysics Data System (ADS)

    Parthasarathy, Ashwin B.; Chong, Sang Hoon; Moscatelli, Frank A.; Singhal, Sunil; Yodh, Arjun G.

    2015-03-01

    Surgery is the most effective treatment strategy for solid tumors. Intraoperative imaging of tumors helps detect tumor margins and establish the most appropriate surgical margins. Endoscopic surgery is a standard of care procedure for the resection of tumors, and is applicable for a wide range of solid tumors. While several imaging methodologies can be used for intraoperative imaging, optical imaging is promising for clinical application because it can detect microscopic disease, is minimally invasive, is inexpensive, does not require advance training for surgeons and can provide real-time images. Fluorescence from an injected contrast agent (Indo-cyanine green, ICG) has been effectively used for the identification of tumors in humans. In this study, we adapt a commercially available endoscope for intraoperative imaging of solid tumors. Our instrument utilizes light from a near-infrared 780nm LED to illuminate the surgical field of view and two CCD cameras for imaging the reflected fluorescence as well as the background tissue. We show that our instrument can simultaneously image fluorescence from the tumor as well as the background tissue. We characterize our instrument in tissue simulating phantoms, with tumor simulating `targets'.

  8. Real Time Intraoperative Monitoring of Blood Loss with a Novel Tablet Application

    PubMed Central

    Sharareh, Behnam; Woolwine, Spencer; Satish, Siddarth; Abraham, Peter; Schwarzkopf, Ran

    2015-01-01

    Introduction : Real-time monitoring of blood loss is critical in fluid management. Visual estimation remains the standard of care in estimating blood loss, yet is demonstrably inaccurate. Photometric analysis, which is the referenced “gold-standard” for measuring blood loss, is both time-consuming and costly. The purpose of this study was to evaluate the efficacy of a novel tablet-monitoring device for measurement of Hb loss during orthopaedic procedures. Methods : This is a prospective study of 50 patients in a consecutive series of joint arthroplasty cases. The novel System with Feature Extraction Technology was used to measure the amount of Hb contained within surgical sponges intra-operatively. The system’s measures were then compared with those obtained via gravimetric method and photometric analysis. Accuracy was evaluated using linear regression and Bland-Altman analysis. Results : Our results showed a significant positive correlation between Triton tablet system and photometric analysis with respect to intra-operative hemoglobin and blood loss at 0.92 and 0.91, respectively. Discussion : This novel system can accurately determine Hb loss contained within surgical sponges. We believe that this user-friendly software can be used for measurement of total intraoperative blood loss and thus aid in a more accurate fluid management protocols during orthopaedic surgical procedures. PMID:26401167

  9. Intraoperative detection and removal of microscopic residual sarcoma using wide-field imaging

    PubMed Central

    Mito, Jeffrey K; Ferrer, Jorge M; Brigman, Brian E; Lee, Chang-Lung; Dodd, Rebecca D; Eward, William C; Marshall, Lisa F; Cuneo, Kyle C; Carter, Jessica E; Ramasunder, Shalini; Kim, Yongbaek; Lee, W David; Griffith, Linda G; Bawendi, Moungi G; Kirsch, David G

    2012-01-01

    Abstract BACKGROUND: The goal of limb-sparing surgery for a soft tissue sarcoma of the extremity is to remove all malignant cells while preserving limb function. After initial surgery, microscopic residual disease in the tumor bed will cause a local recurrence in approximately 33% of patients with sarcoma. To help identify these patients, the authors developed an in vivo imaging system to investigate the suitability of molecular imaging for intraoperative visualization. METHODS: A primary mouse model of soft tissue sarcoma and a wide field-of-view imaging device were used to investigate a series of exogenously administered, near-infrared (NIR) fluorescent probes activated by cathepsin proteases for real-time intraoperative imaging. RESULTS: The authors demonstrated that exogenously administered cathepsin-activated probes can be used for image-guided surgery to identify microscopic residual NIR fluorescence in the tumor beds of mice. The presence of residual NIR fluorescence was correlated with microscopic residual sarcoma and local recurrence. The removal of residual NIR fluorescence improved local control. CONCLUSIONS: The authors concluded that their technique has the potential to be used for intraoperative image-guided surgery to identify microscopic residual disease in patients with cancer. Cancer 2012. © 2012 American Cancer Society. PMID:22437667

  10. Utility of squash smear cytology in intraoperative diagnosis of central nervous system tumors

    PubMed Central

    Patil, Savita S; Kudrimoti, Jyoti K; Agarwal, Rachana D; Jadhav, Meenal V; Chuge, Ashish

    2016-01-01

    Background: Central nervous system (CNS) squash cytology (CSC) has established itself as a technically simple, rapid, inexpensive, fairly accurate, and dependable intraoperative diagnostic tool. It helps neurosurgeons immensely when management is dependent on it. Aims: This study aimed at finding out the utility of CSC as an intraoperative diagnostic tool from a neurosurgeon's perspective. Materials and Methods: Fifty prospectively registered patients with clinical diagnosis of CNS tumors were enrolled in the study. All the patients were subjected to magnetic resonance imaging (MRI). Intraoperative CSC was performed and smears were stained with Leishman and rapid Hematoxylin and Eosin (H and E) stain. The diagnosis of CSC was compared with MRI diagnosis and histopathological diagnosis. The CNS tumors were categorized based on clinical and therapeutic implications. Diagnostic accuracy, sensitivity, specificity, and positive and negative predictive value of MRI and CSC were calculated by using appropriate formulae. Results and Conclusions: The age range of the CNS tumors included in the study was 2 to 68 years. There was a slight female preponderance. Sensitivity, specificity, positive predictive value, and negative predictive value of preoperative MRI were 90.47%, 82.76%, 79.17%, and 92.31% respectively. These values of utility parameters for CSC were 100% for each of the clinical and therapeutic implications. It helped neurosurgeons in optimizing surgical procedure in 12 cases of meningioma. It influenced surgical management in 1 case of infratentorial pilocytic astrocytoma, and helped in the diagnosis and management of 9 unexpected tumors missed on MRI. PMID:28028335

  11. A technique for intraoperative creation of patient-specific titanium mesh implants.

    PubMed

    Sunderland, Ian Rp; Edwards, Glenn; Mainprize, James; Antonyshyn, Oleh

    2015-01-01

    Prefabricated, patient-specific alloplastic implants for cranioplasty reduce surgical complexity, decrease operative times, minimize exposure and risk of contamination, and have resulted in improved aesthetic results. However, in creating a prefabricated custom implant using a patient's computed tomography data, a stable, unalterable defect must be clearly defined before surgery. In the event that an intraoperative modification of an exiting skull defect is required, or in cases of tumour resection in which the size of the skull defect is unknown preoperatively, these prefabricated implants cannot be used. The ideal method for alloplastic cranioplasty would enable cost-effective creation of a patient-specific implant with the capacity for intraoperative modification. The present article describes a novel technique of cranioplasty that uses a patient's computed tomography data to create a custom forming tool (ie, mold), enabling intraoperative creation of a patient-specific titanium mesh implant. The utility of these implants in creating a custom reconstructive solution in cases in which the size of the skull defect is unknown preoperatively will be demonstrated using two case presentations.

  12. Intraoperative probe detecting β- decays in brain tumour radio-guided surgery

    NASA Astrophysics Data System (ADS)

    Solfaroli Camillocci, E.; Bocci, V.; Chiodi, G.; Collamati, F.; Donnarumma, R.; Faccini, R.; Mancini Terracciano, C.; Marafini, M.; Mattei, I.; Muraro, S.; Recchia, L.; Rucinski, A.; Russomando, A.; Toppi, M.; Traini, G.; Morganti, S.

    2017-02-01

    Radio-guided surgery (RGS) is a technique to intraoperatively detect tumour remnants, favouring a radical resection. Exploiting β- emitting tracers provides a higher signal to background ratio compared to the established technique with γ radiation, allowing the extension of the RGS applicability range. We developed and tested a detector based on para-terphenyl scintillator with high sensitivity to low energy electrons and almost transparent to γs to be used as intraoperative probe for RGS with β- emitting tracer. Portable read out electronics was customised to match the surgeon needs. This probe was used for preclinical test on specific phantoms and a test on ;ex vivo; specimens from patients affected by meningioma showing very promising results for the application of this new technique on brain tumours. In this paper, the prototype of the intraoperative probe and the tests are discussed; then, the results on meningioma are used to make predictions on the performance of the probe detecting residuals of a more challenging and more interesting brain tumour: the glioma.

  13. 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.

  14. 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.

  15. Use of intraoperative sodium tetradecyl sulfate for the treatment of a spinal epidural hemangioma. Technical note.

    PubMed

    Baig, Mirza N; Saquib, Syed; Christoforidis, Greg; Caragine, Louis P

    2007-08-01

    Spinal hemangiomas can be categorized into three different groups based on location. Vertebral body (VB) hemangiomas are frequent incidental findings on magnetic resonance (MR) imaging. There is a subdivision of these with spinal epidural extension that have been reported in the literature. Spinal hemangiomas can also be epidural without VB involvement; these are extremely rare with few reported cases in the thoracic epidural spinal column. The diagnosis and imaging characteristics as well as the surgical tools used in gross-total resection of spinal epidural hemangioma are not well understood. The authors present a detailed characterization of a spinal epidural hemangioma in a 30-year-old woman who presented with complaints of gradual onset of low-back pain that worsened over 1 year. The MR imaging findings indicated a large L2-S1 epidural spinal mass causing thecal sac compression. The patient underwent an L2-S1 laminectomy, and a vascular extradural mass was noted on the posterior aspect of the dura mater. Preoperative spinal angiography as well as intraoperative angiography was performed. Total resection of the tumor was achieved using intraoperative embolization with sodium tetradecyl sulfate and microscopic dissection. The postoperative MR imaging findings and clinical outcome were excellent. The findings and use of sodium tetradecyl sulfate in gross-total resection are discussed. The authors also review treatment modalities and demonstrate the utility and effectiveness of intraoperative sodium tetradecyl sulfate in grosstotal resection of large difficult spinal epidural hemangiomas.

  16. Effect of intraoperative infusion of low-dose ketamine on management of postoperative analgesia

    PubMed Central

    Kaur, Sarvjeet; Saroa, Richa; Aggarwal, Shobha

    2015-01-01

    Background: Use of opioids for perioperative analgesia is associated with sedation, respiratory depression and postoperative nausea and vomiting. N-methyl-D-aspartate receptor antagonist such as ketamine has both analgesic and antihyperalgesic properties. We studied the effect of intraoperative infusion of low-dose ketamine on postoperative analgesia and its management with opioids. Materials and Methods: A total of 80 patients scheduled for open cholecystectomy under general anesthesia were randomly allocated into two equal groups in a randomized double-blinded way. The general anesthetic technique was standardized in both groups. Group K patients (n = 40) received bolus of ketamine 0.2 mg/kg intravenously followed by an infusion of 0.1 mg/kg/h before skin incision, which was continued up to the end of surgery. Similar volume of saline was infused in Group C (n = 40). The pain score at different intervals and cumulative morphine consumption over 24 h was observed. Secondary outcomes such as hemodynamic parameters, patient satisfaction score and incidences of side effects were also recorded. Results: Intraoperative infusion of low-dose ketamine resulted in effective analgesia in first 6 h of the postoperative period, which was evident from reduced pain scores and reduced opioid requirements (P = 0.001). The incidence of side effects and patient satisfaction were similar in both groups. Conclusion: Intraoperative low-dose ketamine infusion provides good postoperative analgesia while reducing need of opioid analgesics, which must be considered for better management of postoperative analgesia. PMID:26283834

  17. Intraoperative Vagus Nerve Monitoring: A Transnasal Technique during Skull Base Surgery.

    PubMed

    Schutt, Christopher A; Paskhover, Boris; Judson, Benjamin L

    2015-03-01

    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.

  18. Radiolucent Skull Clamps for Intra-Operative Imaging: A Technical Note

    PubMed Central

    Zeberg, Hugo; Lasala, Patrick; Altschul, David

    2017-01-01

    Conventionally, surgery and procedural-based radiology are performed on different premises. With advances in imaging technology, the operating room is rapidly being transformed into an intraoperative imaging suite. Diagnostic imaging in conjunction with surgery has great utility and by all accounts has great future potential. During the last decade, cone beam computed tomography (CT) scanners have been introduced and have made intraoperative imaging more feasible because these scanners can be made less bulky. The current usefulness of intraoperative magnetic resonance imaging (MRI) or CT for neurosurgery, however, is impaired by the lack of completely radiolucent skull clamps, causing image artifacts. Metal artifacts are particularly problematic, given that they lead to a considerably higher image quality degradation factor for cone beam CT scanners than for conventional CT scanners. Here, we describe our experience with near-radiolucent skull clamps and their associated problems and discuss future improvements to facilitate high-quality image guidance in the field of neurosurgery. PMID:28348939

  19. An intraoperative diagnosis of parotid gland tumors using Raman spectroscopy and support vector machine

    NASA Astrophysics Data System (ADS)

    Yan, Bing; Wen, Zhining; Li, Yi; Li, Longjiang; Xue, Lili

    2014-11-01

    The preoperative and intraoperative diagnosis of parotid gland tumors is difficult, but is important for their surgical management. In order to explore an intraoperative diagnostic method, Raman spectroscopy is applied to detect the normal parotid gland and tumors, including pleomorphic adenoma, Warthin’s tumor and mucoepidermoid carcinoma. In the 600-1800 cm-1 region of the Raman shift, there are numerous spectral differences between the parotid gland and tumors. Compared with Raman spectra of the normal parotid gland, the Raman spectra of parotid tumors show an increase of the peaks assigned to nucleic acids and proteins, but a decrease of the peaks related to lipids. Spectral differences also exist between the spectra of parotid tumors. Based on these differences, a remarkable classification and diagnosis of the parotid gland and tumors are carried out by support vector machine (SVM), with high accuracy (96.7~100%), sensitivity (93.3~100%) and specificity (96.7~100%). Raman spectroscopy combined with SVM has a great potential to aid the intraoperative diagnosis of parotid tumors and could provide an accurate and rapid diagnostic approach.

  20. Hammering sound frequency analysis and prevention of intraoperative periprosthetic fractures during total hip arthroplasty.

    PubMed

    Sakai, Rina; Kikuchi, Aki; Morita, Towa; Takahira, Naonobu; Uchiyama, Katsufumi; Yamamoto, Takeaki; Moriya, Mistutoshi; Uchida, Kentaro; Fukushima, Kensuke; Tanaka, Kensei; Takaso, Masashi; Itoman, Moritoshi; Mabuchi, Kiyoshi

    2011-01-01

    Adequate fixation at the time of cementless stem implantation depends on the operator's experience. An objective evaluation method to determine whether the stem has been appropriately implanted may be helpful. We studied the relationship between the hammering sound frequency during stem implantation and internal stress in a femoral model, and evaluated the possible usefulness of hammering sound frequency analysis for preventing intraoperative fracture. Three types of cementless stem (BiCONTACT®, SL-PLUS®, and AI-Hip®) were used. Surgeons performed stem insertion using a procedure similar to that employed in a routine operation. Stress was estimated by finite element analysis, the hammering force was measured, and frequency analysis of hammering sound data obtained using a microphone. Finite element analysis showed a decrease in the hammering sound frequency with an increase in the estimated maximum stress. When a decrease in frequency was observed, adequate hammering had occurred, and the continuation of hammering risked fracture. Based on the relationship between stress and frequency, the evaluation of changes in frequency may be useful for preventing the development of intraoperative fractures. Using our method, when a decrease in frequency is observed, the hammering force should be reduced. Hammering sound frequency analysis may allow the prediction of bone fractures that can be visually confirmed, and may be a useful objective evaluation method for the prevention of intraoperative periprosthetic fractures during stem insertion.

  1. Intraoperative rupture in the surgical treatment of patients with intracranial aneurysms.

    PubMed

    Chen, S F; Kato, Y; Kumar, A; Tan, G W; Oguri, D; Oda, J; Watabe, T; Imizu, S; Sano, H; Wang, Z X

    2016-12-01

    Intraoperative rerupture (IOR) during clipping of cerebral aneurysms is a difficult complication of microneurosurgery. The aim of this study was to evaluate the incidence of IOR and analyze the strategies for controlling profound hemorrhage. A total of 165 patients with unruptured intracranial aneurysms and 46 patients with subarachnoid hemorrhage (SAH) treated surgically between April 2010 and March 2011, were reviewed. The data were collected with regard to age, sex, presence of symptoms, confounding factors and strategy for controlling intraoperative hemorrhage was analyzed in terms of location of aneurysms, timing of rupture and severity of IOR. 211 patients with 228 aneurysms were treated in this series. There were a total of six IORs which represented an IOR rate of 2.84% per patient and 2.63% per aneurysm. The highest ruptures rates occurred in patients with internal carotid artery aneurysms (25%). Surgeries in the group with ruptured aneurysms had a much higher rate of IOR compared with surgeries in the group with unruptured aneurysms. Of the six IOR aneurysms, one occurred during predissection, four during microdissection and one during clipping. One was major IOR, three were moderate and two were minor. Intraoperative rupture of an intracranial aneurysm can be potentially devastating in vascular neurosurgery. Aneurysm location, presence of SAH and surgical experience of the operating surgeon seem to be important factors affecting the incidence of IOR.

  2. 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.

  3. 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.

  4. Comparative Sensitivity of Intraoperative Motor Evoked Potential Monitoring in Predicting Postoperative Neurologic Deficits: Nondegenerative versus Degenerative Myelopathy

    PubMed Central

    Clark, Aaron J.; Safaee, Michael; Chou, Dean; Weinstein, Philip R.; Molinaro, Annette M.; Clark, John P.; Mummaneni, Praveen V.

    2015-01-01

    Study Design  Retrospective review. Objective  Intraoperative motor evoked potential (MEP) monitoring in spine surgery may assist surgeons in taking corrective measures to prevent neurologic deficits. The efficacy of monitoring MEPs intraoperatively in patients with myelopathy from nondegenerative causes has not been quantified. We compared the sensitivity and specificity of intraoperative MEP monitoring in patients with myelopathy caused by nondegenerative processes to patients with degenerative cervicothoracic spondylotic myelopathy (CSM). Methods  We retrospectively reviewed our myelopathy surgical cases during a 1-year period to identify patients with degenerative CSM and CSM of nondegenerative causes and collected data on intraoperative MEP changes and postoperative new deficits. Categorical variables were analyzed by Fisher exact test. Receiver operator curves assessed intraoperative MEP monitoring performance in the two groups. Results  In all, 144 patients were identified: 102 had degenerative CSM and 42 had CSM of nondegenerative causes (24 extra-axial tumors, 12 infectious processes, 5 traumatic fractures, and 1 rheumatoid arthritis). For degenerative CSM, there were 11 intraoperative MEP alerts and 7 new deficits (p < 0.001). The corresponding sensitivity was 71% and the specificity was 94%. In the nondegenerative group, there were 11 intraoperative MEP alerts and 3 deficits, which was not significant (p > 0.99). The sensitivity (33%) and specificity (74%) were lower. Among patients with degenerative CSM, the model performed well for predicting postoperative deficits (area under the curve [AUC] 0.826), which appeared better than the nondegenerative group, although it did not reach statistical significance (AUC 0.538, p = 0.16). Conclusions  Based on this large retrospective analysis, intraoperative MEP monitoring in surgery for nondegenerative CSM cases appears to be less sensitive to cord injury and less predictive of postoperative

  5. 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

  6. Versatile utilization of real-time intraoperative contrast-enhanced ultrasound in cranial neurosurgery: technical note and retrospective case series

    PubMed Central

    Lekht, Ilya; Brauner, Noah; Bakhsheshian, Joshua; Chang, Ki-Eun; Gulati, Mittul; Shiroishi, Mark S.; Grant, Edward G.; Christian, Eisha; Zada, Gabriel

    2016-01-01

    OBJECTIVE Intraoperative contrast-enhanced ultrasound (iCEUS) offers dynamic imaging and provides functional data in real time. However, no standardized protocols or validated quantitative data exist to guide its routine use in neurosurgery. The authors aimed to provide further clinical data on the versatile application of iCEUS through a technical note and illustrative case series. METHODS Five patients undergoing craniotomies for suspected tumors were included. iCEUS was performed using a contrast agent composed of lipid shell microspheres enclosing perflutren (octafluoropropane) gas. Perfusion data were acquired through a time-intensity curve analysis protocol obtained using iCEUS prior to biopsy and/or resection of all lesions. RESULTS Three primary tumors (gemistocytic astrocytoma, glioblastoma multiforme, and meningioma), 1 metastatic lesion (melanoma), and 1 tumefactive demyelinating lesion (multiple sclerosis) were assessed using real-time iCEUS. No intraoperative complications occurred following multiple administrations of contrast agent in all cases. In all neoplastic cases, iCEUS replicated enhancement patterns observed on preoperative Gd-enhanced MRI, facilitated safe tumor de-bulking by differentiating neoplastic tissue from normal brain parenchyma, and helped identify arterial feeders and draining veins in and around the surgical cavity. Intraoperative CEUS was also useful in guiding a successful intraoperative needle biopsy of a cerebellar tumefactive demyelinating lesion obtained during real-time perfusion analysis. CONCLUSIONS Intraoperative CEUS has potential for safe, real-time, dynamic contrast-based imaging for routine use in neurooncological surgery and image-guided biopsy. Intraoperative CEUS eliminates the effect of anatomical distortions associated with standard neuronavigation and provides quantitative perfusion data in real time, which may hold major implications for intraoperative diagnosis, tissue differentiation, and quantification of

  7. Use of virtual slide system for quick frozen intra-operative telepathology diagnosis in Kyoto, Japan.

    PubMed

    Tsuchihashi, Yasunari; Takamatsu, Terumasa; Hashimoto, Yukimasa; Takashima, Tooru; Nakano, Kooji; Fujita, Setsuya

    2008-07-15

    We started to use virtual slide (VS) and virtual microscopy (VM) systems for quick frozen intra-operative telepathology diagnosis in Kyoto, Japan. In the system we used a digital slide scanner, VASSALO by CLARO Inc., and a broadband optic fibre provided by NTT West Japan Inc. with the best effort capacity of 100 Mbps. The client is the pathology laboratory of Yamashiro Public Hospital, one of the local centre hospitals located in the south of Kyoto Prefecture, where a full-time pathologist is not present. The client is connected by VPN to the telepathology centre of our institute located in central Kyoto. As a result of the recent 15 test cases of VS telepathology diagnosis, including cases judging negative or positive surgical margins, we could estimate the usefulness of VS in intra-operative remote diagnosis. The time required for the frozen section VS file making was found to be around 10 min when we use x10 objective and if the maximal dimension of the frozen sample is less than 20 mm. Good correct focus of VS images was attained in all cases and all the fields of each tissue specimen. Up to now the capacity of best effort B-band appears to be sufficient to attain diagnosis on time in intra-operation. Telepathology diagnosis was achieved within 5 minutes in most cases using VS viewer provided by CLARO Inc. The VS telepathology system was found to be superior to the conventional still image telepathology system using a robotic microscope since in the former we can observe much greater image information than in the latter in a certain limited time of intra-operation and in the much more efficient ways. In the near future VS telepathology will replace conventional still image telepathology with a robotic microscope even in quick frozen intra-operative diagnosis.

  8. Unusual mucoepidermoid carcinoma of the liver misdiagnosed as squamous cell carcinoma by intraoperative histological examination

    PubMed Central

    2014-01-01

    As rare condition, mucoepidermoid carcinoma may occur in liver although its etiology and pathogenesis is still unclear. We report here a case of intrahepatic mucoepidermoid carcinoma misdiagnosed as cholangiocarcinoma and squamous cell carcinoma by preoperative radiologic and intraoperative histological examinations, respectively. A 60-year-old woman presented with a 1-month history of progressive jaundice, epigastric discomfort, and weight loss with slightly increased carbohydrate antigen 19-9 (CA19-9). Computed tomography (CT) showed a large tumor, 8.0 cm in diameter, in the left lobe of the liver. A preliminary diagnosis of a cholangiocarcinoma of the liver was made. In the intraoperative histological examination, a diagnosis of squamous cell carcinoma was made based on predominantly invasive epidermoid cells with abundant keratinization and absence of mucin-producing cell component. However, postoperative histological diagnosis of the lesion was mucoepidermiod carcinoma of liver by thoroughly microscopical inspection and the presence of mucin-producing cells confirmed by Alcian blue staining. Despite surgical excision and chemotherapy, the tumor showed very aggressive malignancy with tumor recurrence. The patient died shortly afterward, surviving 6 months after surgery. Due to its rarity and distinct morphological features, mucoepidermoid carcinoma might be erroneously interpreted as squamous cell carcinoma by those who were not familiar with this condition in unusual locations. Therefore, removal of sufficient tissue from different portions of the lesion is essential for the surgeons and pathologists to make a precise diagnosis in the intraoperative histological examination. Virtual slide The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/4956311271136060 PMID:24475740

  9. Intraoperative template-molded bone flap reconstruction for patient-specific cranioplasty.

    PubMed

    Marbacher, Serge; Andereggen, Lukas; Erhardt, Salome; Fathi, Ali-Reza; Fandino, Javier; Raabe, Andreas; Beck, Jürgen

    2012-10-01

    Cranioplasty is a common neurosurgical procedure. Free-hand molding of polymethyl methacrylate (PMMA) cement into complex three-dimensional shapes is often time-consuming and may result in disappointing cosmetic outcomes. Computer-assisted patient-specific implants address these disadvantages but are associated with long production times and high costs. In this study, we evaluated the clinical, radiological, and cosmetic outcomes of a time-saving and inexpensive intraoperative method to mold custom-made implants for immediate single-stage or delayed cranioplasty. Data were collected from patients in whom cranioplasty became necessary after removal of bone flaps affected by intracranial infection, tumor invasion, or trauma. A PMMA replica was cast between a negative form of the patient's own bone flap and the original bone flap with exactly the same shape, thickness, and dimensions. Clinical and radiological follow-up was performed 2 months post-surgery. Patient satisfaction (Odom criteria) and cosmesis (visual analogue scale for cosmesis) were evaluated 1 to 3 years after cranioplasty. Twenty-seven patients underwent intraoperative template-molded patient-specific cranioplasty with PMMA. The indications for cranioplasty included bone flap infection (56%, n = 15), calvarian tumor resection (37%, n = 10), and defect after trauma (7%, n = 2). The mean duration of the molding procedure was 19 ± 7 min. Excellent radiological implant alignment was achieved in 94% of the cases. All (n = 23) but one patient rated the cosmetic outcome (mean 1.4 years after cranioplasty) as excellent (70%, n = 16) or good (26%, n = 6). Intraoperative cast-molded reconstructive cranioplasty is a feasible, accurate, fast, and cost-efficient technique that results in excellent cosmetic outcomes, even with large and complex skull defects.

  10. Characteristics and Intraoperative Treatments Associated with Head and Neck Free Tissue Transfer Complications and Failures

    PubMed Central

    Hand, William R.; McSwain, Julie R.; McEvoy, Matthew D.; Wolf, Bethany; Algendy, Abdalrahman A.; Parks, Matthew D.; Murray, John L.; Reeves, Scott T.

    2015-01-01

    Objective To investigate the association between perioperative patient characteristics and treatment modalities (eg, vasopressor use and volume of fluid administration) with complications and failure rates in patients undergoing head and neck free tissue transfer (FTT). Study Design A retrospective review of medical records. Setting Perioperative hospitalization for head and neck FTT at 1 tertiary care medical center between January 1, 2009, and October 31, 2011. Subjects and Methods Consecutive patients (N = 235) who underwent head and neck FTT. Demographic, patient characteristic, and intraoperative data were extracted from medical records. Complication and failure rates within the first 30 days were collected Results In a multivariate analysis controlling for age, sex, ethnicity, reason for receiving flap, and type and volume of fluid given, perioperative complication was significantly associated with surgical blood loss (P = .019; 95% confidence interval [CI], 1.01-1.16), while the rate of intraoperative fluid administration did not reach statistical significance (P = .06; 95% CI, 0.99-1.28). In a univariate analysis, FTT failure was significantly associated with reason for surgery (odds ratio, 5.40; P = .03; 95% CI, 1.69-17.3) and preoperative diagnosis of coronary artery disease (odds ratio, 3.60; P = .03; 95% CI, 1.16-11.2). Intraoperative vasopressor administration was not associated with either FTT complication or failure rate. Conclusions FTT complications were associated with surgical blood loss but not the use of vasoactive drugs. For patients undergoing FTT, judicious monitoring of blood loss may help stratify the risk of complication and failure. PMID:25550221

  11. Fast radioactive seed localization in intraoperative cone beam CT for low-dose-rate prostate brachytherapy

    NASA Astrophysics Data System (ADS)

    Hu, Yu-chi; Xiong, Jian-ping; Cohan, Gilad; Zaider, Marco; Mageras, Gig; Zelefsky, Michael

    2013-03-01

    A fast knowledge-based radioactive seed localization method for brachytherapy was developed to automatically localize radioactive seeds in an intraoperative volumetric cone beam CT (CBCT) so that corrections, if needed, can be made during prostate implant surgery. A transrectal ultrasound (TRUS) scan is acquired for intraoperative treatment planning. Planned seed positions are transferred to intraoperative CBCT following TRUS-to-CBCT registration using a reference CBCT scan of the TRUS probe as a template, in which the probe and its external fiducial markers are pre-segmented and their positions in TRUS are known. The transferred planned seeds and probe serve as an atlas to reduce the search space in CBCT. Candidate seed voxels are identified based on image intensity. Regions are grown from candidate voxels and overlay regions are merged. Region volume and intensity variance is checked against known seed volume and intensity profile. Regions meeting the above criteria are flagged as detected seeds; otherwise they are flagged as likely seeds and sorted by a score that is based on volume, intensity profile and distance to the closest planned seed. A graphical interface allows users to review and accept or reject likely seeds. Likely seeds with approximately twice the seed volume are automatically split. Five clinical cases are tested. Without any manual correction in seed detection, the method performed the localization in 5 seconds (excluding registration time) for a CBCT scan with 512×512×192 voxels. The average precision rate per case is 99% and the recall rate is 96% for a total of 416 seeds. All false negative seeds are found with 15 in likely seeds and 1 included in a detected seed. With the new method, updating of calculations of dose distribution during the procedure is possible and thus facilitating evaluation and improvement of treatment quality.

  12. Single-Fraction Intraoperative Radiotherapy for Breast Cancer: Early Cosmetic Results

    SciTech Connect

    Beal, Kathryn McCormick, Beryl; Zelefsky, Michael J.; Borgen, Patrick; Fey, Jane; Goldberg, Jessica; Sacchini, Virgilio

    2007-09-01

    Purpose: To evaluate the cosmetic outcome of patients treated with wide local excision and intraoperative radiotherapy for early-stage breast cancer. Methods and Materials: A total of 50 women were treated on a pilot study to evaluate the feasibility of intraoperative radiotherapy at wide local excision. The eligibility criteria included age >60, tumor size {<=}2.0 cm, clinically negative lymph nodes, and biopsy-established diagnosis. After wide local excision, a custom breast applicator was placed in the excision cavity, and a dose of 20 Gy was prescribed to a depth of 1 cm. After 18 patients were treated, the dose was constrained laterally to 18 Gy. The cosmetic outcome was evaluated by photographs at baseline and at 6 and 12 months postoperatively. Four examiners graded the photographs for symmetry, edema, discoloration, contour, and scarring. The grades were evaluated in relationship to the volume of irradiated tissue, tumor location, and dose at the lateral aspects of the cavity. Results: The median volume of tissue receiving 100% of the prescription dose was 47 cm{sup 3} (range, 20-97 cm{sup 3}). Patients with {<=}47 cm{sup 3} of treated tissue had better cosmetic outcomes than did the women who had >47 cm{sup 3} of treated tissue. Women who had received 18 Gy at the lateral aspects of their cavities had better cosmetic outcomes than did women who had received 20 Gy at the lateral aspects. When comparing the 6- and 12-month results, the scores remained stable for 63%, improved for 17%, and worsened for 20%. Conclusion: Intraoperative radiotherapy appears feasible for selected patients. A favorable cosmetic outcome appears to be related to a smaller treatment volume. The cosmetic outcome is acceptable, although additional follow-up is necessary.

  13. Long-term results of intraoperative electron beam radiation therapy for nonmetastatic locally advanced pancreatic cancer

    PubMed Central

    Chen, Yingtai; Che, Xu; Zhang, Jianwei; Huang, Huang; Zhao, Dongbing; Tian, Yantao; Li, Yexiong; Feng, Qinfu; Zhang, Zhihui; Jiang, Qinglong; Zhang, Shuisheng; Tang, Xiaolong; Huang, Xianghui; Chu, Yunmian; Zhang, Jianghu; Sun, Yuemin; Zhang, Yawei; Wang, Chengfeng

    2016-01-01

    Abstract To assess prognostic benefits of intraoperative electron beam radiation therapy (IOERT) in patients with nonmetastatic locally advanced pancreatic cancer (LAPC) and evaluate optimal adjuvant treatment after IOERT. A retrospective cohort study using prospectively collected data was conducted at the Cancer Hospital of the Chinese Academy of Medical Sciences, China National Cancer Center. Two hundred forty-seven consecutive patients with nonmetastatic LAPC who underwent IOERT between January 2008 and May 2015 were identified and included in the study. Overall survival (OS) was calculated from the day of IOERT. Prognostic factors were examined using Cox proportional hazards models. The 1-, 2-, and 3-year actuarial survival rates were 40%, 14%, and 7.2%, respectively, with a median OS of 9.0 months. On multivariate analysis, an IOERT applicator diameter < 6 cm (hazards ratio [HR], 0.67; 95% confidence interval [CI], 0.47–0.97), no intraoperative interstitial sustained-release 5-fluorouracil chemotherapy (HR, 0.46; 95% CI, 0.32–0.66), and receipt of postoperative chemoradiotherapy followed by chemotherapy (HR, 0.11; 95% CI, 0.04–0.25) were significantly associated with improved OS. Pain relief after IOERT was achieved in 111 of the 117 patients, with complete remission in 74 and partial remission in 37. Postoperative complications rate and mortality were 14.0% and 0.4%, respectively. Nonmetastatic LAPC patients with smaller size tumors could achieve positive long-term survival outcomes with a treatment strategy incorporating IOERT and postoperative adjuvant treatment. Chemoradiotherapy followed by chemotherapy might be a recommended adjuvant treatment strategy for well-selected cases. Intraoperative interstitial sustained-release 5-fluorouracil chemotherapy should not be recommended for patients with nonmetastatic LAPC. PMID:27661028

  14. Intraoperative hemodynamic evaluation of the latissimus dorsi muscle flap: a prospective study.

    PubMed

    Lorenzetti, Fulvio; Giordano, Salvatore; Tukiainen, Erkki

    2012-05-01

    The aim of this study was to assess intraoperatively the hemodynamic changes in the donor vessel of free latissimus dorsi (LD) flap before and after denervation and to analyze flow changes after flap transfer. Twenty-seven patients underwent LD muscle microvascular reconstruction for lower-limb soft tissue defects. Measurements of blood flow were performed intraoperatively by using a 2- to 5-mm probe ultrasonic transit-time flowmeter around the dissected vessels. Registrations were made in the thoracodorsal artery before and after harvesting the flap, after compressing and cutting the motor nerve, and after anastomosis. Mean blood flow of in situ harvested thoracodorsal artery as measured intraoperatively by transit-time flowmeter was (mean ± standard deviation) 16.6 ± 11 mL/min and was significantly increased after raising the flap to 24.0 ± 22 mL/min (p <0.05); it was 25.6 ± 23 mL/min after compressing the motor nerve and was significantly increased after cutting the motor nerve to 32.5 ± 26 mL/min (p <0.05). A significant increase of blood flow to 28.1 ± 19 mL/min was also detected in the thoracodorsal artery after flap transplantation with end-to-side anastomosis (p <0.05). Vascular resistance in the thoracodorsal artery significantly decreased after flap raising and anastomosis (from 7.5 ± 3.4 to 4.0 ± 1.9 and to 4.5 ± 2.4, respectively, p <0.05). LD flap harvesting increases blood flow and decreases resistance in the thoracodorsal artery, especially after denervation.

  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. Long-Term Results of Targeted Intraoperative Radiotherapy (Targit) Boost During Breast-Conserving Surgery

    SciTech Connect

    Vaidya, Jayant S.; Baum, Michael; Tobias, Jeffrey S.; Wenz, Frederik; Massarut, Samuele; Keshtgar, Mohammed; Hilaris, Basil; Saunders, Christobel; Williams, Norman R.; Brew-Graves, Chris; Corica, Tammy; Roncadin, Mario; Kraus-Tiefenbacher, Uta; Suetterlin, Marc; Bulsara, Max; Joseph, David

    2011-11-15

    Purpose: We have previously shown that delivering targeted radiotherapy to the tumour bed intraoperatively is feasible and desirable. In this study, we report on the feasibility, safety, and long-term efficacy of TARGeted Intraoperative radioTherapy (Targit), using the Intrabeam system. Methods and Materials: A total of 300 cancers in 299 unselected patients underwent breast-conserving surgery and Targit as a boost to the tumor bed. After lumpectomy, a single dose of 20 Gy was delivered intraoperatively. Postoperative external beam whole-breast radiotherapy excluded the usual boost. We also performed a novel individualized case control (ICC) analysis that computed the expected recurrences for the cohort by estimating the risk of recurrence for each patient using their characteristics and follow-up period. Results: The treatment was well tolerated. The median follow up was 60.5 months (range, 10-122 months). Eight patients have had ipsilateral recurrence: 5-year Kaplan Meier estimate for ipsilateral recurrence is 1.73% (SE 0.77), which compares well with that seen in the boosted patients in the European Organization for Research and Treatment of Cancer study (4.3%) and the UK STAndardisation of breast RadioTherapy study (2.8%). In a novel ICC analysis of 242 of the patients, we estimated that there should be 11.4 recurrences; in this group, only 6 recurrences were observed. Conclusions: Lumpectomy and Targit boost combined with external beam radiotherapy results in a low local recurrence rate in a standard risk patient population. Accurate localization and the immediacy of the treatment that has a favorable effect on tumour microenvironment may contribute to this effect. These long-term data establish the long-term safety and efficacy of the Targit technique and generate the hypothesis that Targit boost might be superior to an external beam boost in its efficacy and justifies a randomized trial.

  17. Intraoperative dorsal language network mapping by using single-pulse electrical stimulation.

    PubMed

    Yamao, Yukihiro; Matsumoto, Riki; Kunieda, Takeharu; Arakawa, Yoshiki; Kobayashi, Katsuya; Usami, Kiyohide; Shibata, Sumiya; Kikuchi, Takayuki; Sawamoto, Nobukatsu; Mikuni, Nobuhiro; Ikeda, Akio; Fukuyama, Hidenao; Miyamoto, Susumu

    2014-09-01

    The preservation of language function during brain surgery still poses a challenge. No intraoperative methods have been established to monitor the language network reliably. We aimed to establish intraoperative language network monitoring by means of cortico-cortical evoked potentials (CCEPs). Subjects were six patients with tumors located close to the arcuate fasciculus (AF) in the language-dominant left hemisphere. Under general anesthesia, the anterior perisylvian language area (AL) was first defined by the CCEP connectivity patterns between the ventrolateral frontal and temporoparietal area, and also by presurgical neuroimaging findings. We then monitored the integrity of the language network by stimulating AL and by recording CCEPs from the posterior perisylvian language area (PL) consecutively during both general anesthesia and awake condition. High-frequency electrical stimulation (ES) performed during awake craniotomy confirmed language function at AL in all six patients. Despite an amplitude decline (≤32%) in two patients, CCEP monitoring successfully prevented persistent language impairment. After tumor removal, single-pulse ES was applied to the white matter tract beneath the floor of the removal cavity in five patients, in order to trace its connections into the language cortices. In three patients in whom high-frequency ES of the white matter produced naming impairment, this "eloquent" subcortical site directly connected AL and PL, judging from the latencies and distributions of cortico- and subcortico-cortical evoked potentials. In conclusion, this study provided the direct evidence that AL, PL, and AF constitute the dorsal language network. Intraoperative CCEP monitoring is clinically useful for evaluating the integrity of the language network.

  18. Long-Term Outcome and Toxicities of Intraoperative Radiotherapy for High-Risk Neuroblastoma

    SciTech Connect

    Gillis, Amy M.; Sutton, Elizabeth; DeWitt, Kelly D.; Matthay, Katherine K.; Weinberg, Vivian; Fisch, Benjamin M.; Chan, Albert; Gooding, Charles; Daldrup-Link, Heike; Wara, William M.; Farmer, Diana L.; Harrison, Michael R.; Haas-Kogan, Daphne

    2007-11-01

    Purpose: To review a historical cohort of consecutively accrued patients with high-risk neuroblastoma treated with intraoperative radiotherapy (IORT) to determine the therapeutic effect and late complications of this treatment. Methods and Materials: Between 1986 and 2002, 31 patients with newly diagnosed high-risk neuroblastoma were treated with IORT as part of multimodality therapy. Their medical records were reviewed to determine the outcome and complications. Kaplan-Meier probability estimates of local control, progression-free survival, and overall survival at 36 months after diagnosis were recorded. Results: Intraoperative radiotherapy to the primary site and associated lymph nodes achieved excellent local control at a median follow-up of 44 months. The 3-year estimate of the local recurrence rate was 15%, less than that of most previously published series. Only 1 of 22 patients who had undergone gross total resection developed recurrence at the primary tumor site. The 3-year estimate of local control, progression-free survival, and overall survival was 85%, 47%, and 60%, respectively. Side effects attributable to either the disease process or multimodality treatment were observed in 7 patients who developed either hypertension or vascular stenosis. These late complications resulted in the death of 2 patients. Conclusions: Intraoperative radiotherapy at the time of primary resection offers effective local control in patients with high-risk neuroblastoma. Compared with historical controls, IORT achieved comparable control and survival rates while avoiding many side effects associated with external beam radiotherapy in young children. Although complications were observed, additional analysis is needed to determine the relative contributions of the disease process and specific components of the multimodality treatment to these adverse events.

  19. Assessment of intraoperative 3D imaging alternatives for IOERT dose estimation.

    PubMed

    García-Vázquez, Verónica; Marinetto, Eugenio; Guerra, Pedro; Valdivieso-Casique, Manlio Fabio; Calvo, Felipe Ángel; Alvarado-Vásquez, Eduardo; Sole, Claudio Vicente; Vosburgh, Kirby Gannett; Desco, Manuel; Pascau, Javier

    2016-08-23

    Intraoperative electron radiation therapy (IOERT) involves irradiation of an unresected tumour or a post-resection tumour bed. The dose distribution is calculated from a preoperative computed tomography (CT) study acquired using a CT simulator. However, differences between the actual IOERT field and that calculated from the preoperative study arise as a result of patient position, surgical access, tumour resection and the IOERT set-up. Intraoperative CT imaging may then enable a more accurate estimation of dose distribution. In this study, we evaluated three kilovoltage (kV) CT scanners with the ability to acquire intraoperative images. Our findings indicate that current IOERT plans may be improved using data based on actual anatomical conditions during radiation. The systems studied were two portable systems ("O-arm", a cone-beam CT [CBCT] system, and "BodyTom", a multislice CT [MSCT] system) and one CBCT integrated in a conventional linear accelerator (LINAC) ("TrueBeam"). TrueBeam and BodyTom showed good results, as the gamma pass rates of their dose distributions compared to the gold standard (dose distributions calculated from images acquired with a CT simulator) were above 97% in most cases. The O-arm yielded a lower percentage of voxels fulfilling gamma criteria owing to its reduced field of view (which left it prone to truncation artefacts). Our results show that the images acquired using a portable CT or even a LINAC with on-board kV CBCT could be used to estimate the dose of IOERT and improve the possibility to evaluate and register the treatment administered to the patient.

  20. Towards intraoperative assessment of tumor margins in breast surgery using optical coherence elastography (Conference Presentation)

    NASA Astrophysics Data System (ADS)

    Kennedy, Brendan F.; Wijesinghe, Philip; Allen, Wes M.; Chin, Lixin; Latham, Bruce; Saunders, Christobel M.; Sampson, David D.

    2016-03-01

    Surgical excision of tumor is a critical factor in the management of breast cancer. The most common surgical procedure is breast-conserving surgery. The surgeon's goal is to remove the tumor and a rim of healthy tissue surrounding the tumor: the surgical margin. A major issue in breast-conserving surgery is the absence of a reliable tool to guide the surgeon in intraoperatively assessing the margin. A number of techniques have been proposed; however, the re-excision rate remains high and has been reported to be in the range 30-60%. New tools are needed to address this issue. Optical coherence elastography (OCE) shows promise as a tool for intraoperative tumor margin assessment in breast-conserving surgery. Further advances towards clinical translation are limited by long scan times and small fields of view. In particular, scanning over sufficient areas to assess the entire margin in an intraoperative timeframe has not been shown to be feasible. Here, we present a protocol allowing ~75% of the surgical margins to be assessed within 30 minutes. To achieve this, we have incorporated a 65 mm-diameter (internal), wide-aperture annular piezoelectric transducer, allowing the entire surface of the excised tumor mass to be automatically imaged in an OCT mosaic comprised of 10 × 10 mm tiles. As OCT is effective in identifying adipose tissue, our protocol uses the wide-field OCT to selectively guide subsequent local OCE scanning to regions of solid tissue which often present low contrast in OCT images. We present promising examples from freshly excised human breast tissue.

  1. Phase I-II Study of Intraoperative Radiation Therapy (IORT) After Radical Prostatectomy for Prostate Cancer

    SciTech Connect

    Saracino, Biancamaria Gallucci, Michele; De Carli, Piero; Soriani, Antonella; Papalia, Rocco; Marzi, Simona; Landoni, Valeria; Petrongari, Maria Grazia; Arcangeli, Stefano; Forastiere, Ester; Sentinelli, Steno; Arcangeli, Giorgio

    2008-07-15

    Purpose: Recent studies have suggested an {alpha}/{beta} ratio in prostate cancer of 1.5-3 Gy, which is lower than that assumed for late-responsive normal tissues. Therefore the administration of a single, intraoperative dose of irradiation should represent a convenient irradiation modality in prostate cancer. Materials and Methods: Between February 2002 and June 2004, 34 patients with localized prostate cancer with only one risk factor (Gleason score {>=}7, Clinical Stage [cT] {>=}2c, or prostate-specific antigen [PSA] of 11-20 ng/mL) and without clinical evidence of lymph node metastases were treated with radical prostatectomy (RP) and intraoperative radiotherapy on the tumor bed. A dose-finding procedure based on the Fibonacci method was employed. Dose levels of 16, 18, and 20 Gy were selected, which are biologically equivalent to total doses of about 60-80 Gy administered with conventional fractionation, using an {alpha}/{beta} ratio value of 3. Results: At a median follow-up of 41 months, 24 (71%) patients were alive with an undetectable PSA value. No patients died from disease, whereas 2 patients died from other malignancies. Locoregional failures were detected in 3 (9%) patients, 2 in the prostate bed and 1 in the common iliac node chain outside the radiation field. A PSA rise without local or distant disease was observed in 7 (21%) cases. The overall 3-year biochemical progression-free survival rate was 77.3%. Conclusions: Our dose-finding study demonstrated the feasibility of intraoperative radiotherapy in prostate cancer also at the highest administered dose.

  2. Clinical impact of intraoperative navigation using a Doppler ultrasonographic guided vessel tracking technique for pancreaticoduodenectomy.

    PubMed

    Maemura, Kosei; Mataki, Yuko; Kurahara, Hiroshi; Iino, Satoshi; Sakoda, Masahiko; Ueno, Shinichi; Shinchi, Hiroyuki; Takao, Sonshin; Natsugoe, Shoji

    2014-01-01

    During pancreaticoduodenectomy (PD), early ligation of critical vessels such as the inferior pancreaticoduodenal artery (IPDA) has been reported to reduce blood loss. Color Doppler flow imaging has become the useful diagnostic methods for the delineation of the anatomy. In this study, we assessed the utility of the intraoperative Doppler ultrasonography (Dop-US) guided vessel detection and tracking technique (Dop-Navi) for identifying critical arteries in order to reduce operative bleeding. Ninety patients who received PD for periampullary or pancreatic disease were enrolled. After 14 patients were excluded because of combined resection of portal vein or other organs, the remaining were assigned to 1 of 2 groups: patients for whom Dop-Navi was used (n = 37) and those for whom Dop-Navi was not used (n = 39; controls). We compared the ability of Dop-Navi to identify critical vessels to that of preoperative multi-detector computed tomography (MD-CT), using MD-CT data, as well as compared the perioperative status and postoperative outcome between the 2 patient groups. Intraoperative Dop-US was significantly superior to MD-CT in terms of identifying number of vessels and the ability to discriminate the IPDA from the superior mesenteric artery (SMA) based on blood flow velocity. The Dop-Navi patients had shorter operation times (531 min versus 577 min; no significance) and smaller bleeding volumes (1120 mL versus 1590 mL; P < 0.01) than the control patients without increasing postoperative complications. Intraoperative Dop-Navi method allows surgeons to clearly identify the IPDA during PD and to avoid injuries to major arteries.

  3. Clinical Impact of Intraoperative Navigation Using a Doppler Ultrasonographic Guided Vessel Tracking Technique for Pancreaticoduodenectomy

    PubMed Central

    Maemura, Kosei; Mataki, Yuko; Kurahara, Hiroshi; Iino, Satoshi; Sakoda, Masahiko; Ueno, Shinichi; Shinchi, Hiroyuki; Takao, Sonshin; Natsugoe, Shoji

    2014-01-01

    During pancreaticoduodenectomy (PD), early ligation of critical vessels such as the inferior pancreaticoduodenal artery (IPDA) has been reported to reduce blood loss. Color Doppler flow imaging has become the useful diagnostic methods for the delineation of the anatomy. In this study, we assessed the utility of the intraoperative Doppler ultrasonography (Dop-US) guided vessel detection and tracking technique (Dop-Navi) for identifying critical arteries in order to reduce operative bleeding. Ninety patients who received PD for periampullary or pancreatic disease were enrolled. After 14 patients were excluded because of combined resection of portal vein or other organs, the remaining were assigned to 1 of 2 groups: patients for whom Dop-Navi was used (n = 37) and those for whom Dop-Navi was not used (n = 39; controls). We compared the ability of Dop-Navi to identify critical vessels to that of preoperative multi-detector computed tomography (MD-CT), using MD-CT data, as well as compared the perioperative status and postoperative outcome between the 2 patient groups. Intraoperative Dop-US was significantly superior to MD-CT in terms of identifying number of vessels and the ability to discriminate the IPDA from the superior mesenteric artery (SMA) based on blood flow velocity. The Dop-Navi patients had shorter operation times (531 min versus 577 min; no significance) and smaller bleeding volumes (1120 mL versus 1590 mL; P < 0.01) than the control patients without increasing postoperative complications. Intraoperative Dop-Navi method allows surgeons to clearly identify the IPDA during PD and to avoid injuries to major arteries. PMID:25437586

  4. Intraoperative electrophysiological monitoring for C1-2 spinal cord stimulation.

    PubMed

    Muncie, Laura M; Ellens, Nathaniel R; Tolod-Kemp, Emeline; Feler, Claudio A; Winestone, John S

    2017-02-01

    OBJECTIVE This study is a retrospective case series involving C1-2 spinal cord stimulation in patients with complex regional pain syndrome (CRPS) under general endotracheal anesthesia. Currently, C1-2 paddle lead placement is an accepted practice, which provides effective cervical stimulation to ameliorate upper-extremity and sometimes lower-extremity symptoms experienced by patients with CRPS. However, this technique must be performed under general endotracheal anesthesia rather than in an awake or semiconscious state due to intraoperative safety concerns and patient comfort. The authors aim to provide additional data to support the following novel technique: the use of somatosensory evoked potential (SSEP) diminution data to assist with proper midline placement of C1-2 leads under general anesthesia. METHODS SSEP median nerve (MN) and posterior tibial nerve (PTN) data were collected from 6 patients undergoing placement of C1-2 leads under general anesthesia. Fluoroscopy was used as an initial guide for proper anatomical midline placement. This was followed by the activation of the spinal cord stimulator and simultaneous collection of primarily MN SSEPs as well as PTN SSEPs for physiological midline placement. Unilateral and bilateral reductions in SSEPs assisted with the correct lateralization of the lead to ensure effective postoperative coverage according to the patient's individual preoperative symptoms. RESULTS Six patients were monitored using SSEPs and repeatable, reliable MN and PTN baseline responses were obtained from all. A reduction in amplitude ranging from 5% to 87% was observed, confirming inhibition of dorsal column conduction, and an average pain relief of 63% at short-term and 64% at long-term follow-up was recorded with 6 of 6 and 5 of 6 patients responding, respectively. CONCLUSIONS Intraoperative SSEP collision study testing appears to be a safe technique to monitor placement of C1-2 paddle leads intraoperatively under general anesthesia.

  5. NC-14SPEECH MAPS GENERATED BY nTMS AND CORRELATION WITH DIRECT INTRAOPERATIVE ELECTRICAL STIMULATION

    PubMed Central

    Rotta, Roger; Tummala, Sudhakar; Guillory, Sean; Prabhu, Sujit; Rao, Ganesh; Levine, Nicholas; Suki, Dima; Lang, Frederick; Weinberg, Jeffrey; Sawaya, Raymond

    2014-01-01

    INTRODUCTION: IOM of language pathways is the gold standard for the safe resection of gliomas; navigated TMS has been shown to be useful in generating speech maps prior surgery. This study test the clinical utility of nTMS for mapping language and its concordance with intraoperative stimulation. METHODS: We describe 12 patients with gliomas adjacent to language areas. All cases were performed with nTMS, DES for language mapping. We analyzed, positive and negative sites preoperatively and intraoperatively, and correlated them to the extent of resection and a 1-mo follow-up. RESULTS: Navigated TMS positive maps, was achieved in 11 (92%), and 8 (80%) of cases had language errors during DES. 3527 site were stimulated during nTMS mapping, 225 (7%) was positive, 77 (34%) speech arrest, 78 (35%) performance errors and 70 (31%) semantic errors. TP correlation was achieved in 8 (67%) of cases, TN correlation 1 (8%) and FP correlation was achieved in 1 (8%) of cases. In TP cases, GTR was achieved in 6 (75%) of cases and after 1-mo follow-up 1 (14%) case developed new deficit and improvement was seen in 1(14%) case. In the only case of TN correlation, GTR resection was achieved, without deficits after 1-mo follow-up. CONCLUSION: nTMS correlated well with DES in generated language mapping, with a rate of TP according 67% and the only case with negative response in nTMS was TN. We have shown that nTMS has a high rate of concordance with DES; nTMS has 100% sensitivity, and 50% specificity when compared with DES. PPV at 89% and NPV 100%. The majority of positive sites were achieved in Broca's area and Wernicke's area. Additionally, if the nTMS reveal speech arrest distant from surgical exposure, this may be an additional utility for nTMS in explaining apparent negative mapping results in intraoperative stimulation.

  6. Fusion of intraoperative cone-beam CT and endoscopic video for image-guided procedures

    NASA Astrophysics Data System (ADS)

    Daly, M. J.; Chan, H.; Prisman, E.; Vescan, A.; Nithiananthan, S.; Qiu, J.; Weersink, R.; Irish, J. C.; Siewerdsen, J. H.

    2010-02-01

    Methods for accurate registration and fusion of intraoperative cone-beam CT (CBCT) with endoscopic video have been developed and integrated into a system for surgical guidance that accounts for intraoperative anatomical deformation and tissue excision. The system is based on a prototype mobile C-Arm for intraoperative CBCT that provides low-dose 3D image updates on demand with sub-mm spatial resolution and soft-tissue visibility, and also incorporates subsystems for real-time tracking and navigation, video endoscopy, deformable image registration of preoperative images and surgical plans, and 3D visualization software. The position and pose of the endoscope are geometrically registered to 3D CBCT images by way of real-time optical tracking (NDI Polaris) for rigid endoscopes (e.g., head and neck surgery), and electromagnetic tracking (NDI Aurora) for flexible endoscopes (e.g., bronchoscopes, colonoscopes). The intrinsic (focal length, principal point, non-linear distortion) and extrinsic (translation, rotation) parameters of the endoscopic camera are calibrated from images of a planar calibration checkerboard (2.5×2.5 mm2 squares) obtained at different perspectives. Video-CBCT registration enables a variety of 3D visualization options (e.g., oblique CBCT slices at the endoscope tip, augmentation of video with CBCT images and planning data, virtual reality representations of CBCT [surface renderings]), which can reveal anatomical structures not directly visible in the endoscopic view - e.g., critical structures obscured by blood or behind the visible anatomical surface. Video-CBCT fusion is evaluated in pre-clinical sinus and skull base surgical experiments, and is currently being incorporated into an ongoing prospective clinical trial in CBCT-guided head and neck surgery.

  7. Intradural Intramedullary Mixed Type Hemangioma: Optimizing the Surgical Management through Intraoperative Neurophysiological Monitoring

    PubMed Central

    Rahyussalim, Ahmad Jabir; Situmeang, Adrian; Safri, Ahmad Yanuar; Fadhly, Zulfa Indah K.

    2015-01-01

    Intradural intramedullary mixed type hemangioma is a rare histotype of primary spinal cord tumors, though it can carry a severe clinical burden leading to limb dysfunction or motor and sensory disturbances. Timely intervention with radical resection is the hallmark of treatment but achieving it is not an easy task even for experienced neurosurgeons. We herein present an exemplificative case presenting with sudden paraplegia in which total resection was achieved under intraoperative neurophysiology monitoring. A thorough discussion on the operative technique and the role of neuromonitoring in allowing a safe surgical management of primary spinal cord tumors is presented. PMID:26839729

  8. Late Chronic Tamponade after Intraoperative Right Ventricular Rupture Repair with Mediastinal Fat.

    PubMed

    Gualis, Javier; Castaño, Mario; Rodríguez, Miguel Angel; García, Cristina

    2015-12-01

    Advanced age and female sex are known risk factors for ventricular wall rupture during open-heart procedures. We present the case of an 83-year-old female patient with an intraoperative traumatic right ventricular free wall rupture during an aortic valve replacement procedure. Pledgetted interrupted sutures reinforced with large pieces of mediastinal fat were used for rupture repair. After 6 months, the patient was readmitted with the diagnosis of a retrosternal mediastinal mass and clinical signs of cardiac tamponade that required reoperation.

  9. [ANALYSIS OF THE INTRAOPERATIVE PROPHYLAXIS EFFICACY OF THE ABDOMINAL CAVITY ADHESIVE DISEASE].

    PubMed

    Yevtushenko, D A

    2015-09-01

    Results of treatment of 152 patients, operated on for various diseases of the abdominal cavity, were analyzed. In 72 of them (the main group) intraoperatively a Defensal was used as an antiadhesive barrier preparation for the abdominal adhesions prophylaxis, and in 80 (a comparison group)--antiadhesive measures were not conducted. Application of antiadhesive sterile solution have promoted a reduction of period, which is necessary for the gut motor-evacuation function restoration--by 1.5 days, stationary treatment--by 2.5 days, postoperative morbidity rate--in 2.7 times.

  10. Intraoperative intrinsic optical imaging of human somatosensory cortex during neurosurgical operations.

    PubMed

    Sato, Katsushige; Nariai, Tadashi; Momose-Sato, Yoko; Kamino, Kohtaro

    2017-07-01

    Intrinsic optical imaging as developed by Grinvald et al. is a powerful technique for monitoring neural function in the in vivo central nervous system. The advent of this dye-free imaging has also enabled us to monitor human brain function during neurosurgical operations. We briefly describe our own experience in functional mapping of the human somatosensory cortex, carried out using intraoperative optical imaging. The maps obtained demonstrate new additional evidence of a hierarchy for sensory response patterns in the human primary somatosensory cortex.

  11. New radiolucent head fixation made of engineering plastics for intraoperative CT scanning.

    PubMed

    Okudera, H; Kobayashi, S; Kyoshima, K; Tokushige, K; Sugita, K

    1994-01-01

    A newly developed head fixation for intraoperative computerized tomographic (IOCT) scanning is presented. The system is developed based on the head holder of multipurpose head frame and is made of two kinds of advanced engineering material; carbon fiber reinforced plastic for head holder and frames, polyamide-imide polymer for joints, screws, and head pin. Clinical tests including autoclaving and sterilization were performed and revealed all materials had sufficient strength for clinical use. This fixation system enables us to increase the efficacy of IOCT scanning during open-field neurosurgery.

  12. Acute functional reactivation of the language network during awake intraoperative brain mapping.

    PubMed

    Spena, Giannantonio; Costi, Emanuele; Panciani, Pier Paolo; Roca, Elena; Migliorati, Karol; Fontanella, Marco Maria

    2015-01-01

    Acute brain plasticity during resection of central lesions has been recently described. In the cases reported, perilesional latent networks, useful to preserve the neurological functions, were detected in asymptomatic patients. In this paper, we presented a case of acute functional reactivation (AFR) of the language network in a symptomatic patient. Tumor resection allowed to acutely restore the neurological deficit. Intraoperative direct cortical stimulation (DCS) and functional neuroimaging showed new epicentres of activation of the language network after tumor excision. DCS in awake surgery is mandatory to reveal AFR needful to improve the extent of resection preserving the quality of life.

  13. Transient Intraoperative Central Diabetes Insipidus in Moyamoya Patients Undergoing Revascularization Surgery: A Mere Coincidence?

    PubMed

    Hong, Joe C; Ramos, Emilio; Copeland, Curtis C; Ziv, Keren

    2016-04-15

    We present 2 patients with Moyamoya disease undergoing revascularization surgery who developed transient intraoperative central diabetes insipidus with spontaneous resolution in the immediate postoperative period. We speculate that patients with Moyamoya disease may be predisposed to a transient acute-on-chronic insult to the arginine vasopressin-producing portion of their hypothalamus mediated by anesthetic agents. We describe our management, discuss pertinent literature, and offer possible mechanisms of this transient insult. We hope to improve patient safety by raising awareness of this potentially catastrophic complication.

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

    PubMed Central

    2012-01-01

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

  15. Laparoscopic repair for intraoperative injury of the right hepatic artery during cholecystectomy.

    PubMed

    Fujioka, Shuichi; Fuke, Azusa; Funamizu, Naotake; Nakayoshi, Tomoko; Okamoto, Tomoyoshi; Yanaga, Katsuhiko

    2015-02-01

    Right hepatic artery (RHA) injury is a complication that occurs during laparoscopic cholecystectomy, which can sometimes cause hepatic artery pseudoaneurysm or ischemic hepatic necrosis. Therefore, RHA should be managed carefully. Herein, we report a case of intraoperative RHA injury that was successfully repaired during laparoscopic cholecystectomy. Bleeding was controlled prior to the cholecystectomy with vascular clamp forceps that had been inserted through an additional trocar, and repair of the RHA injury was then performed laparoscopically. The postoperative course was uneventful, and patency of the RHA and its sectional arteries were confirmed by CT arteriography. Laparoscopic repair of minor RHA injuries can be managed safely if bleeding is adequately controlled.

  16. Liposomally formulated phospholipid-conjugated indocyanine green for intra-operative brain tumor detection and resection.

    PubMed

    Suganami, Akiko; Iwadate, Yasuo; Shibata, Sayaka; Yamashita, Masamichi; Tanaka, Tsutomu; Shinozaki, Natsuki; Aoki, Ichio; Saeki, Naokatsu; Shirasawa, Hiroshi; Okamoto, Yoshiharu; Tamura, Yutaka

    2015-12-30

    Some tumor-specific near-infrared (NIR) fluorescent dyes such as indocyanine green (ICG), IDRye800CW, and 5-aminolevulinic acid have been used clinically for detecting tumor margins or micro-cancer lesions. In this study, we evaluated the physicochemical properties of liposomally formulated phospholipid-conjugated ICG, denoted by LP-iDOPE, as a clinically translatable NIR imaging nanoparticle for brain tumors. We also confirmed its brain-tumor-specific biodistribution and its characteristics as the intra-operative NIR imaging nanoparticles for brain tumor surgery. These properties of LP-iDOPE may enable neurosurgeons to achieve more accurate identification and more complete resection of brain tumor.

  17. Intraoperative drug-eluting stent thrombosis in a patient undergoing robotic prostatectomy.

    PubMed

    Sharma, Aarti; Berkeley, Abiona

    2009-11-01

    Insertion of drug-eluting stents is one of the strategies for treating patients with coronary artery disease. These patients can be a perioperative challenge in management as they need to be maintained on antiplatelet therapy to prevent stent thrombosis, which puts them at an increased risk for surgical bleeding. Recently revised guidelines on elective surgery following insertion of a drug-eluting stent recommend dual antiplatelet therapy for a period of twelve months. The management of a patient who presented for surgery more than two years after the insertion of a drug-eluting stent, and who developed in-stent thrombosis intraoperatively, is presented.

  18. Psychological Sequelae of Surgery in a Prospective Cohort of Patients from Three Intraoperative Awareness Prevention Trials

    PubMed Central

    Whitlock, Elizabeth L.; Rodebaugh, Thomas L.; Hassett, Afton L.; Shanks, Amy M.; Kolarik, Ellen; Houghtby, Janet; West, Hannah M.; Burnside, Beth A.; Shumaker, Erik; Villafranca, Alex; Edwards, W. Alex; Levinson, Cheri A; Langer, Julia K.; Fernandez, Katya C; El-Gabalawy, Renee; Zhou, Elizabeth Y; Sareen, Jitender; Jacobsohn, Eric; Mashour, George A; Avidan, Michael S

    2015-01-01

    Background Elective surgery can have long-term psychological sequelae, especially for patients who experience intraoperative awareness. However, risk factors other than awareness for symptoms of posttraumatic stress disorder (PTSD) after surgery are poorly defined, and practical screening methods have not been applied to a broad population of surgical patients. Methods The Psychological Sequelae of Surgery (Psych SOS) study was a prospective cohort study of patients previously enrolled in the United States and Canada in 3 trials for the prevention of intraoperative awareness. The 68 patients who experienced definite or possible awareness were matched, based on age, sex, surgery type, and awareness risk, with 418 patients who denied awareness. Participants completed the PTSD Checklist–Specific (PCL-S) and/or a modified Mini International Neuropsychiatric Interview telephone assessment to identify symptoms of PTSD and symptom complexes consistent with a PTSD diagnosis. We then used structural equation modeling to produce a composite PTSD score and examined potential risk factors. Results One hundred forty patients were unreachable; of those contacted, 303 (88%) participated a median of 2 years postoperatively. Forty-four of the 219 patients (20.1%) who completed the PCL-S exceeded the civilian screening cutoff score for PTSD symptoms resulting from their surgery (15 of 35 [43%] with awareness and 29 of 184 [16%] without). Nineteen patients (8.7%; 5 of 35 [14%] with awareness and 14 of 184 [7.6%] without) both exceeded the cutoff and endorsed a breadth of symptoms consistent with the DSM-IV diagnosis of PTSD attributable to their surgery. Factors independently associated with PTSD symptoms were poor social support, prior PTSD symptoms, prior mental health treatment, dissociation related to surgery, perceiving that one's life was threatened during surgery, and intraoperative awareness(all p ≤ 0.017). Perioperative dissociation was identified as a potential mediator

  19. Intraoperative Extracorporeal Carbon Dioxide Removal During Apneic Oxygenation with an EZ-Blocker in Tracheal Surgery.

    PubMed

    Rispoli, Marco; Nespoli, Moana Rossella; Mattiacci, Dario Maria; Esposito, Marianna; Corcione, Antonio; Buono, Salvatore

    2016-06-01

    Tracheal surgery requires continued innovation to manage the anesthetic during an open airway phase. A common approach is apneic oxygenation with continuous oxygen flow, but the lack of effective ventilation causes hypercapnia, with respiratory acidosis. We used extracorporeal carbon dioxide removal for intraoperative decapneization during apneic oxygenation in a 64-year-old woman who was scheduled for tracheal surgery because of tracheal stenosis caused by long-term intubation. Our findings demonstrate that even after 40 minutes of total apnea, using an EZ-blocker for oxygenation and external decapneization, hemodynamic and gas exchange variables never demonstrated any dangerous alterations.

  20. Intraoperative optical biopsy for brain tumors using spectro-lifetime properties of intrinsic fluorophores

    NASA Astrophysics Data System (ADS)

    Vasefi, Fartash; Kittle, David S.; Nie, Zhaojun; Falcone, Christina; Patil, Chirag G.; Chu, Ray M.; Mamelak, Adam N.; Black, Keith L.; Butte, Pramod V.

    2016-04-01

    We have developed and tested a system for real-time intra-operative optical identification and classification of brain tissues using time-resolved fluorescence spectroscopy (TRFS). A supervised learning algorithm using linear discriminant analysis (LDA) employing selected intrinsic fluorescence decay temporal points in 6 spectral bands was employed to maximize statistical significance difference between training groups. The linear discriminant analysis on in vivo human tissues obtained by TRFS measurements (N = 35) were validated by histopathologic analysis and neuronavigation correlation to pre-operative MRI images. These results demonstrate that TRFS can differentiate between normal cortex, white matter and glioma.

  1. Analysis of Intraoperative and Postoperative Complications in Pseudoexfoliation Eyes Undergoing Cataract Surgery

    PubMed Central

    Shetty, Sathyendranath B

    2016-01-01

    Introduction Pseudoexfoliation (PXE) is a genetically inherited condition affecting usually seen in those aged over 50 years. Surgical management of cataract in patients with PXE pose a challenge due to associated changes in ocular structures. Aim To study the challenges in the management of cataract in patients with PXE. Materials and Methods This was an interventional study conducted in the Ophthalmology Department of MS Ramaiah Medical College and Memorial Hospital, Bangalore from June 2012 to September 2014. All patients admitted for cataract surgery during this period who were diagnosed as cataract associated with PXE above 50 years of age belonging to either sex were included in the study. All patients underwent cataract surgery with intraocular lens implantation. Depending on type of cataract both small incision and phacoemulsification operations were conducted. Intraoperative and postoperative complications were studied. The patients were reviewed up to 6 weeks postoperatively. Results A total of 50 eyes of 50 patients diagnosed as cataract with PXE underwent cataract surgery. Of which 40 eyes (80%) underwent small incision cataract surgery whereas, 10 (20%) underwent phacoemusification. Corneal thinning (<535 microns) was noted in majority of the cases (41 cases). Preoperatively there were 3 cases of zonular weakness. Pseudo exfoliation with glaucoma was seen in 5 cases. Intraoperative complications encountered during surgery were; zonular dialysis in 3 cases, posterior capsular tear in 2 cases, out of these 5 cases vitreous loss was seen in 3 cases. Postoperative complications were corneal odema in 17 cases, of which endothelium de-compensated in one case, while early posterior capsular opacification was seen in 6 cases. Final best corrected visual acuity was between 6/6-6/12 in 39(78%) eyes, 6/18 -6/36 in 6(12%) cases; 6/60 to less in 5(10%) cases. Conclusion Cataract surgery in eyes with PXE has higher incidence of intraoperative and postoperative

  2. Peri- and intra-operative management of the goat during acute surgical experimentation.

    PubMed

    Flaherty, Devin C; Hoxha, Besim; Nelson, Shirley; Sun, Jie; Gurji, Hunaid; Simecka, Jerry W; Mallet, Robert T; Olivencia-Yurvati, Albert H; Daniels, Egeenee Q

    2010-03-01

    Goats are used as animal models for surgery and trauma research. The authors discuss appropriate methods for induction of anesthetics, intubation and surgical maintenance of the goat during acute experimentation. Risks imposed by the Q fever pathogen Coxiella burnetii are described, as well as measures that have proven effective in minimizing zoonotic transmission of this pathogen to laboratory personnel. With appropriate knowledge of its applications, peri- and intra-operative management and limitations, the goat is a suitable animal model for a variety of biomedical research applications.

  3. Use of Intraoperative Indocyanine Green Videoangiography to Guide Cutaneous Angiosarcoma Excision

    PubMed Central

    Tan, Teresa; Mo, Kevin W. L.; Wong, Pauline S. Y.; Chiu, Tor

    2016-01-01

    Summary: Complete excision of cutaneous angiosarcoma, which is a rare, vascular, and aggressive tumor, is challenging. Its multifocal nature and propensity for lateral spread make the gross assessment of surgical margins difficult. Neither the use of frozen section analysis nor Mohs surgery consistently improves the probability of margin-free excision. Recent studies have advocated the use of indocyanine green to evaluate the vascular system perioperatively. We describe the intraoperative use of indocyanine green to help define the excision margin of a locally extensive scalp angiosarcoma in an elderly man. PMID:27536487

  4. Dosimetric differences between intraoperative and postoperative plans using Cs-131 in transrectal ultrasound–guided brachytherapy for prostatic carcinoma

    SciTech Connect

    Jones, Andrew; Treas, Jared; Yavoich, Brian; Dean, Douglas; Danella, John; Yumen, Omar

    2014-01-01

    The aim of the study was to investigate the differences between intraoperative and postoperative dosimetry for transrectal ultrasound–guided transperineal prostate implants using cesium-131 ({sup 131}Cs). Between 2006 and 2010, 166 patients implanted with {sup 131}Cs had both intraoperative and postoperative dosimetry studies. All cases were monotherapy and doses of 115 were prescribed to the prostate. The dosimetric properties (D{sub 90}, V{sub 150}, and V{sub 100} for the prostate) of the studies were compared. Two conformity indices were also calculated and compared. Finally, the prostate was automatically sectioned into 6 sectors (anterior and posterior sectors at the base, midgland, and apex) and the intraoperative and postoperative dosimetry was compared in each individual sector. Postoperative dosimetry showed statistically significant changes (p < 0.01) in every dosimetric value except V{sub 150}. In each significant case, the postoperative plans showed lower dose coverage. The conformity indexes also showed a bimodal frequency distribution with the index indicating poorer dose conformity in the postoperative plans. Sector analysis revealed less dose coverage postoperatively in the base and apex sectors with an increase in dose to the posterior midgland sector. Postoperative dosimetry overall and in specific sectors of the prostate differs significantly from intraoperative planning. Care must be taken during the intraoperative planning stage to ensure complete dose coverage of the prostate with the understanding that the final postoperative dosimetry will show less dose coverage.

  5. Biomechanics of the intra-operative lateral decubitus position for the scoliotic spine: effect of the pelvic obliquity.

    PubMed

    Lalonde, Nadine M; Aubin, Carl-Eric; Parent, Stefan; Pannetier, Romain; Villemure, Isabelle

    2010-01-01

    The intra-operative prone position used for the posterior instrumentation of scoliotic patients has been shown to reduce the spinal deformities prior to instrumentation by 37% on average. However, the effects of the lateral decubitus position used for anterior approaches and minimally invasive techniques have not been investigated. The objectives were to characterize, model and study the biomechanics of this intra-operative posture. Several clinical indices were measured on the pre- and intra-operative radiographs of six scoliotic patients. A personalized finite element mode (FEM) was developed using the pre-op 3D reconstruction, and a three-step method was developed to simulate the lateral decubitus positioning. Two additional intra-op postures, simulating different pelvic obliquities, were also tested by varying the inclination of L5. The radiographic evaluation of the lateral decubitus position showed a significant reduction of 44% of the major curve with 18 mm of apical vertebra translation. The FEM was able to reproduce the intra-op spine geometry with no significant difference with the measured values. Simulations also showed that the pelvic obliquity had different effects on the lumbar and major Cobb angles depending on the scoliotic curve type. The lateral decubitus posture reduces significantly the scoliotic curvatures prior to instrumentation, which was dependent on the pelvic obliquity.

  6. Evaluation of Pediatric Liver Transplantation-Related Artery Complications Using Intra-Operative Multi-Parameter Ultrasonography

    PubMed Central

    Ren, Xiuyun; Guan, Junhui; Gao, Nong; Niu, Hong; Tang, Jie

    2016-01-01

    Background This article discusses the value of using multi-parameter evaluation of intra-operative ultrasonography in evaluating pediatric liver transplantation-related arterial complications. Material/Methods Sixty-eight children receiving a liver transplant underwent intraoperative ultrasonography for monitoring of artery hemodynamics. The ultrasonic measurement parameters included the diameters of the hepatic artery (HA) of the donor and anastomotic stoma, peak systolic velocity (PSV), resistance index (RI), acceleration time (SAT), and blood flow volume. Results After being treated immediately using surgery or other means, blood flow returned to normal in 8 cases, and did not in 3 cases, of whom 2 experienced postoperative HAT. There was a significant difference in HA diameter of the donor, anastomotic stoma diameter, PSV, RI, SAT, and blood flow volume before and after treatment of the donor in the complications group. Postoperative complications occurred in 7 of 68 recipients, including the 2 cases exhibiting complications during the surgery (complication group) and 5 without complications during the surgery (no complication group). There was a statistically significant difference (P<0.05) between the 2 groups in intraoperative ultrasonography parameters of HA diameter, anastomotic stoma diameter, RI, and blood flow volume. Conclusions Through intraoperative multi-parameter ultrasonic measurement, a definite diagnosis of hepatic artery complications can be made in liver transplantation patients. HA diameter of the donor, anastomotic stoma diameter, PSV, RI, SAT, and blood flow volume are important in assessing intraoperative artery complications. PMID:27870825

  7. Intraoperative Motor Symptoms during Brain Tumor Resection in the Supplementary Motor Area (SMA) without Positive Mapping during Awake Surgery.

    PubMed

    Nakajima, Riho; Nakada, Mitsutoshi; Miyashita, Katsuyoshi; Kinoshita, Masashi; Okita, Hirokazu; Yahata, Tetsutaro; Hayashi, Yutaka

    2015-01-01

    Awake surgery could be a useful modality for lesions locating in close proximity to the eloquent areas including primary motor cortex and pyramidal tract. In case with supplementary motor area (SMA) lesion, we often encounter with intraoperative motor symptoms during awake surgery even in area without positive mapping. Although the usual recovery of the SMA syndrome has been well documented, rare cases with permanent deficits could be encountered in the clinical setting. It has been difficult to evaluate during surgery whether the intraoperative motor symptoms lead to postoperative permanent deficits. The purpose of this study was to demonstrate the intraoperative motor symptoms could be reversible, further to provide useful information for making decision to continue surgical procedure of tumor resection. Eight consecutive patients (from July 2012 to June 2014, six men and two women, aged 33-63 years) with neoplastic lesions around the SMA underwent an awake surgery. Using a retrospective analysis of intraoperative video records, intraoperative motor symptoms during tumor resection were investigated. In continuous functional monitoring during resection of SMA tumor under awake conditions, the following motor symptoms were observed during resection of the region without positive mapping: delayed motor weakness, delay of movement initiation, slowness of movement, difficulty in dual task response, and coordination disturbance. In seven patients hemiparesis observed immediately after surgery recovered to preoperative level within 6 weeks. During awake surgery for SMA tumors, the above-mentioned motor symptoms could occur in area without positive mapping and might be predictors for reversible SMA syndrome.

  8. Comparison of Intraoperative Portable CT Scanners in Skull Base and Endoscopic Sinus Surgery: Single Center Case Series

    PubMed Central

    Conley, David B.; Tan, Bruce; Bendok, Bernard R.; Batjer, H. Hunt; Chandra, Rakesh; Sidle, Douglas; Rahme, Rudy J.; Adel, Joseph G.; Fishman, Andrew J.

    2011-01-01

    Precise and safe management of complex skull base lesions can be enhanced by intraoperative computed tomography (CT) scanning. Surgery in these areas requires real-time feedback of anatomic landmarks. Several portable CT scanners are currently available. We present a comparison of our clinical experience with three portable scanners in skull base and craniofacial surgery. We present clinical case series and the participants were from the Northwestern Memorial Hospital. Three scanners are studied: one conventional multidetector CT (MDCT), two digital flat panel cone-beam CT (CBCT) devices. Technical considerations, ease of use, image characteristics, and integration with image guidance are presented for each device. All three scanners provide good quality images. Intraoperative scanning can be used to update the image guidance system in real time. The conventional MDCT is unique in its ability to resolve soft tissue. The flat panel CBCT scanners generally emit lower levels of radiation and have less metal artifact effect. In this series, intraoperative CT scanning was technically feasible and deemed useful in surgical decision-making in 75% of patients. Intraoperative portable CT scanning has significant utility in complex skull base surgery. This technology informs the surgeon of the precise extent of dissection and updates intraoperative stereotactic navigation. PMID:22470270

  9. Intraoperative Electrophysiologic Monitoring of Ocular Motor Nerves Under Conditions of Partial Neuromuscular Blockade During Skull Base Surgery

    PubMed Central

    Kawaguchi, Masahiko; Ohnishi, Hideyuki; Sakamoto, Takanori; Shimizu, Kiyoshi; Karasawa, Jun; Furuya, Hitoshi

    1996-01-01

    The feasibility and usefulness of intraoperative electromyographic monitoring of the oculomotor nerve (CN III), trochlear nerve (CN IV), and abducens nerve (CN IV) were evaluated under conditions of partial neuromuscular blockade in 21 patients undergoing skill base surgery. Intracranial electrical stimulation of each nerve was performed, and compound muscle action potentials (CMAPs) were reconded from the inferior or superior rectus muscle, the superior oblique muscle, and the lateral rectus muscle for monitoring of CN III, IV, and VI, respectively. Partial neuromuscular blockade was achieved by controlled infusion of vecuronium titrated to eliminate about 90% of the twitch response of the abductor pollicis brevis to electrical stimulation of the median nerve. A total of 30 cranial nerves were stimulated intraoperatively. Of these, 29 were successfully monitored (19 CN III, 6 CN IV, 4 CN VI). A relationship was found between intraoperative findings of cranial nerve monitoring, such as disappearance of response and increase in latency and stimulus threshold during manipulation of a lesion, and the presence of postoperative nerve deficits. We conclude that intraoperative electromyographic monitoring of ocular motor nerves is feasible during partial neuromuscular blockade, and that partial neuromuscular blockade does not affect the relationship between findings of intraoperative monitoring and postoperative nerve function. PMID:17170948

  10. Intraoperative usefulness and postoperative results of the endoilluminator for performing primary posterior capsulectomy and anterior vitrectomy during pediatric cataract surgery

    PubMed Central

    Matalia, J; Anaspure, H; Shetty, B K; Matalia, H

    2014-01-01

    Purpose To analyze the intraoperative usefulness and postoperative results of endoilluminator use during pediatric cataract surgery. Methods Medical records of children <8 years of age who underwent lens aspiration with primary posterior capsulectomy (PPC) and anterior vitrectomy (AV) with or without intraocular lens implantation (IOL) were studied. An endoilluminator was used intraoperatively as an external light source in all cases to ensure the completeness of PPC and adequacy of AV. All children were divided into three groups depending upon the age at surgery and presence of IOL. We included only the first operated eye in bilateral cases. We studied the intraoperative performance for all and postoperative complications for those with >6 months follow-up. Results The charts of 79 eyes of 46 children (26 boys, 20 girls: 33 bilateral, 13 unilateral) were reviewed, of which we analyzed 46 eyes of 46 children for intraoperative performance and 42 eyes of 42 children for postoperative complications. The intraoperatively adequate size of PPC was obtained in all cases with no vitreous in the anterior chamber. Two cases in the first group developed peaking of the pupil, and one case developed visual axis contraction requiring membranectomy. None of the cases in the other groups developed any complication. Conclusion An endoilluminator is a simple, safe, and powerful tool for better visualization of the posterior capsule and anterior vitreous during pediatric cataract surgery. It helps in confirming a good vitrectomy, ensuring its completeness and thereby reducing the chances of any complication due to inadequate AV. PMID:24946844

  11. Using Transcranial Magnetic Stimulation to Evaluate the Motor Pathways After an Intraoperative Spinal Cord Injury and to Predict the Recovery of Intraoperative Transcranial Electrical Motor Evoked Potentials: A Case Report.

    PubMed

    Grover, Helen J; Thornton, Rachel; Lutchman, Lennel N; Blake, Julian C

    2016-06-01

    The authors report a case of unilateral loss of intraoperative transcranial electrical motor evoked potentials (TES MEP) associated with a spinal cord injury during scoliosis correction and the subsequent use of extraoperative transcranial magnetic stimulation to monitor the recovery of spinal cord function. The authors demonstrate the absence of TES MEPs and absent transcranial magnetic stimulation responses in the immediate postoperative period, and document the partial recovery of transcranial magnetic stimulation responses, which corresponded to partial recovery of TES MEPs. Intraoperative TES MEPs were enhanced using spatial facilitation technique, which enabled the patient to undergo further surgery to stabilize the spine and correct her scoliosis. This case report supports evidence of the use of extraoperative transcranial magnetic stimulation to predict the presence of intraoperative TES responses and demonstrates the usefulness of spatial facilitation to monitor TES MEPs in a patient with a preexisting spinal cord injury.

  12. Intraoperative Optical Coherence Tomography-Assisted 27-Gauge Vitrectomy in Eyes with Vitreoretinal Diseases

    PubMed Central

    Kunikata, Hiroshi; Nakazawa, Toru

    2015-01-01

    Objective To report intraoperative optical coherence tomography (iOCT)-assisted 27-gauge microincision vitrectomy surgery (MIVS) in eyes with vitreoretinal disease. Methods A retrospective, interventional case series performed at a single center, including 6 eyes with retinal disease that underwent iOCT-assisted 27-gauge MIVS. Results The advantages of iOCT were most notable when it was used to evaluate, in real time, different macular areas: the pre-macula, in vitreomacular traction or epiretinal membrane; the intra-macula, in macular edema or macular hole; and the sub-macula, in macular detachment. Real-time imaging and the minimization of shadows cast on the underlying tissues by the 27-gauge instrumentation made it possible to quickly select the best procedure at each critical juncture of the surgery. No patients experienced any complications. Conclusion Real-time iOCT imaging during 27-gauge MIVS provided excellent intraoperative visualization of retinal tissues without causing significant obstructions to the surgeon. The positive feedback from the system allowed the surgeon to better judge the necessity of additional surgical procedures. PMID:26265908

  13. Safety and effectiveness of a synthetic hemostatic patch for intraoperative soft tissue bleeding

    PubMed Central

    Schuhmacher, Christoph; Pratschke, Johann; Weiss, Sascha; Schneeberger, Stefan; Mihaljevic, André L; Schirren, Rebekka; Winkler, Michael; Emmanouilidis, Nikos

    2015-01-01

    Background Continuous bleeding after using conventional hemostatic methods involving energy, sutures, or clips, is a serious and costly surgical complication. Many topical agents have been developed to promote intraoperative hemostasis, but improvement is needed in both decreasing time to hemostasis and increasing ease of use. Veriset™ hemostatic patch is CE-marked for controlling bleeding on the liver and in soft tissue. In the current study, we aimed to gather further evidence for the safety and effectiveness of Veriset™ hemostatic patch in soft tissue bleeding during a variety of surgical procedures. Methods Thirty patients scheduled for nonemergency surgery, each with an intraoperative soft tissue bleeding site, were treated with Veriset™ hemostatic patch. Time to hemostasis was monitored, and adverse events were assessed during the 90 days after surgery. Results When Veriset™ hemostatic patch was used, hemostasis occurred within 5 minutes in 29/30 (96.7%) subjects and within 1 minute in 21/30 (70.0%) subjects. No device-related serious adverse events were recorded during the 30 days after surgery, and no reoperations for device-related bleeding complications were performed during the 5 days after surgery. Conclusions Veriset™ hemostatic patch is a safe and effective hemostat for controlling soft tissue bleeding during a variety of surgical procedures. PMID:25878513

  14. Intraoperative radiation therapy for recurrent head-and-neck cancer: The UCSF experience

    SciTech Connect

    Chen, Allen M. . E-mail: allenmchen@yahoo.com; Bucci, M. Kara; Singer, Mark I.; Garcia, Joaquin; Kaplan, Michael J.; Chan, Albert S.; Phillips, Theodore L.

    2007-01-01

    Purpose: To review a single-institutional experience with the use of intraoperative radiation therapy (IORT) for recurrent head-and-neck cancer. Methods and Materials: Between 1991 and 2004, 137 patients were treated with gross total resection and IORT for recurrence or persistence of locoregional cancer of the head and neck. One hundred and thirteen patients (83%) had previously received external beam radiation as a component of definitive therapy. Ninety-four patients (69%) had squamous cell histology. Final surgical margins were microscopically positive in 56 patients (41%). IORT was delivered using either a modified linear accelerator or a mobile electron unit and was administered as a single fraction to a median dose of 15 Gy (range, 10-18 Gy). Median follow-up among surviving patients was 41 months (range, 3-122 months). Results: The 1-year, 2-year, and 3-year estimates of in-field control after salvage surgery and IORT were 70%, 64%, and 61%, respectively. Positive margins at the time of IORT predicted for in-field failure (p = 0.001). The 3-year rates of locoregional control, distant metastasis-free survival, and overall survival were 51%, 46%, and 36%, respectively. There were no perioperative fatalities. Complications included wound infection (4 patients), orocutaneous fistula (2 patients), flap necrosis (1 patient), trismus (1 patient), and neuropathy (1 patient). Conclusions: Intraoperative RT results in effective disease control with acceptable toxicity and should be considered for selected patients with recurrent or persistent cancers of the head and neck.

  15. Intraoperative targeted optical imaging: a guide towards tumor-free margins in cancer surgery.

    PubMed

    Orbay, Hakan; Bean, Jero; Zhang, Yin; Cai, Weibo

    2013-01-01

    Over the last several decades, development of various imaging techniques such as computed tomography, magnetic resonance imaging, and positron emission tomography greatly facilitated the early detection of cancer. Another important aspect that is closely related to the survival of cancer patients is complete tumor removal during surgical resection. The major obstacle in achieving this goal is to distinguish between tumor tissue and normal tissue during surgery. Currently, tumor margins are typically assessed by visual assessment and palpation of the tumor intraoperatively. However, the possibility of microinvasion to the surrounding tissues makes it difficult to determine an adequate tumor-free excision margin, often forcing the surgeons to perform wide excisions including the healthy tissue that may contain vital structures. It would be ideal to remove the tumor completely, with minimal safety margins, if surgeons could see precise tumor margins during the operation. Molecular imaging with optical techniques can visualize the tumors via fluorophore conjugated probes targeting tumor markers such as proteins and enzymes that are upregulated during malignant transformation. Intraoperative use of this technique may facilitate complete excision of the tumor and tumor micromasses located beyond the visual capacity of the naked eye, ultimately improving the clinical outcome and survival rates of cancer patients.

  16. Assessment of free microvascular flap perfusion by intraoperative fluorescence angiography in craniomaxillofacial surgery.

    PubMed

    Preidl, Raimund H M; Schlittenbauer, Tilo; Weber, Manuel; Neukam, Friedrich W; Wehrhan, Falk

    2015-06-01

    Microsurgical tissue transfer represents a standard technique for reconstruction in craniomaxillofacial surgery. The transferred tissue is anastomosed to vessels of varying diameters and different physiological conditions. The aim of this study was to evaluate the blood flow in free flaps at their origin and compare this with the flow after reperfusion. In 24 patients undergoing microsurgical procedures (13 radial forearm free flaps (RFFF) and 11 parascapular/scapular free flaps (PSFF)), blood flow was evaluated by intraoperative fluorescence angiography after flap raising and again after reperfusion in the neck area (Flow800, Carl Zeiss AG, Oberkochen, Germany). Flow is expressed by the blood flow index (BFI), maximum intensity (MaxInt) and half-time to MaxInt (t1/2) and was measured in the flap pedicle itself, as well as in the supplying vessels. Following anastomosis of the free flaps in the head and neck area, both the arterial and the venous BFI and MaxInt significantly increased, whereas t1/2 decreased significantly. There was no significant difference in the perfusion parameters between RFFF and PSFF. Intraoperative fluorescence angiography is a reliable method for assessing the perfusion of free microvascular flaps. In the head and neck area, free flaps undergo a significant increase in perfusion but show no differences between varying flap types.

  17. Accuracy of intra-operative frozen section analysis of ovarian tumours.

    PubMed

    Gorisek, B; Stare, M Rebolj; Krajnc, I

    2009-01-01

    During operative treatment for ovarian tumours assistance is frequently required to make decisions regarding malignancy status and the extent of the ensuing procedure. Intra-operative frozen section analysis may be useful, provided there is adequate acquaintance with the correlation between using frozen sections and permanent histopathological sections for diagnosis at the institution where the operation is being undertaken. This retrospective study aimed to determine this correlation. Findings from 131 intra-operative frozen sections were compared with the subsequent diagnosis from permanent histopathological sections for women with benign, borderline and malignant ovarian tumours at the Maribor Teaching Hospital (now the University Clinical Centre Maribor) between 1 January 1993 and 31 December 2001. Frozen-section findings corresponded to histopathological findings in 84.7% of cases, with 15.3% false-negative and no false-positive results. For benign, borderline and malignant ovarian tumours, sensitivity was 100.0%, 76.1% and 89.0%, respectively, and specificity was 90.6%, 90.6% and 100.0%, respectively. The majority of errors occurred in diagnosing mucinous borderline tumours. Precise pre-operative diagnosis is extremely important in the treatment of ovarian tumours.

  18. Registration of liver images to minimally invasive intraoperative surface and subsurface data

    NASA Astrophysics Data System (ADS)

    Wu, Yifei; Rucker, D. C.; Conley, Rebekah H.; Pheiffer, Thomas S.; Simpson, Amber L.; Geevarghese, Sunil K.; Miga, Michael I.

    2014-03-01

    Laparoscopic liver resection is increasingly being performed with results comparable to open cases while incurring less trauma and reducing recovery time. The tradeoff is increased difficulty due to limited visibility and restricted freedom of movement. Image-guided surgical navigation systems have the potential to help localize anatomical features to improve procedural safety and achieve better surgical resection outcome. Previous research has demonstrated that intraoperative surface data can be used to drive a finite element tissue mechanics organ model such that high resolution preoperative scans are registered and visualized in the context of the current surgical pose. In this paper we present an investigation of using sparse data as imposed by laparoscopic limitations to drive a registration model. Non-contact laparoscopicallyacquired surface swabbing and mock-ultrasound subsurface data were used within the context of a nonrigid registration methodology to align mock deformed intraoperative surface data to the corresponding preoperative liver model as derived from pre-operative image segmentations. The mock testing setup to validate the potential of this approach used a tissue-mimicking liver phantom with a realistic abdomen-port patient configuration. Experimental results demonstrates a range of target registration errors (TRE) on the order of 5mm were achieving using only surface swab data, while use of only subsurface data yielded errors on the order of 6mm. Registrations using a combination of both datasets achieved TRE on the order of 2.5mm and represent a sizeable improvement over either dataset alone.

  19. Intraoperative Neurophysiological Monitoring in Spine Surgery: A Significant Tool for Neuronal Protection and Functional Restoration.

    PubMed

    Scibilia, Antonino; Raffa, Giovanni; Rizzo, Vincenzo; Quartarone, Angelo; Visocchi, Massimiliano; Germanò, Antonino; Tomasello, Francesco

    2017-01-01

    Although there is recent evidence for the role of intraoperative neurophysiological monitoring (IONM) in spine surgery, there are no uniform opinions on the optimal combination of the different tools. At our institution, multimodal IONM (mIONM) approach in spine surgery involves the evaluation of somatosensory evoked potentials (SEPs) and motor evoked potentials (MEPs) with electrical transcranial stimulation, including the use of a multipulse technique with multiple myomeric registration of responses from limbs, and a single-pulse technique with D-wave registration through epi- and intradural recording, and free running and evoked electromyography (frEMG and eEMG) with bilateral recording from segmental target muscles. We analyzed the impact of the mIONM on the preservation of neuronal structures and on functional restoration in a prospective series of patients who underwent spine surgery. We observed an improvement of neurological status in 50 % of the patients. The D-wave registration was the most useful intraoperative tool, especially when MEP and SEP responses were absent or poorly recordable. Our preliminary data confirm that mIONM plays a fundamental role in the identification and functional preservation of the spinal cord and nerve roots. It is highly sensitive and specific for detecting and avoiding neurological injury during spine surgery and represents a helpful tool for achieving optimal postoperative functional outcome.

  20. [Detection of intraoperative awareness via auditory evoked potentials in an infant].

    PubMed

    Feuerecker, M S; Daunderer, M; Pape, N-B; Kuhnle, G E H

    2006-10-01

    Intraoperative wakefulness is not only limited to adults and can also be found at a similar percentage (0.8%) in paediatric anaesthesia. For prevention of awareness neurophysiologic methods like auditory evoked potentials might be helpful. We report a case of a 2-year-old boy receiving balanced anaesthesia with sevoflurane and alfentanil. Midlatency auditory evoked potentials (MLAEPs) were recorded continuously before, during and after the surgical procedure. During the surgical procedure sevoflurane was withdrawn unintentionally. After a short period of time the boy started coughing and moved his legs, which was interpreted as insufficient analgesia. Several boli of alfentanil did not lead to the expected clinical effect on the depth of anaesthesia. After a recheck of the anaesthetic ventilator the error was determined and delivery of the volatile anaesthetic restored. The postoperative evaluation of the MLAEPs revealed the inadequate suppression of auditory processing during this incident with latencies comparable to the awake state. After reapplication of sevoflurane the MLAEPs were almost completely suppressed demonstrating adequate anesthetic depth. Exemplarily this case suggests that MLAEPs could be used to detect intraoperative awareness also in paediatric anaesthesia. Investigations to prove the validity and reproducibility of MLAEPs in children will be necessary.

  1. High spatial frequency structured light imaging for intraoperative breast tumor margin assessment

    NASA Astrophysics Data System (ADS)

    McClatchy, David M.; Krishnaswamy, Venkataramanan; Kanick, Stephen C.; Elliott, Jonathan T.; Wells, Wendy A.; Barth, Richard J.; Paulsen, Keith D.; Pogue, Brian W.

    2015-03-01

    A new superficial wide-field imaging technique is presented, which utilizes high spatial frequency structured illumination to constrain the light sampling volume to a sub-diffuse regime. In this transport regime, the effects of absorption are drastically reduced and the sensitivity to local scattering from ultrastructrual alterations is increased. Absorption independence is validated with multiple experiments including a bovine blood-Intralipid solution matrix and avian tissue with superficial bovine blood. The resulting structured light demodulated images show a complete insensitivity to the blood over Hb concentrations of 0 - 240 μM. Increased sensitivity to ultrastructual changes is demonstrated by imaging avian tissue with controlled morphological alterations including formalin-induced crosslinking. This imaging technique is currently being translated towards intraoperative assessment of breast tumor margins because of its ability to capture an entire lumpectomy margin in a single field of view, insensitivity to confounding surface blood present on lumpectomies, and its inherent scatter signal without the need of any model inversion. Further, a new lumpectomy marking system is introduced that allows for both the surgeon to mark the lumpectomy during excision and optical assessment of the specimen after the margins have been marked. Structured light images acquired intraoperatively of all margins of lumpectomy specimens are presented to show feasibility of clinical translation. Immediate future work will focus on developing a multi-spectral system.

  2. Belmont Hyperthermia Pump in the conduct of intra-operative heated chemotherapy.

    PubMed

    Riley, W

    2009-03-01

    Intra-operative heated chemotherapy (IOHC) has been performed in the Thoracic surgical department of Brigham and Women's Hospital (BWH, Boston, MA, USA) for over a decade. A "home-grown" system was developed for this purpose with limited improvements made to it through the years. This technology is used for neo-adjuvant therapy in the conduct of extra-pleural pneumonectomy and pleurectomy for treatment of mesothelioma. Improvements to the traditional BWH system were sought due to the hazardous nature of the chemotherapy solution and the relative complexity of the IOHC circuit. Belmont Instrument (Belmont Instrument Corporation, Billerica, MA, USA) applied their proprietary infusion/warming technology to develop the Belmont Hyperthermia Pump. The Hyperthermia Pump was designed to recirculate large volumes of fluid while maintaining perfusate temperatures up to 46oC at a flow rate of up to 750 ml/min. Approval from the FDA for clinical use of this device was granted June 2007. Parameters were defined and investigated to determine if the Hyperthermia Pump would meet or exceed the performance characteristics of the traditional BWH system. Our investigation resulted in the replacement of the traditional BWH circuit. The Belmont Hyperthermia Pump is a compact, easy to use, extremely safe means to deliver intra-operative hyperthermic chemotherapy in the conduct of surgical treatment of mesothelioma.

  3. The impact of preoperative skin disinfection on preventing intraoperative wound contamination.

    PubMed

    Garibaldi, R A; Skolnick, D; Lerer, T; Poirot, A; Graham, J; Krisuinas, E; Lyons, R

    1988-03-01

    The efficacy of total body showering and incision site scrub with disinfectant agents was evaluated in a randomized, prospective study of 575 patients undergoing selected surgical procedures. Patients who showered twice with 4% chlorhexidine gluconate had lower mean colony counts of skin bacteria at the surgical incision site in the operating room prior to the final scrub than patients who showered twice with povidone-iodine solution or medicated bar soap. Patients in the chlorhexidine group had no growth on 43% of the incision site skin cultures compared with 16% in the povidone-iodine group and 6% in the soap and water group. Patients who showered and who were scrubbed with chlorhexidine also had lower rates of intraoperative wound contamination. Bacteria were recovered from the wounds of 4% of patients using this regimen compared with 9% for patients who used povidone-iodine and 15% for patients who showered with medicated soap and water and were scrubbed with povidone-iodine. We noted no difference in surgery-specific infection rates among patients in the three treatment groups; however, our sample sizes were too small to evaluate this outcome parameter adequately. These data suggest that preoperative showering and scrubbing with chlorhexidine is an effective regimen to reduce extrinsic intraoperative contamination of the surgical wound from skin bacteria. The efficacy of this regimen to prevent postoperative wound infection needs to be evaluated in a well-designed, carefully controlled prospective trial with adequate numbers of patients to achieve statistically valid conclusions.

  4. Assessment of Macular Function during Vitrectomy: New Approach Using Intraoperative Focal Macular Electroretinograms

    PubMed Central

    Matsumoto, Celso Soiti; Shinoda, Kei; Terauchi, Gaku; Matsumoto, Harue; Mizota, Atsushi; Miyake, Yozo

    2015-01-01

    Purpose To describe a new technique to record focal macular electroretinograms (FMERGs) during vitrectomy to assess macular function. Methods Intraoperative FMERGs (iFMERGs) were recorded in ten patients (10 eyes) who undergo vitrectomy. iFMERGs were elicited by focal macular stimulation. The stimulus light was directed to the macular area through a 25 gauge (25G) glass fiber optic bundle. Background light was delivered through a dual chandelier-type light fiber probe. Focal macular responses elicited with combinations of stimulus and background luminances were analyzed. Results A stimulus luminance that was approximately 1.75 log units brighter than the background light was able to elicit focal macular responses that were not contaminated by stray light responses. Thus, a stimulus luminance of 160 cd/m2 delivered on a background of 3 cd/m2 elicited iFMEGs from only the stimulated area. This combination of stimulus and background luminances did not elicit a response when the stimulus was projected onto the optic nerve head. The iFMERGs elicited by a 10° stimulus with a duration of 100 ms and an interstimulus interval of 150 ms consisted of an a-, b-, and d-waves, the oscillatory potentials, and the photopic negative response (PhNR). Conclusions Focal ERGs with all components can be recorded from the macula and other retinal areas during vitreous surgery. This new technique will allow surgeons to assess the function of focal areas of the retina intraoperatively. PMID:26658489

  5. Impact of right-handedness on anaesthetic sensitivity, intra-operative awareness and postoperative mortality.

    PubMed

    Rao, S; Huverserian, A R; Ben Abdallah, A; Lees, K; Willingham, M D; Burnside, B A; Villafranca, A J; Glick, D B; Jacobsohn, E; Avidan, M S

    2014-08-01

    Anatomical, neurological and behavioural research has suggested differences between the brains of right- and non-right-handed individuals, including differences in brain structure, electroencephalogram patterns, explicit memory and sleep architecture. Some studies have also found decreased longevity in left-handed individuals. We therefore aimed to determine whether handedness independently affects the relationship between volatile anaesthetic concentration and the bispectral index, the incidence of definite or possible intra-operative awareness with explicit recall, or postoperative mortality. We studied 5585 patients in this secondary analysis of data collected in a multicentre clinical trial. There were 4992 (89.4%) right-handed and 593 (10.6%) non-right-handed patients. Handedness was not associated with (a) an alteration in anaesthetic sensitivity in terms of the relationship between the bispectral index and volatile anaesthetic concentration (estimated effect on the regression relationship -0.52 parallel shift; 95% CI -1.27 to 0.23, p = 0.17); (b) the incidence of intra-operative awareness with 26/4992 (0.52%) right-handed vs 1/593 (0.17%) non-right-handed (difference = 0.35%; 95% CI -0.45 to 0.63%; p = 0.35); or (c) postoperative mortality rates (90-day relative risk for non-right-handedness 1.19, 95% CI 0.76-1.86; p = 0.45). Thus, no change in anaesthetic management is indicated for non-right-handed patients.

  6. Dry Eye Following Phacoemulsification Surgery and its Relation to Associated Intraoperative Risk Factors

    PubMed Central

    Sahu, P. K.; Das, G. K.; Malik, Aman; Biakthangi, Laura

    2015-01-01

    Purpose: The purpose was to study dry eye following phacoemulsification surgery and analyze its relation to associated intra-operative risk factors. Materials and Methods: A prospective observational study was carried out on 100 eyes of 100 patients without preoperative dry eye. Schirmer's Test I, tear meniscus height, tear break-up time, and lissamine green staining of cornea and conjunctiva were performed preoperatively and at 5 days, 10 days, 1-month, and 2 months after phacoemulsification surgery, along with the assessment of subjective symptoms, using the dry eye questionnaire. The correlations between these values and the operating microscope light exposure time along with the cumulative dissipated energy (CDE) were investigated. Results: There was a significant deterioration of all dry eye test values following phacoemulsification surgery along with an increase in subjective symptoms. These values started improving after 1-month postoperatively, but preoperative levels were not achieved till 2 months after surgery. Correlations of dry eye test values were noted with the operating microscope light exposure time and CDE, but they were not significant. Conclusion: Phacoemulsification surgery is capable of inducing dry eye, and patients should be informed accordingly prior to surgery. The clinician should also be cognizant that increased CDE can induce dry eyes even in eyes that were healthy preoperatively. In addition, intraoperative exposure to the microscopic light should be minimized. PMID:26692720

  7. Intraoperative Dexmedetomidine Promotes Postoperative Analgesia and Recovery 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 and stress response may lead to prolonged convalescence. The present study was designed to investigate the effects of intraoperative dexmedetomidine on postoperative analgesia and recovery after abdominal colectomy surgeries. Sixty-seven patients scheduled for abdominal colectomy under general anesthesia were divided into two 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 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 after surgery, PRD patients consumed less morphine in patient-controlled analgesia, and had a lower score in visual analog scale, than their controls from the PRS group. The global 40-item quality of recovery questionnaire and 9-question fatigue severity score both showed a higher recovery score from day 3 after surgery in the PRD group. Intraoperative administration of dexmedetomidine seems to promote the analgesic property of morphine-based patient-controlled analgesia, and speed recovery from surgery in patients after abdominal colectomy. PMID:26512563

  8. A Simple, Reliable, and Inexpensive Intraoperative External Expansion System for Enhanced Autologous Structural Fat Grafting

    PubMed Central

    Oranges, Carlo M.; Tremp, Mathias; Ling, Barbara; Wettstein, Reto; Largo, René D.

    2016-01-01

    External volume expansion of the recipient site by suction has been proposed as a way of improving fat graft survival. The objective of this study was to present an innovative and simple intraoperative external expansion system to enhance small-volume autologous fat grafting (40–80 mL) and to discuss its background and its mechanism of action. In this system, expansion is performed using a complete vacuum delivery system known as the Kiwi VAC-6000M with a PalmPump (Clinical Innovations). The recipient site is rapidly expanded intraoperatively 10 times for 30 seconds each with a negative pressure of up to 550 mm Hg before autologous fat injection. During this repetitive stimulation, the tissues become grossly expanded, developing macroscopic swelling that regresses slowly over the course of hours following the cessation of the stimulus. The system sets various mechanisms in motion, including scar release, mechanical stimulation, edema, ischemia, and inflammation, which provide an environment conducive for cell proliferation and angiogenesis. In order to maintain the graft construct in its expansive state, all patients are encouraged postoperatively to use the Kiwi three times daily for one minute per session over the course of three days. The handling of this system is simple for both the patients and the surgeon. Satisfactory clinical outcomes have been achieved without significant complications. PMID:27689056

  9. Hemisection spinal cord injury in rat: The value of intraoperative somatosensory evoked potential monitoring

    PubMed Central

    Cloud, Beth A.; Ball, Bret G.; Chen, Bingkun; Knight, Andrew M.; Hakim, Jeffrey S.; Ortiz, Ana M.; Windebank, Anthony J.

    2012-01-01

    Techniques used to produce partial spinal cord injuries in animal models have the potential for creating variability in lesions. The amount of tissue affected may influence the functional outcomes assessed in the animals. The recording of somatosensory evoked potentials (SSEPs) may be a valuable tool for assessing the extent of lesion applied in animal models of traumatic spinal cord injury (SCI). Intraoperative tibial SSEP recordings were assessed during surgically induced lateral thoracic hemisection SCI in Sprague-Dawley rats. The transmission of SSEPs, or lack thereof, was determined and compared against the integrity of the dosal funiculi on each side of the spinal cord upon histological sectioning. An association was found between the presence of an SSEP signal and presence of intact dorsal funiculus tissue. The relative risk is 4.50 (95% confidence interval: 1.83 to 11.08) for having an intact dorsal funiculus when the ipsilateral SSEP was present compared to when it was absent. Additionally, the amount of spared spinal cord tissue correlates with final functional assessments at nine weeks post injury: BBB (linear regression, R2 = 0.618, p <0.001) and treadmill test (linear regression, R2 = 0.369, p = 0.016). Therefore, we propose intraoperative SSEP monitoring as a valuable tool to assess extent of lesion and reduce variability between animals in experimental studies of SCI. PMID:22960163

  10. Intraoperative near-infrared fluorescence imaging and spectroscopy identifies residual tumor cells in wounds.

    PubMed

    Holt, David; Parthasarathy, Ashwin B; Okusanya, Olugbenga; Keating, Jane; Venegas, Ollin; Deshpande, Charuhas; Karakousis, Giorgos; Madajewski, Brian; Durham, Amy; Nie, Shuming; Yodh, Arjun G; Singhal, Sunil

    2015-07-01

    Surgery is the most effective method to cure patients with solid tumors, and 50% of all cancer patients undergo resection. Local recurrences are due to tumor cells remaining in the wound, thus we explore near-infrared (NIR) fluorescence spectroscopy and imaging to identify residual cancer cells after surgery. Fifteen canines and two human patients with spontaneously occurring sarcomas underwent intraoperative imaging. During the operation, the wounds were interrogated with NIR fluorescence imaging and spectroscopy. NIR monitoring identified the presence or absence of residual tumor cells after surgery in 14/15 canines with a mean fluorescence signal-to-background ratio (SBR) of ∼16 . Ten animals showed no residual tumor cells in the wound bed (mean SBR<2 , P<0.001 ). None had a local recurrence at >1-year follow-up. In five animals, the mean SBR of the wound was >15 , and histopathology confirmed tumor cells in the postsurgical wound in four/five canines. In the human pilot study, neither patient had residual tumor cells in the wound bed, and both remain disease free at >1.5-year follow up. Intraoperative NIR fluorescence imaging and spectroscopy identifies residual tumor cells in surgical wounds. These observations suggest that NIR imaging techniques may improve tumor resection during cancer operations.

  11. Silk-elastin-like protein polymer matrix for intraoperative delivery of an oncolytic vaccinia virus

    PubMed Central

    Price, Daniel L.; Li, Pingdong; Chen, Chun-Hao; Wong, Danni; Yu, Zhenkun; Chen, Nanhai G.; Yu, Yong A.; Szalay, Aladar A.; Cappello, Joseph; Fong, Yuman; Wong, Richard J.

    2016-01-01

    Background Oncolytic viral efficacy may be limited by the penetration of the virus into tumors. This may be enhanced by intraoperative application of virus immediately after surgical resection. Methods Oncolytic vaccinia virus GLV-1h68 was delivered in silk-elastin-like protein polymer (SELP) in vitro and in vivo in anaplastic thyroid carcinoma cell line 8505c in nude mice. Results GLV-1h68 in SELP infected and lysed anaplastic thyroid cancer cells in vitro equally as effectively as in phosphate-buffered saline (PBS), and at 1 week retains a thousand fold greater infectious plaque-forming units. In surgical resection models of residual tumor, GLV-1h68 in SELP improves tumor control and shows increased viral β-galactosidase expression as compared to PBS. Conclusion The use of SELP matrix for intraoperative oncolytic viral delivery protects infectious viral particles from degradation, facilitates sustained viral delivery and transgene expression, and improves tumor control. Such optimization of methods of oncolytic viral delivery may enhance therapeutic outcomes. PMID:25244076

  12. Intraoperative near-infrared fluorescence imaging and spectroscopy identifies residual tumor cells in wounds

    NASA Astrophysics Data System (ADS)

    Holt, David; Parthasarathy, Ashwin B.; Okusanya, Olugbenga; Keating, Jane; Venegas, Ollin; Deshpande, Charuhas; Karakousis, Giorgos; Madajewski, Brian; Durham, Amy; Nie, Shuming; Yodh, Arjun G.; Singhal, Sunil

    2015-07-01

    Surgery is the most effective method to cure patients with solid tumors, and 50% of all cancer patients undergo resection. Local recurrences are due to tumor cells remaining in the wound, thus we explore near-infrared (NIR) fluorescence spectroscopy and imaging to identify residual cancer cells after surgery. Fifteen canines and two human patients with spontaneously occurring sarcomas underwent intraoperative imaging. During the operation, the wounds were interrogated with NIR fluorescence imaging and spectroscopy. NIR monitoring identified the presence or absence of residual tumor cells after surgery in 14/15 canines with a mean fluorescence signal-to-background ratio (SBR) of ˜16. Ten animals showed no residual tumor cells in the wound bed (mean SBR<2, P<0.001). None had a local recurrence at >1-year follow-up. In five animals, the mean SBR of the wound was >15, and histopathology confirmed tumor cells in the postsurgical wound in four/five canines. In the human pilot study, neither patient had residual tumor cells in the wound bed, and both remain disease free at >1.5-year follow up. Intraoperative NIR fluorescence imaging and spectroscopy identifies residual tumor cells in surgical wounds. These observations suggest that NIR imaging techniques may improve tumor resection during cancer operations.

  13. Visualization of vitreoretinal surgical manipulations using intraoperative spectral domain optical coherence tomography

    NASA Astrophysics Data System (ADS)

    Tao, Yuankai K.; Ehlers, Justis P.; Toth, Cynthia A.; Izatt, Joseph A.

    2011-03-01

    Vitreoretinal surgical visualization by ophthalmic microscopy is limited in its ability to distinguish thin translucent tissues from other retinal substructures. Conventional methods for supplementing poor contrast, such as with increased illumination and application of exogenous contrast agents, have been limited by the risks of toxicity at the retina. Spectral domain optical coherence tomography (SDOCT) has demonstrated strong clinical success in retinal imaging, enabling high-resolution, motion-artifact-free cross-sectional imaging and rapid accumulation of volumetric macular datasets. Current generation SDOCT systems achieve <5 μm axial resolutions in tissue, and have been used to obtain high resolution datasets from patients with neovascular AMD, high risk drusen, and geographic atrophy. Recently, an intraoperative microscope-mounted OCT system (MMOCT) was presented as a method of augmenting a surgical microscope to concurrently acquire high-resolution, high-contrast SDOCT volumetric datasets. Here, we demonstrated the utility of intraoperative MMOCT for the visualization of vitreoretinal surgical procedures. Vitreoretinal surgery was simulated by performing procedures, through an ophthalmic surgical microscope, on cadaveric porcine eyes. The datasets acquired with the MMOCT show both instrument-tissue interaction as well as the ability of OCT to image certain surgical tools, which would directly translate to better surgical visualization and impact the treatment of ocular diseases.

  14. Vascular Structure Identification in Intraoperative 3D Contrast-Enhanced Ultrasound Data

    PubMed Central

    Ilunga-Mbuyamba, Elisee; Avina-Cervantes, Juan Gabriel; Lindner, Dirk; Cruz-Aceves, Ivan; Arlt, Felix; Chalopin, Claire

    2016-01-01

    In this paper, a method of vascular structure identification in intraoperative 3D Contrast-Enhanced Ultrasound (CEUS) data is presented. Ultrasound imaging is commonly used in brain tumor surgery to investigate in real time the current status of cerebral structures. The use of an ultrasound contrast agent enables to highlight tumor tissue, but also surrounding blood vessels. However, these structures can be used as landmarks to estimate and correct the brain shift. This work proposes an alternative method for extracting small vascular segments close to the tumor as landmark. The patient image dataset involved in brain tumor operations includes preoperative contrast T1MR (cT1MR) data and 3D intraoperative contrast enhanced ultrasound data acquired before (3D-iCEUSstart) and after (3D-iCEUSend) tumor resection. Based on rigid registration techniques, a preselected vascular segment in cT1MR is searched in 3D-iCEUSstart and 3D-iCEUSend data. The method was validated by using three similarity measures (Normalized Gradient Field, Normalized Mutual Information and Normalized Cross Correlation). Tests were performed on data obtained from ten patients overcoming a brain tumor operation and it succeeded in nine cases. Despite the small size of the vascular structures, the artifacts in the ultrasound images and the brain tissue deformations, blood vessels were successfully identified. PMID:27070610

  15. Intraoperative localization of early-stage gastrointestinal tumors using a marking clip detector system.

    PubMed

    Ohdaira, Takeshi; Nagai, Hideo; Shibusawa, Hiroyuki

    2005-01-01

    Intraoperative Tumor site recognition is extremely difficult during laparoscopic surgical treatment of early-stage gastrointestinal carcinoma. A novel marking method that uses both metallic clips and a marking clip detector system (MCDS, Olympus Optical Co., Tokyo, Japan) modified from a metal detector system, was designed by the authors. Metallic clips were applied to the tumor site during preoperative endoscopy, and the clip site was identified intraoperatively using the MCDS. In a basic ex vivo study, three metallic clips were detected easily (100% detection). In a clinical study, the marking site was detected in all gastric cancer patients who underwent laparoscopic subtotal gastrectomy. The mean distance between detected site and clip along the longitudinal bowel axis was 6.4 +/- 2.9 mm. Mean detection time was 18.1 +/- 5.7 seconds. None of the patients in this study experienced complications from this marking technique. MCDS allows accurate identification of tumor sites. This method may be useful for tumor-site identification during laparoscopic gastrectomy.

  16. Oil-on-water: proposed method for intraoperative identification of perilymphatic fistula.

    PubMed

    Todd, N W; Jackson, R T

    1995-07-01

    The intraoperative diagnosis of a perilymphatic fistula is usually subjective and controversial. Unless there is profuse gushing of fluid, there is no reliable, objective, intraoperative indicator of a perilymphatic fistula. The authors suggest a technique for the real-time determination of the existence and location of a perilymphatic fistula: visualization of clear perilymphatic fluid beneath a layer of mineral oil. Mineral oil is transparent to visible light, hydrophobic, and lighter than perilymphatic fluid. The oil traps the aqueous fluid, and tends to keep it contained in a droplet. With standard otomicroscopic viewing, a droplet of less than 1 microL of fluid is readily visible through the oil. In vitro temporal bone studies showing the utility and objectivity of identifying the aqueous fluid in the mesotympanum are reported. Mineral oil floats on saline and is readily removed with suction-irrigation techniques. The authors consider the oil-on-water technique to increase the resolution of identifying minute aqueous droplets and recommend in vivo study in patients.

  17. Towards intraoperative surgical margin assessment and visualization using bioimpedance properties of the tissue

    NASA Astrophysics Data System (ADS)

    Khan, Shadab; Mahara, Aditya; Hyams, Elias S.; Schned, Alan; Halter, Ryan

    2015-03-01

    Prostate cancer (PCa) has a high 10-year recurrence rate, making PCa the second leading cause of cancer-specific mortality among men in the USA. PCa recurrences are often predicted by assessing the status of surgical margins (SM) with positive surgical margins (PSM) increasing the chances of biochemical recurrence by 2-4 times. To this end, an SM assessment system using Electrical Impedance Spectroscopy (EIS) was developed with a microendoscopic probe. This system measures the tissue bioimpedance over a range of frequencies (1 kHz to 1MHz), and computes a Composite Impedance Metric (CIM). CIM can be used to classify tissue as benign or cancerous. The system was used to collect the impedance spectra from excised prostates, which were obtained from men undergoing radical prostatectomy. The data revealed statistically significant (p<0.05) differences in the impedance properties of the benign and tumorous tissues, and between different tissue morphologies. To visualize the results of SM-assessment, a visualization tool using da Vinci stereo laparoscope is being developed. Together with the visualization tool, the EIS-based SM assessment system can be potentially used to intraoperatively classify tissues and display the results on the surgical console with a video feed of the surgical site, thereby augmenting a surgeon's view of the site and providing a potential solution to the intraoperative SM assessment needs.

  18. The role of dominant striatum in language: a study using intraoperative electrical stimulations

    PubMed Central

    Robles, S; Gatignol, P; Capelle, L; Mitchell, M; Duffau, H

    2005-01-01

    Background: The role of the striatum in language remains poorly understood. Intraoperative electrical stimulation during surgery for tumours involving the caudate nucleus or putamen in the dominant hemisphere might be illuminating. Objectives: To study the role of these structures in language, with the aim of avoiding postoperative definitive aphasia. Methods: 11 patients with cortico-subcortical low grade gliomas were operated on while awake, and striatal functional mapping was done. Intraoperative direct electrical stimulation was used while the patients carried out motor and naming tasks during the resection. Results: In five cases of glioma involving the dominant putamen, stimulations induced anarthria, while in six cases of glioma involving the dominant caudate, stimulations elicited perseveration. There was no motor effect. The striatum was systematically preserved. Postoperatively, all patients except one had transient dysphasia which resolved within three months. Conclusions: There appear to be two separate basal ganglia systems in language, one mediated by the putamen which might have a motor role, and one by the caudate which might have a role in cognitive control. These findings could have implications for surgical strategy in lesions involving the dominant striatum. PMID:15965199

  19. Intraoperative monitoring during surgery for acoustic neuroma: benefits of an extratympanic intrameatal electrode

    PubMed Central

    Mullatti, N; Coakham, H; Maw, A; Butler, S; Morgan, M

    1999-01-01

    OBJECTIVES—To assess the utility of an extratympanic intrameatal electrode for intraoperative monitoring during acoustic neuroma and other cerebellopontine angle tumour surgery and to define the neurophysiological and surgical factors which influence hearing preservation.
METHODS—Twenty two patients, 18 with acoustic neuromas and four with other cerebellopontine angle tumours, underwent intraoperative monitoring during tumour excision. The extratympanic intrameatal electrode (IME) was used to record the electrocochleogram (ECoG) and surface electrodes to record the brainstem auditory evoked response (ABR).
RESULTS—The compound action potential (CAP) of the ECoG was two and a half times greater in amplitude than wave I of the ABR and was easily monitored. Virtually instant information was available as minimal averaging was required. Continuous monitoring was possible from the commencement of anaesthesia to skin closure. The IME was easy to place, non-invasive, and did not interfere with the operative field. Operative procedures which affected CAP or wave V latency or amplitude were drilling around the internal auditory meatus, tumour dissection, nerve section, and brainstem and cerebellar retraction. Hearing was achieved in 59% of patients.
CONCLUSIONS—The IME had significant benefits in comparison with other methods of monitoring. The technique provided information beneficial to preservation of hearing.

 PMID:10209169

  20. Reducing intraoperative red blood cell unit wastage in a large academic medical center

    PubMed Central

    Whitney, Gina M.; Woods, Marcella C.; France, Daniel J.; Austin, Thomas M.; Deegan, Robert J.; Paroskie, Allison; Booth, Garrett S.; Young, Pampee P.; Dmochowski, Roger R.; Sandberg, Warren S.; Pilla, Michael A.

    2015-01-01

    BACKGROUND The wastage of red blood cell (RBC) units within the operative setting results in significant direct costs to health care organizations. Previous education-based efforts to reduce wastage were unsuccessful at our institution. We hypothesized that a quality and process improvement approach would result in sustained reductions in intraoperative RBC wastage in a large academic medical center. STUDY DESIGN AND METHODS Utilizing a failure mode and effects analysis supplemented with time and temperature data, key drivers of perioperative RBC wastage were identified and targeted for process improvement. RESULTS Multiple contributing factors, including improper storage and transport and lack of accurate, locally relevant RBC wastage event data were identified as significant contributors to ongoing intraoperative RBC unit wastage. Testing and implementation of improvements to the process of transport and storage of RBC units occurred in liver transplant and adult cardiac surgical areas due to their history of disproportionately high RBC wastage rates. Process interventions targeting local drivers of RBC wastage resulted in a significant reduction in RBC wastage (p <0.0001; adjusted odds ratio, 0.24; 95% confidence interval, 0.15–0.39), despite an increase in operative case volume over the period of the study. Studied process interventions were then introduced incrementally in the remainder of the perioperative areas. CONCLUSIONS These results show that a multidisciplinary team focused on the process of blood product ordering, transport, and storage was able to significantly reduce operative RBC wastage and its associated costs using quality and process improvement methods. PMID:26202213

  1. Intraoperative passive kinematics of osteoarthritic knees before and after total knee arthroplasty.

    PubMed

    Siston, Robert A; Giori, Nicholas J; Goodman, Stuart B; Delp, Scott L

    2006-08-01

    Total knee arthroplasty is a successful procedure to treat pain and functional disability due to osteoarthritis. However, precisely how a total knee arthroplasty changes the kinematics of an osteoarthritic knee is unknown. We used a surgical navigation system to measure normal passive kinematics from 7 embalmed cadaver lower extremities and in vivo intraoperative passive kinematics on 17 patients undergoing primary total knee arthroplasty to address two questions: How do the kinematics of knees with advanced osteoarthritis differ from normal knees?; and, Does posterior substituting total knee arthroplasty restore kinematics towards normal? Osteoarthritic knees displayed a decreased screw-home motion and abnormal varus/valgus rotations between 10 degrees and 90 degrees of knee flexion when compared to normal knees. The anterior-posterior motion of the femur in osteoarthritic knees was not different than in normal knees. Following total knee arthroplasty, we found abnormal varus/valgus rotations in early flexion, a reduced screw-home motion when compared to the osteoarthritic knees, and an abnormal anterior translation of the femur during the first 60 degrees of flexion. Posterior substituting total knee arthroplasty does not appear to restore normal passive varus/valgus rotations or the screw motion and introduces an abnormal anterior translation of the femur during intraoperative evaluation.

  2. Intraoperative measurements on the mitral apparatus using optical tracking: a feasibility study

    NASA Astrophysics Data System (ADS)

    Engelhardt, Sandy; De Simone, Raffaele; Wald, Diana; Zimmermann, Norbert; Al Maisary, Sameer; Beller, Carsten J.; Karck, Matthias; Meinzer, Hans-Peter; Wolf, Ivo

    2014-03-01

    Mitral valve reconstruction is a widespread surgical method to repair incompetent mitral valves. During reconstructive surgery the judgement of mitral valve geometry and subvalvular apparatus is man