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Sample records for intraoperative warming comparison

  1. Thermal burn associated with intraoperative convective forced-air warming blanket (bair paws™ flex gown system).

    PubMed

    Hansen, Elizabeth K; Apostolidou, Ioanna; Layton, Heather; Prielipp, Richard

    2014-10-01

    A 44-year-old man undergoing ambulatory surgery sustained a 5% total body surface first-degree burn on his lower and lateral torso and upper thigh during routine use of a new forced-air warming Bair Paws™ flex gown system. We describe the likely mechanism of injury, intraoperative events suggesting special variation in the warming process, and a brief review of adverse events associated with forced-air warming systems. PMID:25611618

  2. Intraoperative Core Temperature Patterns, Transfusion Requirement, and Hospital Duration in Patients Warmed with Forced Air

    PubMed Central

    Sun, Zhuo; Honar, Hooman; Sessler, Daniel I.; Dalton, Jarrod E.; Yang, Dongsheng; Panjasawatwong, Krit; Deroee, Armin F.; Salmasi, Vafi; Saager, Leif; Kurz, Andrea

    2015-01-01

    Background Core temperature patterns in patients warmed with forced-air remain poorly characterized. Also unknown is the extent to which transient and mild intraoperative hypothermia contributes to adverse outcomes in broad populations. Methods We evaluated esophageal (core) temperatures in 58,814 adults having surgery lasting >60 min who were warmed with forced air. Independent associations between hypothermic exposure and transfusion requirement and duration of hospitalization was evaluated. Results In every percentile subgroup, core temperature decreased during the first hour and subsequently increased. The mean lowest core temperature during the first hour was 35.7 ± 0.6°C. Sixty-four percent of the patients reached a core temperature threshold of <36°C 45 min after induction; 29% reached a core temperature threshold of <35.5°C. Nearly half the patients had continuous core temperatures <36°C for more than an hour, and 20% of the patients were <35.5°C for more than an hour. Twenty percent of patients had continuous core temperatures <36°C for more than 2 h, and 8% of the patients were below 35.5°C for more than 2 h. Hypothermia was independently associated with both transfusion and duration of hospitalization, although prolongation of hospitalization was small. Conclusions Even in actively warmed patients, hypothermia is routine in the first hour of anesthesia. Thereafter, average core temperatures progressively increase. Nonetheless, intraoperative hypothermia was common, and often prolonged. Hypothermia was associated with increased transfusion requirement which is consistent with numerous randomized trials. PMID:25603202

  3. Noninvasive Electrocardiographic Imaging (ECGI): Comparison to intraoperative mapping in patients

    PubMed Central

    Ghanem, Raja N.; Jia, Ping; Ramanathan, Charulatha; Ryu, Kyungmoo; Markowitz, Alan; Rudy, Yoram

    2007-01-01

    OBJECTIVES/BACKGROUND Cardiac arrhythmias are a leading cause of death and disability. Electrocardiographic imaging (ECGI) is a noninvasive imaging modality that reconstructs potentials, electrograms, and isochrones on the epicardial surface from body surface measurements. We previously demonstrated in animal experiments through comparison with simultaneously measured epicardial data the high accuracy of ECGI in imaging cardiac electrical events. Here, images obtained by noninvasive ECGI are compared to invasive direct epicardial mapping in open heart surgery patients. METHODS Three patients were studied during sinus rhythm and right ventricular endocardial and epicardial pacing (total of five datasets). Body surface potentials were acquired preoperatively or postoperatively using a 224-electrode vest. Heart-torso geometry was determined preoperatively using computed tomography. Intraoperative mapping was performed with two 100-electrode epicardial patches. RESULTS Noninvasive potential maps captured epicardial breakthrough sites and reflected general activation and repolarization patterns, localized pacing sites to ∼1 cm and distinguished between epicardial and endocardial origin of activation. Noninvasively reconstructed electrogram morphologies correlated moderately with their invasive counterparts (cross correlation = 0.72 ± 0.25 [sinus rhythm], 0.67 ± 0.23 [endocardial pacing], 0.71 ± 0.21 [epicardial pacing]). Noninvasive isochrones captured the sites of earliest activation, areas of slow conduction, and the general excitation pattern. CONCLUSIONS Despite limitations due to nonsimultaneous acquisition of the surgical and noninvasive data under different conditions, the study demonstrates that ECGI can capture important features of cardiac electrical excitation in humans noninvasively during a single beat. It also shows that general excitation patterns and electrogram morphologies are largely preserved in open chest conditions. PMID:15851333

  4. SEP Montage Variability Comparison during Intraoperative Neurophysiologic Monitoring

    PubMed Central

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

    2016-01-01

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

  5. SEP Montage Variability Comparison during Intraoperative Neurophysiologic Monitoring.

    PubMed

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

    2016-01-01

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

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

    PubMed

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

    2014-04-01

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

  7. Comparison of Folate Receptor Targeted Optical Contrast Agents for Intraoperative Molecular Imaging.

    PubMed

    De Jesus, Elizabeth; Keating, Jane J; Kularatne, Sumith A; Jiang, Jack; Judy, Ryan; Predina, Jarrod; Nie, Shuming; Low, Philip; Singhal, Sunil

    2015-01-01

    Background. Intraoperative imaging can identify cancer cells in order to improve resection; thus fluorescent contrast agents have emerged. Our objective was to do a preclinical comparison of two fluorescent dyes, EC17 and OTL38, which both target folate receptor but have different fluorochromes. Materials. HeLa and KB cells lines were used for in vitro and in vivo comparisons of EC17 and OTL38 brightness, sensitivity, pharmacokinetics, and biodistribution. In vivo experiments were then performed in mice. Results. The peak excitation and emission wavelengths of EC17 and OTL38 were 470/520 nm and 774/794 nm, respectively. In vitro, OTL38 required increased incubation time compared to EC17 for maximum fluorescence; however, peak signal-to-background ratio (SBR) was 1.4-fold higher compared to EC17 within 60 minutes (p < 0.001). Additionally, the SBR for detecting smaller quantity of cells was improved with OTL38. In vivo, the mean improvement in SBR of tumors visualized using OTL38 compared to EC17 was 3.3 fold (range 1.48-5.43). Neither dye caused noticeable toxicity in animal studies. Conclusions. In preclinical testing, OTL38 appears to have superior sensitivity and brightness compared to EC17. This coincides with the accepted belief that near infrared (NIR) dyes tend to have less autofluorescence and scattering issues than visible wavelength fluorochromes. PMID:26491562

  8. Digital Photographic Measurement in Hypospadias: Validation and Comparison to Intraoperative Measurement

    PubMed Central

    Akhavan, Ardavan; Merguerian, Paul A; Grady, Richard W; DiSandro, Michael; Shnorhavorian, Margarett

    2013-01-01

    Background We propose a standardized method of photographing the hypospadias penis to capture penile dimensions that may be relevant for surgery. We also validate the use of digital imaging software for calculating penile dimensions as a substitute for intraoperative caliper-based measurements. Methods Photographs were taken of hypospadias penises in four different views after placement of a traction stitch and retraction of the preputial hood. Intraoperative measurements were obtained with a caliper. Digital measurements were taken of the same parameters postoperatively. All measurements were obtained in triplicate by multiple participants, and averages were tested for equivalency by determining the correlation coefficient for each parameter. Inter-observer correlation was also calculated for each parameter. Results 180 intraoperative and 180 digital measurements were taken from 60 dimensions on 10 hypospadiac penises. Strong correlation existed between most digital and intraoperative measurements. Average inter-observer correlations ranged from 0.91 to 0.99 for each of the intraoperative measurements, and 0.90 to 1.00 for each of the digital measurements. Conclusions Standardized imaging is effective in capturing penile dimensions and measurements during hypospadias surgery. When compared with intraoperative measurements, digital measurements are reliable and precise; digital photography has the potential to both aid in surgical planning and improve documentation. PMID:24291248

  9. Comparison of Intraoperative C-Arm Fluoroscopy to Postoperative Radiographs in Operative Fracture Fixation.

    PubMed

    Horst, Taylor A; Mooney, James F; Hooker, Jennifer A; Barfield, William R; Glaser, John A

    2015-01-01

    The purpose of this study is to evaluate the differences between intraoperative C-arm images and postoperative plain film radiographs and the utility of each in assessing fracture fixation and determining postoperative management. Intraoperative and postoperative images with varying fracture types and locations were analyzed. C-arm images were compared to postoperative plain film radiographs for each treated fracture and reviewed by two orthopaedic surgeons. Image adequacy and quality for each radiograph were analyzed. The quality of reduction and fixation was also analyzed. Information was apparent on the postoperative radiographs, such that a reviewer felt that the postoperative treatment plan should change in 8.2% of cases. In the cases where treatment change was recommended, fracture gap, rotation, and angulation were found to be the strongest predictors. The ability of intraoperative and postoperative images to reflect fracture gap, rotation, and angulation may vary between images.

  10. 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

  11. 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

  12. Comparison of intraoperative completion flowmeter versus duplex ultrasonography and contrast arteriography for carotid endarterectomy.

    PubMed

    Winkler, Gabor A; Calligaro, Keith D; Kolakowski, Steven; Doerr, Kevin J; McAffee-Bennett, Sandy; Muller, Kathy; Dougherty, Matthew J

    Intraoperative completion studies of the internal carotid artery following carotid endarterectomy are recommended to ensure technical perfection of the repair. Transit time ultrasound flowmeter does not require trained technicians, requires less time than other completion studies such as duplex ultrasonography and contrast arteriography, and is noninvasive. Flowmetry was compared with duplex ultrasonography and contrast arteriography to determine if the relatively simpler flowmetry could replace these two more widely accepted completion studies in the intraoperative assessment of carotid endarterectomy. Comparative intraoperative assessment was performed in 116 carotid endarterectomies using all three techniques between December 1, 2000 and November 30, 2003. Eversion endarterectomy was performed in 51 cases and standard endarterectomy with prosthetic patching in 65 cases. Patients underwent completion flowmetry, duplex ultrasonography, and contrast arteriography studies of the exposed arteries, which were performed by vascular fellows or senior surgical residents under direct supervision of board-certified vascular surgeons. Duplex ultrasonography surveillance was performed 1 and 6 months postoperatively and annually thereafter. Mean follow-up was 18 months (range, 6-42 months). The combined ipsilateral stroke and death rate was 0%. The mean internal carotid artery flow using flowmetry was 249 mL/min (range, 60-750 mL/min). Five (4.3%) patients had flow < 100 mL/min as measured with flowmetry, but completion contrast arteriography and duplex ultrasonography were normal and none of the arteries were re-explored. One carotid endarterectomy was re-explored based on completion duplex ultrasonography that showed markedly elevated internal carotid artery peak systolic velocity (> 500 cm/sec); however, exploration was normal and completion flowmetry and contrast arteriography were normal. Duplex ultrasonography studies revealed internal carotid artery peak systolic

  13. 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.

  14. Comparison of Preoperative Temporal Bone CT with Intraoperative Findings in Patients with Cholesteatoma

    PubMed Central

    Rogha, Mehrdad; Hashemi, Sayyed Mostafa; Mokhtarinejad, Farhad; Eshaghian, Afrooz; Dadgostar, Alireza

    2014-01-01

    Introduction: Cholesteatoma is traditionally diagnosed by otoscopic examination and treated by surgery. The necessity for imaging in an uncomplicated case is controversial. This study was planned to investigate the usefulness of a preoperative high-resolution computed tomography (HRCT) scan in depicting the status of middle ear structures in the presence of cholesteatoma and also to compare the correspondence between pre- and intraoperative CT findings in patients with cholesteatoma. Materials and Methods: This prospective descriptive study was performed from January 2009 to May 2011 in 36 patients with cholesteatoma who were referred to the Kashani and Al-Zahra Clinics of Otolaryngology. Preoperative high-resolution temporal bone CT scans (axial and coronal views) were carried out and compared with intraoperative findings. Results: Evaluation of 36 patients and their CT scans revealed excellent correlation for sigmoid plate erosion, widening of aditus, and erosion of scutum; good correlation for erosion of malleus and tegmen; moderate correlation for lateral canal fistula (LCF) and erosion of mastoid air cells; and poor correlation for facial nerve dehiscence (FND), incus, and stapes erosion. Conclusion: A preoperative CT scan may be helpful in relation to diagnosis and decision making for surgery in cases of cholesteatoma and ossicular erosion. The CT scan can accurately predict the extent of disease and is helpful for detection of lateral canal fistula, erosions of dural plate, and ossicular erosions. However it is not able to distinguish between cholesteatoma and mucosal disease, facial nerve dehiscency, incus, and stapes erosion. PMID:24505568

  15. Intra-Operative Tissue Oxygen Tension Is Increased by Local Insufflation of Humidified-Warm CO2 during Open Abdominal Surgery in a Rat Model

    PubMed Central

    Marshall, Jean K.; Lindner, Pernilla; Tait, Noel; Maddocks, Tracy; Riepsamen, Angelique; van der Linden, Jan

    2015-01-01

    Introduction Maintenance of high tissue oxygenation (PtO2) is recommended during surgery because PtO2 is highly predictive of surgical site infection and colonic anastomotic leakage. However, surgical site perfusion is often sub-optimal, creating an obstructive hurdle for traditional, systemically applied therapies to maintain or increase surgical site PtO2. This research tested the hypothesis that insufflation of humidified-warm CO2 into the abdominal cavity would increase sub-peritoneal PtO2 during open abdominal surgery. Materials and Methods 15 Wistar rats underwent laparotomy under general anesthesia. Three sets of randomized cross-over experiments were conducted in which the abdominal cavity was subjected to alternating exposure to 1) humidified-warm CO2 & ambient air; 2) humidified-warm CO2 & dry-cold CO2; and 3) dry-cold CO2 & ambient air. Sub-peritoneal PtO2 and tissue temperature were measured with a polarographic oxygen probe. Results Upon insufflation of humidified-warm CO2, PtO2 increased by 29.8 mmHg (SD 13.3; p<0.001), or 96.6% (SD 51.9), and tissue temperature by 3.0°C (SD 1.7 p<0.001), in comparison with exposure to ambient air. Smaller, but significant, increases in PtO2 were seen in experiments 2 and 3. Tissue temperature decreased upon exposure to dry-cold CO2 compared with ambient air (-1.4°C, SD 0.5, p = 0.001). Conclusions In a rat model, insufflation of humidified-warm CO2 into the abdominal cavity during open abdominal surgery causes an immediate and potentially clinically significant increase in PtO2. The effect is an additive result of the delivery of CO2 and avoidance of evaporative cooling via the delivery of the CO2 gas humidified at body temperature. PMID:25835954

  16. Comparison of intraoperative and postoperative pain during canine ovariohysterectomy and ovariectomy.

    PubMed

    Tallant, Amanda; Ambros, Barbara; Freire, Carol; Sakals, Sherisse

    2016-07-01

    This study compared physiologic parameters indicating nociception during surgery and pain scores after surgery among dogs undergoing ovariohysterectomy (OHE) and ovariectomy (OVE). Twenty healthy adult female dogs were randomly assigned to either the OHE or the OVE group. Physiologic data collected during surgery included heart rate, respiratory rate, temperature, blood pressure, hemoglobin oxygen saturation, end-tidal CO2 and isoflurane, and vaporizer settings. Postoperative pain was measured using the short form Glasgow Composite Pain Scale, an interactive visual analog scale, and algometry. There were no clinically relevant differences in intraoperative nociception indices between groups. Duration of surgery for OVE was significantly shorter than for OHE (OVE 15.4 minutes, OHE 17.5 minutes, P = 0.04). There was no significant difference between groups in the use of rescue analgesia after surgery, in the average interactive visual analog scale score over the 24-hour postoperative period (P = 0.12), and in algometer readings (P = 0.34).

  17. The Ahmed Baerveldt Comparison Study: Methodology, Baseline Patient Characteristics, and Intraoperative Complications

    PubMed Central

    Barton, Keith; Gedde, Steven J.; Budenz, Donald L.; Feuer, William J.; Schiffman, Joyce

    2010-01-01

    Purpose The Ahmed Baerveldt Comparative (ABC) Study compares the long-term outcomes and complications of the Ahmed Glaucoma Valve (AGV), model FP7, and the Baerveldt Glaucoma Implant (BGI), model 101–350. Design Multicenter randomized controlled clinical trial. Participants 276 glaucoma patients at 16 clinical centers worldwide, aged 18–85 years with inadequately controlled intraocular pressure (IOP ≥ 18 mm Hg) in whom placement of an aqueous shunt was planned. Methods Study patients were randomized to undergo implantation of an AGV or a BGI. Main Outcome Measure Failure, defined as IOP > 21 mm Hg or not reduced by 20% below baseline IOP ≤ 5 mm Hg (2 consecuteive visits after 3 months), additional glaucoma surgery, removal of the implant or loss of light perception vision Results A total of 276 patients were enrolled between October 2006 and April 2008, including 143 in the AGV group and 133 in the BGI group. The age of patients enrolled was 63 ± 14 years (mean ± standard deviation, SD), and 52% were male. The baseline IOP was 31.5 ± 11.8 mmHg (mean ± SD). Except for a 13% higher prevalence of hypertension in the AGV group, no significant differences in baseline demographic or ocular characteristics were observed between the study groups. Intraoperative complications occurred in 11 (8%) patients in the AGV group and 16 (12%) patients in the BGI group (p = 0.31). Conclusions The ABC study should yield valuable prospective data comparing two commonly used aqueous shunts in clinical practice. PMID:20932581

  18. Comparison of Stratospheric Sudden Warming definitions in reanalysis data.

    NASA Astrophysics Data System (ADS)

    Palmeiro, Froila M.; Barriopedro, David; Calvo, Natalia; Garcia-Herrera, Ricardo

    2014-05-01

    Stratospheric Sudden Warmings (SSWs) are characterized by a weakening of the polar vortex and a pronounced rise of the stratospheric polar temperature during the winter season. However, multiple definitions and climatic variables have been used in the literature to diagnose the occurrence of SSWs, yielding discrepancies in the detection of the events. Since SSWs are rare events, the lack of consensus in the definition is expected to cause changes among the resulting SSW climatologies. In this study, we have identified the occurrence of SSWs for the extended-winter season of the ERA-40 and ERA-Interim Reanalysis period (1958-2013) according to a suite of representative definitions. Some of them are based exclusively on the zonal-mean zonal wind, while others also include the zonal-mean temperature latitudinal gradient. SSWs can be also defined attending to certain indices such as the northern annular mode (NAM) or the stratospheric zonal index (SZI). Following the original definitions given in the literature, different thresholds and criteria (e.g., latitudinal averages, pressure levels) have been demanded across definitions. We have analyzed the influence of the detecting method on several parameters associated with SSWs, such as frequency, temporal distribution, or the impact on tropospheric climate. The results show strong differences in the climatological mean winter frequency among certain detection methods. The evolution of the SSW parameters and the downward propagation of the anomalies from the stratosphere to the troposphere are also method-dependent. In particular, certain methods are not able to capture the tropospheric response following the SSW occurrence. Our results provide a guide to select the most representative definitions, avoiding redundancies, for constructing a SSW catalogue from reanalysis data and/or climatic model simulations.

  19. Comparison of effects of intraoperative nefopam and ketamine infusion on managing postoperative pain after laparoscopic cholecystectomy administered remifentanil

    PubMed Central

    Choi, Sung Kwan; Choi, Jung Il; Kim, Woong Mo; Heo, Bong Ha; Park, Keun Seok; Song, Ji A

    2016-01-01

    Background Although intraoperative opioids provide more comfortable anesthesia and reduce the use of postoperative analgesics, it may cause opioid induced hyperalgesia (OIH). OIH is an increased pain response to opioids and it may be associated with N-methyl-D-aspartate (NMDA) receptor. This study aimed to determine whether intraoperative nefopam or ketamine, known being related on NMDA receptor, affects postoperative pain and OIH after continuous infusion of intraoperative remifentanil. Methods Fifty-four patients undergoing laparoscopic cholecystectomy were randomized into three groups. In the nefopam group (N group), patients received nefopam 0.3 mg/kg at the induction of anesthesia followed by a continuous infusion of 0.065 mg/kg/h. In the ketamine group (K group), patients received ketamine 0.3 mg/kg at the induction of anesthesia followed by a continuous infusion of 3 µg/kg/min. The control group did not received any other agents except for the standard anesthetic regimen. Postoperative pain score, first time and number of demanding rescue analgesia, OIH and degrees of drowsiness/sedation scale were examined. Results Co-administrated nefopam or ketamine significantly reduced the total amount of intraoperative remifentanil and postoperative supplemental morphine. Nefopam group showed superior property over control and ketamine group in the postoperative VAS score and recovery index (alertness and respiratory drive), respectively. Nefopam group showed lower morphine consumption than ketamine group, but not significant. Conclusions Both nefopam and ketamine infusion may be useful in managing in postoperative pain control under concomitant infusion of remifentanil. However, nefopam may be preferred to ketamine in terms of sedation. PMID:27703629

  20. Comparison of open and percutaneous lumbar pedicle screw revision rate using 3-D image guidance and intraoperative CT.

    PubMed

    Santos, Edward Rainier G; Sembrano, Jonathan N; Yson, Sharon C; Polly, David W

    2015-02-01

    Complications arising from a malpositioned screw can be both devastating and costly. The incidence of neurologic injury secondary to a malpositioned screw is reported to be as high as 7% to 12%. The advancement of image-guided technology has allowed surgeons to place screws more accurately and confirm correct placement prior to leaving the operating room. Only a small number of studies have examined image-guided pedicle screw accuracy in terms of intraoperative revision and reoperation rates. The purpose of this study was to determine the intraoperative revision and return to surgery rates for navigated lumbar pedicle screws and to compare navigated open and percutaneous techniques. The authors reviewed 199 cases of 3-dimensional image-guided lumbar pedicle screw instrumentation from November 2006 to December 2011. Screw or K-wire removal, repositioning, or eventual abandonment of insertion were noted. Chi-square test was used to determine statistical significance in rates between the 2 groups (alpha=0.05). The authors also noted return to surgery secondary to complications from a malpositioned screw. The overall intraoperative revision rate of navigated lumbar pedicle screws was 4.6%. There were significantly more revisions in the percutaneously inserted screws (7.5%) than with the open technique (2.7%) (P=.0004). If K-wire revisions are excluded, there was no statistically significant difference in intraoperative revision rates between the percutaneous and open groups (2.1% vs 2.7%, respectively) (P=.0004). No patients underwent reoperation for a malpositioned screw. This technology has virtually eliminated the need for reoperation for screw malposition. It may suggest a more cost-effective way of preventing neurovascular injuries and revision surgeries.

  1. 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.

  2. Comparison of Effects of Labetalol and Nitroglycerine on Intraoperative Blood Loss and Surgical Field Quality in Rhinoplasty Surgery

    PubMed Central

    Hadavi, Mohamad Reza; Zarei, Yadollah; Tarogh, Shojaolhagh

    2015-01-01

    BACKGROUND Rhinoplasty is one of the most common surgeries of the plastic surgery and as well as ear, throat and nose. Intra-operative bleeding during surgery is one of the most important factors that may impair the surgeon’s job. Providing a clean blood-free surgical filed makes the operation faster, easier and with a better quality. One way to achieve this goal is to induce hypotension. This study aimed to compare the impacts and outcomes of administration of labetalol or nitroglycerin for this purpose. METHODS In this randomized clinical trial, 60 ASA I and ASA II patients who were referred for rhinoplasty were enrolled. Patients were randomly assigned to two groups. Labetalol was given to the first and nitroglycerin to the second group of patients. Blood pressure and the amount of intra-operative bleeding during surgery and surgeon satisfaction were measured. RESULTS The average age of patients was 25.9±7.52 years. The average amount of bleeding among all patients was 117.87±324.86 ml, and the average quality of the surgical site was 1.65±4.48, considering all patients. The average quality and average surgical site bleeding between the two groups was not significant. CONCLUSION There was a little difference between labetalol and nitroglycerine on the effect of intraoperative blood loss and surgical field quality in rhinoplasty surgery. PMID:25606478

  3. Comparison of the accuracy and proximal shunt failure rate of freehand placement versus intraoperative guidance in parietooccipital ventricular catheter placement.

    PubMed

    Wilson, Thomas J; McCoy, Kathleen E; Al-Holou, Wajd N; Molina, Sergio L; Smyth, Matthew D; Sullivan, Stephen E

    2016-09-01

    OBJECTIVE The aim of this paper is to compare the accuracy of the freehand technique versus the use of intraoperative guidance (either ultrasound guidance or frameless stereotaxy) for placement of parietooccipital ventricular catheters and to determine factors associated with reduced proximal shunt failure. METHODS This retrospective cohort study included all patients from 2 institutions who underwent a ventricular cerebrospinal fluid (CSF) shunting procedure in which a new parietooccipital ventricular catheter was placed between January 2005 and December 2013. Data abstracted for each patient included age, sex, method of ventricular catheter placement, side of ventricular catheter placement, Evans ratio, and bifrontal ventricular span. Postoperative radiographic studies were reviewed for accuracy of ventricular catheter placement. Medical records were also reviewed for evidence of shunt failure requiring revision. Standard statistical methods were used for analysis. RESULTS A total of 257 patients were included in the study: 134 from the University of Michigan and 123 from Washington University in St. Louis. Accurate ventricular catheter placement was achieved in 81.2% of cases in which intraoperative guidance was used versus 67.3% when the freehand technique was used. Increasing age reduced the likelihood of accurate catheter placement (OR 0.983, 95% CI 0.971-0.995; p = 0.005), while the use of intraoperative guidance significantly increased the likelihood (OR 2.809, 95% CI 1.406-5.618; p = 0.016). During the study period, 108 patients (42.0%) experienced shunt failure, 79 patients (30.7%) had failure involving the proximal catheter, and 53 patients (20.6%) had distal failure (valve or distal catheter). Increasing age reduced the likelihood of being free from proximal shunt failure (OR 0.983, 95% CI 0.970-0.995; p = 0.008), while both the use of intraoperative guidance (OR 2.385, 95% CI 1.227-5.032; p = 0.011), and accurate ventricular catheter placement (OR 3

  4. Intraoperative ultrasonography (IOUS) in thoracolumbar fractures.

    PubMed

    Blumenkopf, B; Daniels, T

    1988-01-01

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

  5. Comparison of electron transport calculations in warm dense matter using the Ziman formula

    DOE PAGESBeta

    Burrill, D. J.; Feinblum, D. V.; Charest, M. R. J.; Starrett, C. E.

    2016-02-10

    The Ziman formulation of electrical conductivity is tested in warm and hot dense matter using the pseudo-atom molecular dynamics method. Several implementation options that have been widely used in the literature are systematically tested through a comparison to the accurate, but expensive Kohn–Sham density functional theory molecular dynamics (KS-DFT-MD) calculations. As a result, the comparison is made for several elements and mixtures and for a wide range of temperatures and densities, and reveals a preferred method that generally gives very good agreement with the KS-DFT-MD results, but at a fraction of the computational cost.

  6. Comparison of electron transport calculations in warm dense matter using the Ziman formula

    NASA Astrophysics Data System (ADS)

    Burrill, D. J.; Feinblum, D. V.; Charest, M. R. J.; Starrett, C. E.

    2016-06-01

    The Ziman formulation of electrical conductivity is tested in warm and hot dense matter using the pseudo-atom molecular dynamics method. Several implementation options that have been widely used in the literature are systematically tested through a comparison to the accurate, but expensive Kohn-Sham density functional theory molecular dynamics (KS-DFT-MD) calculations. The comparison is made for several elements and mixtures and for a wide range of temperatures and densities, and reveals a preferred method that generally gives very good agreement with the KS-DFT-MD results, but at a fraction of the computational cost.

  7. Simulations of the February 1979 stratospheric sudden warming: Model comparisons and three-dimensional evolution

    SciTech Connect

    Manney, G.L. ); Farrara, J.D.; Mechoso, C.R. )

    1994-06-01

    The evolution of the stratospheric flow during the major stratospheric sudden warming of February 1979 is studied using two primitive equation models of the stratosphere and mesosphere. The United Kingdom Meteorological Office Stratosphere-Mesosphere Model (SMM) uses log pressure as a vertical coordinate. A spectral, entropy coordinate version of the SMM (entropy coordinate model, or ECM) that has recently been developed is also used. The ECM produces a more realistic recombination and recovery of the polar vortex in the midstratosphere after the warming. Comparison of SMM simulations with forecasts performed using the University of California, Los Angeles general circulation model confirms the previously noted sensitivity of stratospheric forecasts to tropospheric forecast and emphasizes the importance of adequate vertical resolution in modeling the stratosphere. The ECM simulations provide a schematic description of the three-dimensional evolution of the polar vortex and the motion of air through it. During the warming, the two cyclonic vortices tilt westward and equatorward with height. Strong upward velocities develop in the lower stratosphere on the west (cold) side of a baroclinic zone as it forms over Europe and Asia. Strong downward velocities appear in the upper stratosphere on the east (warm) side, strengthening the temperature gradients. After the peak of the warming, vertical velocities decrease, downward velocities move into the lower stratosphere, and upward velocities move into the upper stratosphere. Transport calculations show that air with high ozone mixing ratios is advected toward the pole from low latitudes during the warming, and air with low ozone mixing ratios is transported to the midstratosphere from both higher and lower altitudes along the baroclinic zone in the polar regions. 32 refs., 23 figs., 1 tab.

  8. Comparison of computational fluid dynamics findings with intraoperative microscopy findings in unruptured intracranial aneurysms- An initial analysis

    PubMed Central

    Talari, Sandeep; Kato, Yoko; Shang, Hanbing; Yamada, Yasuhiro; Yamashiro, Kei; Suyama, Daisuke; Kawase, Tsukasa; Balik, Vladimir; Rile, Wu

    2016-01-01

    Context: The increase in the detection of unruptured cerebral aneurysms has led to management dilemma. Prediction of risk based on the size of the aneurysm is not always accurate. There is no objective way of predicting rupture of aneurysm so far. Computational fluid dynamics (CFDs) was proposed as a tool to identify the rupture risk. Aims: To know the correlation of CFD findings with intraoperative microscopic findings and to know the relevance of CFD in the prediction of rupture risk and in the management of unruptured intracranial aneurysms. Settings and Design: A prospective study involving nine cases over a period of 6 months as an initial analysis. Subjects and Methods: Both males and females were included in the study. Preoperative analysis was performed using computed tomography angiogram, magnetic resonance imaging in all cases and digital substraction angiogram in some cases. Intraoperatively microscopic examination of the aneurysm wall was carried out and images recorded. The correlation was done between microscopic and CFD images. Results: Seven cases were found intraoperatively to have a higher risk of rupture based on the thinning of the wall. Two cases had an atherosclerotic wall. All cases had low wall shear stress (WSS).Only two cases with atherosclerotic wall had a correlation with low WSS. Conclusions: While the pressure measured with CFD technique is a good predictor of rupture risk, the WSS component is controversial. Multicentric trials involving a larger subset of population are needed before drawing any definite conclusions. On-going development in the CFD analysis may help to predict the rupture chances accurately in future.

  9. Comparison of computational fluid dynamics findings with intraoperative microscopy findings in unruptured intracranial aneurysms- An initial analysis

    PubMed Central

    Talari, Sandeep; Kato, Yoko; Shang, Hanbing; Yamada, Yasuhiro; Yamashiro, Kei; Suyama, Daisuke; Kawase, Tsukasa; Balik, Vladimir; Rile, Wu

    2016-01-01

    Context: The increase in the detection of unruptured cerebral aneurysms has led to management dilemma. Prediction of risk based on the size of the aneurysm is not always accurate. There is no objective way of predicting rupture of aneurysm so far. Computational fluid dynamics (CFDs) was proposed as a tool to identify the rupture risk. Aims: To know the correlation of CFD findings with intraoperative microscopic findings and to know the relevance of CFD in the prediction of rupture risk and in the management of unruptured intracranial aneurysms. Settings and Design: A prospective study involving nine cases over a period of 6 months as an initial analysis. Subjects and Methods: Both males and females were included in the study. Preoperative analysis was performed using computed tomography angiogram, magnetic resonance imaging in all cases and digital substraction angiogram in some cases. Intraoperatively microscopic examination of the aneurysm wall was carried out and images recorded. The correlation was done between microscopic and CFD images. Results: Seven cases were found intraoperatively to have a higher risk of rupture based on the thinning of the wall. Two cases had an atherosclerotic wall. All cases had low wall shear stress (WSS).Only two cases with atherosclerotic wall had a correlation with low WSS. Conclusions: While the pressure measured with CFD technique is a good predictor of rupture risk, the WSS component is controversial. Multicentric trials involving a larger subset of population are needed before drawing any definite conclusions. On-going development in the CFD analysis may help to predict the rupture chances accurately in future. PMID:27695537

  10. A Lagrangian analysis of a sudden stratospheric warming - Comparison of a model simulation and LIMS observations

    NASA Technical Reports Server (NTRS)

    Pierce, R. B.; Remsberg, Ellis E.; Fairlie, T. D.; Blackshear, W. T.; Grose, William L.; Turner, Richard E.

    1992-01-01

    Lagrangian area diagnostics and trajectory techniques are used to investigate the radiative and dynamical characteristics of a spontaneous sudden warming which occurred during a 2-yr Langley Research Center model simulation. The ability of the Langley Research Center GCM to simulate the major features of the stratospheric circulation during such highly disturbed periods is illustrated by comparison of the simulated warming to the observed circulation during the LIMS observation period. The apparent sink of vortex area associated with Rossby wave-breaking accounts for the majority of the reduction of the size of the vortex and also acts to offset the radiatively driven increase in the area occupied by the 'surf zone'. Trajectory analysis of selected material lines substantiates the conclusions from the area diagnostics.

  11. Comparison of Real-Time Intraoperative Ultrasound-Based Dosimetry With Postoperative Computed Tomography-Based Dosimetry for Prostate Brachytherapy

    SciTech Connect

    Nag, Subir; Shi Peipei; Liu Bingren; Gupta, Nilendu; Bahnson, Robert R.; Wang, Jian Z.

    2008-01-01

    Purpose: To evaluate whether real-time intraoperative ultrasound (US)-based dosimetry can replace conventional postoperative computed tomography (CT)-based dosimetry in prostate brachytherapy. Methods and Materials: Between December 2001 and November 2002, 82 patients underwent {sup 103}Pd prostate brachytherapy. An interplant treatment planning system was used for real-time intraoperative transrectal US-guided treatment planning. The dose distribution was updated according to the estimated seed position to obtain the dose-volume histograms. Postoperative CT-based dosimetry was performed a few hours later using the Theraplan-Plus treatment planning system. The dosimetric parameters obtained from the two imaging modalities were compared. Results: The results of this study revealed correlations between the US- and CT-based dosimetry. However, large variations were found in the implant-quality parameters of the two modalities, including the doses covering 100%, 90%, and 80% of the prostate volume and prostate volumes covered by 100%, 150%, and 200% of the prescription dose. The mean relative difference was 38% and 16% for doses covering 100% and 90% of the prostate volume and 10% and 21% for prostate volumes covered by 100% and 150% of the prescription dose, respectively. The CT-based volume covered by 200% of the prescription dose was about 30% greater than the US-based one. Compared with CT-based dosimetry, US-based dosimetry significantly underestimated the dose to normal organs, especially for the rectum. The average US-based maximal dose and volume covered by 100% of the prescription dose for the rectum was 72 Gy and 0.01 cm{sup 3}, respectively, much lower than the 159 Gy and 0.65 cm{sup 3} obtained using CT-based dosimetry. Conclusion: Although dosimetry using intraoperative US-based planning provides preliminary real-time information, it does not accurately reflect the postoperative CT-based dosimetry. Until studies have determined whether US-based dosimetry

  12. Comparison of dexmedetomidine with fentanyl for maintenance of intraoperative hemodynamics in hypertensive patients undergoing major surgery: A randomized controlled trial

    PubMed Central

    Bilgi, Kanchan V.; Vasudevan, Arumugam; Bidkar, Prasanna Udupi

    2016-01-01

    Background: The objective of this study was to study and compare the effects of intravenous dexmedetomidine and fentanyl on intraoperative hemodynamics, opioid consumption, and recovery characteristics in hypertensive patients. Methods: Fifty-seven hypertensive patients undergoing major surgery were randomized into two groups, Group D (dexmedetomidine, n = 29) and Group F (fentanyl, n = 28). The patients received 1 μg/kg of either dexmedetomidine or fentanyl, followed by 0.5 μg/kg/h infusion of the same drug, followed by a standard induction protocol. Heart rate (HR), mean arterial pressures (MAPs), end-tidal isoflurane concentration, and use of additional fentanyl and vasopressors were recorded throughout. Results: Both dexmedetomidine and fentanyl caused significant fall in HR and MAP after induction and dexmedetomidine significantly reduced the induction dose of thiopentone (P = 0.026). After laryngoscopy and intubation, patients in Group D experienced a fall in HR and a small rise in MAP (P = 0.094) while those in Group F showed significant rise in HR (P = 0.01) and MAP (P = 0.004). The requirement of isoflurane and fentanyl boluses was significantly less in Group D. The duration of postoperative analgesia was longer in Group D (P = 0.015) with significantly lower postoperative nausea and vomiting (PONV) (P < 0.001). Conclusion: Infusion of dexmedetomidine in hypertensive patients controlled the sympathetic stress response better than fentanyl and provided stable intraoperative hemodynamics. It reduced the dose of thiopentone, requirement of isoflurane and fentanyl boluses. The postoperative analgesia was prolonged, and incidence of PONV was less in patients who received dexmedetomidine. PMID:27212770

  13. A comparison of SAGE I data during the stratospheric warming of February-March, 1979

    NASA Technical Reports Server (NTRS)

    Nagatani, R. M.; Mccormick, M. P.; Mcmaster, L. R.

    1985-01-01

    The fine scale vertical structure of SAGE I ozone and aerosol data during a stratospheric warming is investigated using meteorological and SBUV ozone data. By stratifying the ozone and aerosol data for a limited time period, a comparison of the structure of profiles becomes possible under different meteorological conditions. For example, the cold air region shows more laminated structures than the other regions. In addition, vertical motions calculated at the same locations as the SAGE profiles show that they are consistent with variances found in the ozone and aerosol data.

  14. Comparison of intraoperative brain condition, hemodynamics and postoperative recovery between desflurane and sevoflurane in patients undergoing supratentorial craniotomy

    PubMed Central

    Dube, Surya Kumar; Pandia, Mihir Prakash; Chaturvedi, Arvind; Bithal, Parmod; Dash, Hari Hara

    2015-01-01

    Background: Post operative recovery has been reported to be faster with desflurane than sevoflurane anesthesia in previous studies. The use of desflurane is often criticized in neurosurgery due to the concerns of cerebral vasodilation and increase in ICP and studies comparing desflurane and sevoflurane in neurosurgey are scarce. So we compared the intraoperative brain condition, hemodynamics and postoperative recovery in patients undergoing elective supratentorial craniotomy receiving either desflurane or sevoflurane. Materials and Methods: Fifty three patients between 18-60yr undergoing elective supratentorial craniotomy receiving N2O and oxygen (60%:40%) and 0.8-1.2 MAC of either desflurane or sevoflurane were randomized to group S (Sevoflurane) or group D (Desflurane). Subdural intra cranial pressure (ICP) was measured and brain condition was assessed.. Emergence time, tracheal extubation time and recovery time were recorded. Cognitive behavior was evaluated with Short Orientation Memory Concentration Test (SOMCT) and neurological outcome (at the time of discharge) was assessed using Glasgow Outcome Score (GOS) between the two groups. Results: The emergence time [Group D 7.4 ± 2.7 minutes vs. Group S 7.8 ± 3.7 minutes; P = 0.65], extubation time [Group D 11.8 ± 2.8 minutes vs. Group S 12.9 ± 4.9 minutes; P = 0.28] and recovery time [Group D 16.4 ± 2.6 minutes vs. Group S 17.1 ± 4.8 minutes; P = 0.50] were comparable between the two groups. There was no difference in ICP [Group D; 9.1 ± 4.3 mmHg vs. Group S; 10.9 ± 4.2 mmHg; P = 0.14] and brain condition between the two groups. Both groups had similar post-operative complications, hospital and ICU stay and GOS. Conclusion: In patients undergoing elective supratentorial craniotomy both sevoflurane and desflurane had similar intra-operative brain condition, hemodynamics and post operative recovery profile. PMID:25829905

  15. Comparison of Preoperative Topical Dexamethasone Phosphate Versus Ketorolac Tromethamine in Maintaining Intraoperative Mydriasis During Small Incision Cataract Surgery

    PubMed Central

    Sharma, Hans Raj; Sharma, Rajni; Singh, Amrita

    2016-01-01

    Introduction Intraoperative miosis is one of the many challenges which a surgeon can face during cataract surgery. It may lead to impaired view and difficulty in delivering the nucleus. Also, it increases the chances of more serious intraoperative and postoperative complications. Therefore, maintaining adequate pupillary dilatation is of utmost importance during cataract surgery. Aim To study the efficacy of topical dexamethasone phosphate (0.1%) and topical ketorolac tromethamine (0.4%) in maintaining pupillary dilatation during cataract surgery. Materials and Methods A total of 200 patients were studied. These were randomly divided into two groups of 100 each. Group1 was given topical dexamethasone phosphate (0.1%) and Group 2, topical ketorolac tromethamine (0.4%). Medications were started 1-day before surgery in the form of one drop to be instilled every 6 hours. Pupillary diameter was measured in the horizontal meridian; 4 readings were taken - before making the incision, after nucleus delivery, following cortical clean-up and after Intraocular Lens (IOL) implantation. Results The two drugs showed no statistically significant difference in pupillary diameter at the commencement of surgery (p=0.435). The difference between the two drugs was statistically significant, for the mean pupillary diameter which changed from the start of surgery to after cortical clean-up. At this stage, ketorolac group showed a tendency towards larger mean pupillary diameter than dexamethasone group (6.70 ± 0.85mm and 6.32 ± 0.84mm, respectively, p=0.002). Again, ketorolac group patients had larger pupillary diameter after IOL implantation than dexamethasone group patients (the mean was 6.16± 0.97mm and 5.75 ± 0.73mm, respectively, p=0.001). Conclusion Both ketorolac tromethamine (0.4%) and dexamethasone phosphate (0.1%) are effective in maintaining adequate mydriasis during cataract surgery, but the comparative analysis of the two drugs concludes that, ketorolac is definitely a

  16. Intraoperative prediction of ischaemic injury of the bowel: a comparison of laser Doppler flowmetry and tissue oximetry to histological analysis.

    PubMed

    Krohg-Sørensen, K; Line, P D; Haaland, T; Horn, R S; Kvernebo, K

    1992-09-01

    Intraoperative diagnosis of inadequate colonic perfusion would contribute to prevention of ischaemic colitis after abdominal aortic reconstructions. The aim of this study was to evaluate laser Doppler flowmetry (LDF) and tissue oximetry (TpO2) as predictors of the development of bowel necrosis. Devascularised loops of colon and ileum in anaesthetised pigs were divided into 10-20 mm segments and measurements of laser Doppler flux and TpO2 were performed in each segment. After 7 h of ischaemia the segments were resected for histological and biochemical analysis. In 65 colonic and 58 ileal segments a significantly lower flux was found in segments with necrosis of greater than or equal to 30% of the mucosal thickness compared to segments with necrosis of less than or equal to 10% (p less than 0.01). The discriminant flux value was 50 perfusion units, confirming a previous clinical study. The specificity was 0.96 and the sensitivity 0.94. Flux was inversely correlated to tissue lactate concentration. Significantly lower TpO2 was found in 19 colonic segments with necrosis of greater than or equal to 30% of mucosa compared to 19 colonic segments with necrosis of less than or equal to 10% (p less than 0.01). Using a discriminant value of 5kPa, a specificity of 0.79, and a sensitivity of 0.95 were calculated. In 27 ileum segments no significant difference in TpO2 between different histological groups was found (p greater than 0.30). The results show that LDF and TpO2 can predict ischaemic injury of the colon, and LDF also of the small bowel. PMID:1397347

  17. Biomechanical comparison of two intraoperative mobilization techniques for maxillary distraction osteogenesis: Down-fracture versus non-down-fracture

    PubMed Central

    Yang, Lili; Suzuki, Eduardo Yugo; Suzuki, Boonsiva

    2014-01-01

    Purposes: The purpose of this study was to compare the distraction forces and the biomechanical effects between two different intraoperative surgical procedures (down-fracture [DF] and non-DF [NDF]) for maxillary distraction osteogenesis. Materials and Methods: Eight patients were assigned into two groups according to the surgical procedure: DF, n = 6 versus NDF, n = 2. Lateral cephalograms taken preoperatively (T1), immediately after removal of the distraction device (T2), and after at least a 6 months follow-up period (T3) were analyzed. Assessment of distraction forces was performed during the distraction period. The Mann–Whitney U-test was used to compare the difference in the amount of advancement, the maximum distraction force and the amount of relapse. Results: Although a significantly greater amount of maxillary movement was observed in the DF group (median 9.5 mm; minimum-maximum 7.9-14.1 mm) than in the NDF group (median 5.9 mm; minimum-maximum 4.4-7.6 mm), significantly lower maximum distraction forces were observed in the DF (median 16.4 N; minimum-maximum 15.1-24.6 N) than in the NDF (median 32.9 N; minimum-maximum 27.6-38.2 N) group. A significantly greater amount of dental anchorage loss was observed in the NDF group. Moreover, the amount of relapse observed in the NDF group was approximately 3.5 times greater than in the DF group. Conclusions: In this study, it seemed that, the use of the NDF procedure resulted in lower levels of maxillary mobility at the time of the maxillary distraction, consequently requiring greater amounts of force to advance the maxillary bone. Moreover, it also resulted in a reduced amount of maxillary movement, a greater amount of dental anchorage loss and poor treatment stability. PMID:25593865

  18. A Prospective Quasi-Randomized Comparison of Intraoperatively Built Custom-Linked Seeds Versus Loose Seeds for Prostate Brachytherapy

    SciTech Connect

    Ishiyama, Hiromichi; Satoh, Takefumi; Kawakami, Shogo; Tsumura, Hideyasu; Komori, Shouko; Tabata, Ken-ichi; Sekiguchi, Akane; Takahashi, Ryo; Soda, Itaru; Takenaka, Kouji; Iwamura, Masatsugu; Hayakawa, Kazushige

    2014-09-01

    Purpose: To compare dosimetric parameters, seed migration rates, operation times, and acute toxicities of intraoperatively built custom-linked (IBCL) seeds with those of loose seeds for prostate brachytherapy. Methods and Materials: Participants were 140 patients with low or intermediate prostate cancer prospectively allocated to an IBCL seed group (n=74) or a loose seed group (n=66), using quasirandomization (allocated by week of the month). All patients underwent prostate brachytherapy using an interactive plan technique. Computed tomography and plain radiography were performed the next day and 1 month after brachytherapy. The primary endpoint was detection of a 5% difference in dose to 90% of prostate volume on postimplant computed tomography 1 month after treatment. Seed migration was defined as a seed position >1 cm from the cluster of other seeds on radiography. A seed dropped into the seminal vesicle was also defined as a migrated seed. Results: Dosimetric parameters including the primary endpoint did not differ significantly between groups, but seed migration rate was significantly lower in the IBCL seed group (0%) than in the loose seed group (55%; P<.001). Mean operation time was slightly but significantly longer in the IBCL seed group (57 min) than in the loose seed group (50 min; P<.001). No significant differences in acute toxicities were seen between groups (median follow-up, 9 months). Conclusions: This prospective quasirandomized control trial showed no dosimetric differences between IBCL seed and loose seed groups. However, a strong trend toward decreased postimplant seed migration was shown in the IBCL seed group.

  19. [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.

  20. Comparison of Two Types of Warm-Up Upon Repeated-Sprint Performance in Experienced Soccer Players.

    PubMed

    van den Tillaar, Roland; von Heimburg, Erna

    2016-08-01

    van den Tillaar, R and von Heimburg, E. Comparison of two types of warm-up upon repeated-sprint performance in experienced soccer players. J Strength Cond Res 30(8): 2258-2265, 2016-The aim of the study was to compare the effects of a long warm-up and a short warm-up upon repeated-sprint performance in soccer players. Ten male soccer players (age, 21.9 ± 1.9 years; body mass, 77.7 ± 8.3 kg; body height, 1.85 ± 0.03 m) conducted 2 types of warm-ups with 1 week in between: a long warm-up (20 minutes: LWup) and a short warm-up (10 minutes: SWup). Each warm-up was followed by a repeated-sprint test consisting of 8 × 30 m sprints with a new start every 30th second. The best sprint time, total sprinting time, and % decrease in time together with heart rate, lactate, and rate of perceived exertion (RPE) were measured. No significant differences in performance were found for the repeated-sprint test parameters (total sprint time: 35.99 ± 1.32 seconds [LWup] and 36.12 ± 0.96 seconds [SWup]; best sprint time: 4.32 ± 0.13 seconds [LWup] and 4.30 ± 0.10 seconds [SWup]; and % sprint decrease: 4.16 ± 2.15% [LWup] and 5.02 ± 2.07% [SWup]). No differences in lactate concentration after the warm-up and after the repeated-sprint test were found. However, RPE and heart rate were significantly higher after the long warm-up and the repeated-sprint test compared with the short warm-up. It was concluded that a short warm-up is as effective as a long warm-up for repeated sprints in soccer. Therefore, in regular training, less warm-up time is needed; the extra time could be used for important soccer skill training. PMID:26808861

  1. Comparison of Two Types of Warm-Up Upon Repeated-Sprint Performance in Experienced Soccer Players.

    PubMed

    van den Tillaar, Roland; von Heimburg, Erna

    2016-08-01

    van den Tillaar, R and von Heimburg, E. Comparison of two types of warm-up upon repeated-sprint performance in experienced soccer players. J Strength Cond Res 30(8): 2258-2265, 2016-The aim of the study was to compare the effects of a long warm-up and a short warm-up upon repeated-sprint performance in soccer players. Ten male soccer players (age, 21.9 ± 1.9 years; body mass, 77.7 ± 8.3 kg; body height, 1.85 ± 0.03 m) conducted 2 types of warm-ups with 1 week in between: a long warm-up (20 minutes: LWup) and a short warm-up (10 minutes: SWup). Each warm-up was followed by a repeated-sprint test consisting of 8 × 30 m sprints with a new start every 30th second. The best sprint time, total sprinting time, and % decrease in time together with heart rate, lactate, and rate of perceived exertion (RPE) were measured. No significant differences in performance were found for the repeated-sprint test parameters (total sprint time: 35.99 ± 1.32 seconds [LWup] and 36.12 ± 0.96 seconds [SWup]; best sprint time: 4.32 ± 0.13 seconds [LWup] and 4.30 ± 0.10 seconds [SWup]; and % sprint decrease: 4.16 ± 2.15% [LWup] and 5.02 ± 2.07% [SWup]). No differences in lactate concentration after the warm-up and after the repeated-sprint test were found. However, RPE and heart rate were significantly higher after the long warm-up and the repeated-sprint test compared with the short warm-up. It was concluded that a short warm-up is as effective as a long warm-up for repeated sprints in soccer. Therefore, in regular training, less warm-up time is needed; the extra time could be used for important soccer skill training.

  2. A comparison of observed and simulated properties of sudden stratospheric warmings

    NASA Technical Reports Server (NTRS)

    Quiroz, R. S.; Miller, A. J.; Nagatani, R. M.

    1975-01-01

    Review of observational data and dynamical numerical simulations of stratospheric warmings. Classes of warmings, major and minor (major if poleward movement of planetary-scale thermal systems entails reversal of polar circulation at 10 mb or below), trajectories of warm cells, vertical and horizontal scale of warm-air systems, the time-scale of warming, initial zonal flow conditions prior to a warming, circulation reversals, and details of the energy budget before and after a warming are discussed. The 1963 and 1973 types of warmings are contrasted: the strong baroclinic conversion of eddy potential to eddy kinetic energy was not repeated in the latter, but both events were preceded by very large fluxes from the troposphere. Numerical model simulations by various authors are compared and evaluated.

  3. Comparison of contact endoscopy and frozen section histopathology in the intra-operative diagnosis of laryngeal pathology.

    PubMed

    Cikojević, D; Gluncić, I; Pesutić-Pisac, V

    2008-08-01

    Andrea et al. were the first to use contact endoscopy in the diagnosis of laryngeal disease, in 1995. This method enables in vivo microscopy of laryngeal mucosa. In the present study, comparison of contact endoscopy with frozen section histopathology was performed in 142 patients with various diseases of the larynx. Paraffin section histopathology diagnosed 70 benign lesions, 23 precancerous lesions and 49 malignant lesions. Frozen section histopathology showed a sensitivity of 89.8 per cent, a specificity of 98.9 per cent and an accuracy of 95.7 per cent (chi2 = 1.5; p = 0.18). Frozen histopathology diagnosed 45 malignant lesions, including one false positive and five false negative results. Contact endoscopy yielded a sensitivity of 79.59 per cent, a specificity of 100 per cent and an accuracy of 92.95 per cent (chi2 = 8.1; p = 0.002). All malignant lesions diagnosed by contact endoscopy were confirmed by histopathology; contact endoscopy failed to recognise malignant lesions in 10 patients. Contact endoscopy is preferable to frozen section histopathology as it is noninvasive, provides information on microscopic diagnosis and laryngeal lesion margins, and enables visualisation of the laryngeal mucosa microvasculature. The use of contact endoscopy along with frozen section histopathology improves diagnostic accuracy and allows for operative (or other) therapy to continue according to the results obtained.

  4. Multimodel comparison of the ionosphere variability during the 2009 sudden stratosphere warming

    NASA Astrophysics Data System (ADS)

    Pedatella, N. M.; Fang, T.-W.; Jin, H.; Sassi, F.; Schmidt, H.; Chau, J. L.; Siddiqui, T. A.; Goncharenko, L.

    2016-07-01

    A comparison of different model simulations of the ionosphere variability during the 2009 sudden stratosphere warming (SSW) is presented. The focus is on the equatorial and low-latitude ionosphere simulated by the Ground-to-topside model of the Atmosphere and Ionosphere for Aeronomy (GAIA), Whole Atmosphere Model plus Global Ionosphere Plasmasphere (WAM+GIP), and Whole Atmosphere Community Climate Model eXtended version plus Thermosphere-Ionosphere-Mesosphere-Electrodynamics General Circulation Model (WACCMX+TIMEGCM). The simulations are compared with observations of the equatorial vertical plasma drift in the American and Indian longitude sectors, zonal mean F region peak density (NmF2) from the Constellation Observing System for Meteorology, Ionosphere, and Climate (COSMIC) satellites, and ground-based Global Positioning System (GPS) total electron content (TEC) at 75°W. The model simulations all reproduce the observed morning enhancement and afternoon decrease in the vertical plasma drift, as well as the progression of the anomalies toward later local times over the course of several days. However, notable discrepancies among the simulations are seen in terms of the magnitude of the drift perturbations, and rate of the local time shift. Comparison of the electron densities further reveals that although many of the broad features of the ionosphere variability are captured by the simulations, there are significant differences among the different model simulations, as well as between the simulations and observations. Additional simulations are performed where the neutral atmospheres from four different whole atmosphere models (GAIA, HAMMONIA (Hamburg Model of the Neutral and Ionized Atmosphere), WAM, and WACCMX) provide the lower atmospheric forcing in the TIME-GCM. These simulations demonstrate that different neutral atmospheres, in particular, differences in the solar migrating semidiurnal tide, are partly responsible for the differences in the simulated

  5. Comparison of Rapid Smoking, Warm, Smoky Air, and Attention Placebo in the Modification of Smoking Behavior

    ERIC Educational Resources Information Center

    Lichtenstein, Edward; And Others

    1973-01-01

    Forty habitual smokers were assigned to one of four treatment groups: warm, smoky air plus rapid smoking; warm, smoky air only; rapid smoking only; an attention-placebo control group. The three aversion groups were quite similar and, taken together, were smoking less at the six-month follow-up than the controls. (Author)

  6. Weather Research and Forecasting Model Sensitivity Comparisons for Warm Season Convective Initiation

    NASA Technical Reports Server (NTRS)

    Watson, Leela R.; Hoeth, Brian; Blottman, Peter F.

    2007-01-01

    options within each core, provides SMG and NWS MLB with a lot of flexibility. It also creates challenges, such as determining which configuration options are best to address specific forecast concerns. The goal of this project is to assess the different configurations available and to determine which configuration will best predict warm season convective initiation in East-Central Florida. Four different combinations of WRF initializations will be run (ADAS-ARW, ADAS-NMM, LAPS-ARW, and LAPS-NMM) at a 4-km resolution over the Florida peninsula and adjacent coastal waters. Five candidate convective initiation days using three different flow regimes over East-Central Florida will be examined, as well as two null cases (non-convection days). Each model run will be integrated 12 hours with three runs per day, at 0900, 1200, and 1500 UTe. ADAS analyses will be generated every 30 minutes using Level II Weather Surveillance Radar-1988 Doppler (WSR-88D) data from all Florida radars to verify the convection forecast. These analyses will be run on the same domain as the four model configurations. To quantify model performance, model output will be subjectively compared to the ADAS analyses of convection to determine forecast accuracy. In addition, a subjective comparison of the performance of the ARW using a high-resolution local grid with 2-way nesting, I-way nesting, and no nesting will be made for select convective initiation cases. The inner grid will cover the East-Central Florida region at a resolution of 1.33 km. The authors will summarize the relative skill of the various WRF configurations and how each configuration behaves relative to the others, as well as determine the best model configuration for predicting warm season convective initiation over East-Central Florida.

  7. 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

  8. Acute Intraoperative Pulmonary Aspiration

    PubMed Central

    Nason, Katie S.

    2015-01-01

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

  9. Intraoperative aortic dissection

    PubMed Central

    Singh, Ajmer; Mehta, Yatin

    2015-01-01

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

  10. Weather Research and Forecasting Model Sensitivity Comparisons for Warm Season Convective Initiation

    NASA Technical Reports Server (NTRS)

    Watson, Leela R.

    2007-01-01

    This report describes the work done by the Applied Meteorology Unit (AMU) in assessing the success of different model configurations in predicting warm season convection over East-Central Florida. The Weather Research and Forecasting Environmental Modeling System (WRF EMS) software allows users to choose among two dynamical cores - the Advanced Research WRF (ARW) and the Non-hydrostatic Mesoscale Model (NMM). There are also data assimilation analysis packages available for the initialization of the WRF model - the Local Analysis and Prediction System (LAPS) and the Advanced Regional Prediction System (ARPS) Data Analysis System (ADAS). Besides model core and initialization options, the WRF model can be run with one- or two-way nesting. Having a series of initialization options and WRF cores, as well as many options within each core, creates challenges for local forecasters, such as determining which configuration options are best to address specific forecast concerns. This project assessed three different model intializations available to determine which configuration best predicts warm season convective initiation in East-Central Florida. The project also examined the use of one- and two-way nesting in predicting warm season convection.

  11. Prototype hybrid systems for neonatal warming: in vitro comparisons to standard of care devices.

    PubMed

    Hubert, Terrence L; Lindemann, Rolf; Wu, Jichuan; Agnew, Catherine; Shaffer, Thomas H; Wolfson, Marla R

    2010-01-01

    Preterm infants lack necessary thermoregulation. An ideal incubator should maintain a uniform and constant thermal environment. We compared the effectiveness of a supplemental heating blanket to improve the heating characteristics of two different incubator warming devices using assessment of their respective function alone as controls. Device A and device B, with and without a heating blanket (Harvard Apparatus), were instrumented with a distribution matrix of multiple temperature (n = 11) and humidity probes. These data were serially measured during warm up to 37.5 °C and through a series of open-door perturbations. The time constant, temperature variation, and change in air temperature were calculated. Data were analyzed for significance by 2-factor ANOVA for each respective incubator either turned on or off with either the heating blanket turned on or off. Device A warms faster (33.87% ; p < 0.05) than device B, but has a greater (37.27% ; p < 0.05) temperature variation during warmup. The heating blanket enhances the thermal response of device A during warmup, but does not alter those of device B. With the side door open, device A shows a smaller (-16.5% ; p < 0.05) temperature variation than device B; the heating blanket attenuates the temperature change in both devices. These results demonstrate that the use of a supplemental heating blanket, as well as device-related differences, may impact clinical control of a thermal environment.

  12. Prototype Hybrid Systems for Neonatal Warming: In Vitro Comparisons to Standard of Care Devices

    PubMed Central

    Hubert, Terrence L.; Lindemann, Rolf; Wu, Jichuan; Agnew, Catherine; Shaffer, Thomas H.; Wolfson, Marla R.

    2013-01-01

    Preterm infants lack necessary thermoregulation. An ideal incubator should maintain a uniform and constant thermal environment. We compared the effectiveness of a supplemental heating blanket to improve the heating characteristics of two different incubator warming devices using assessment of their respective function alone as controls. Device A and device B, with and without a heating blanket (Harvard Apparatus), were instrumented with a distribution matrix of multiple temperature (n = 11) and humidity probes. These data were serially measured during warm up to 37.5 °C and through a series of open-door perturbations. The time constant, temperature variation, and change in air temperature were calculated. Data were analyzed for significance by 2-factor ANOVA for each respective incubator either turned on or off with either the heating blanket turned on or off. Device A warms faster (33.87% ; p < 0.05) than device B, but has a greater (37.27% ; p < 0.05) temperature variation during warmup. The heating blanket enhances the thermal response of device A during warmup, but does not alter those of device B. With the side door open, device A shows a smaller (−16.5% ; p < 0.05) temperature variation than device B; the heating blanket attenuates the temperature change in both devices. These results demonstrate that the use of a supplemental heating blanket, as well as device-related differences, may impact clinical control of a thermal environment. PMID:21142524

  13. What is "good reasoning" about global warming? A comparison of high school students and specialists

    NASA Astrophysics Data System (ADS)

    Adams, Stephen Thomas

    This study compares the knowledge and reasoning about global warming of 10 twelfth grade students and 6 specialists, including scientists and policy analysts. The study uses global warming as a context for addressing the broad objective of formulating goals for scientific literacy. Subjects evaluated a set of articles about global warming and evaluated policies proposed to ameliorate global warming, including a gasoline tax and a "feebate" system of fees and rebates on automobiles. All students and one scientist participated in a full treatment involving interviews and activities with a computer program (discussed below), averaging about 3.75 hours. In addition, five specialists participated in interviews only, averaging one hour. One line of analysis focuses on knowledge content, examining how subjects applied perspectives from both natural and social sciences. This analysis is positioned as an empirical component to the movement to develop content standards for science education, as exemplified by the recommendations of Science for All Americans (SFAA). Some aspects of competent performance in the present study hinged upon knowledge and skills advocated by SFAA (e.g., fluency with themes of science such as scale). Other aspects involved such skills as evaluating economic interests behind a scientific argument in the media or considering hidden costs in a policy area. By characterizing a range of approaches to how students and specialists performed the experimental tasks, the present study affords a view of scientific literacy not possible without this type of information. Another line of analysis investigates a measure of coherent argumentation from a computer program, Convince Me, in relation to policy reasoning. The program is based on a connectionist model, ECHO. Subjects used the program to create arguments about the aforementioned policies. The study compares Convince Me's Model's Fit argumentation measure to other measures, including ratings of 6 human

  14. Advantages of new technologies in oral mucosal surgery: an intraoperative comparison among Nd:YAG laser, quantic molecular resonance scalpel, and cold blade.

    PubMed

    Ilaria, Giovannacci; Marco, Meleti; Elisabetta, Merigo; Giovanni, Mergoni; Carlo, Fornaini; Maddalena, Manfredi; Mauro, Bonanini; Paolo, Vescovi

    2015-09-01

    The aim of this study is to evaluate the possible intraoperative advantages of Nd:YAG laser and quantic molecular resonance (QMR) scalpel in oral soft tissue surgery. One hundred sixty-three interventions were evaluated. Group 1 (G1) included 77 interventions performed with Nd:YAG laser, group 2 (G2) 45 with QMR scalpel, and group 3 (G3) 41 with cold blade. Parameters analyzed were as follows: speed of incision, time of intervention, intraoperative bleeding, number of stitches, patient compliance, and operator comfort. Data were analyzed using software STATA 12 (StataCorp LP, College Station, TX, USA). Mean speed of incision was 0.54 mm/s in G1, 2.83 mm/s in G2, and 1.58 mm/s in G3, Nd:YAG laser being the slowest. However, no significant differences among times of intervention were found. In particular, interventions in G1 (221.15 ± 220.89 s) have a mean duration lower than G2 (280.56 ± 248.31 s) and G3 (316.10 ± 248.69 s). Intraoperative bleeding occurred in 29.9 % (n = 23/77) of interventions in G1, 97.8 % (n = 44/45) in G2, and 97.6 % (n = 40/41) in G3 (p < 0.0001). Mean number of stitches in G1 was statistically lower (G1, 0.10; G2, 2.07; G3, 2.29; p < 0.0001). No differences with regard to patient compliance were detected. Operator comfort was higher in G1 (p < 0.0003). Nd:YAG laser and QMR scalpel give several advantages in oral mucosal surgery: Nd:YAG laser cuts tissue slowly, but it provides a good visibility and excellent hemostasis. QMR scalpel allows a very rapid cutting with no considerable temperature increase, but there is major risk of bleeding and need for sutures with lower operator comfort.

  15. Do cities simulate climate change? A comparison of herbivore response to urban and global warming.

    PubMed

    Youngsteadt, Elsa; Dale, Adam G; Terando, Adam J; Dunn, Robert R; Frank, Steven D

    2015-01-01

    Cities experience elevated temperature, CO2 , and nitrogen deposition decades ahead of the global average, such that biological response to urbanization may predict response to future climate change. This hypothesis remains untested due to a lack of complementary urban and long-term observations. Here, we examine the response of an herbivore, the scale insect Melanaspis tenebricosa, to temperature in the context of an urban heat island, a series of historical temperature fluctuations, and recent climate warming. We survey M. tenebricosa on 55 urban street trees in Raleigh, NC, 342 herbarium specimens collected in the rural southeastern United States from 1895 to 2011, and at 20 rural forest sites represented by both modern (2013) and historical samples. We relate scale insect abundance to August temperatures and find that M. tenebricosa is most common in the hottest parts of the city, on historical specimens collected during warm time periods, and in present-day rural forests compared to the same sites when they were cooler. Scale insects reached their highest densities in the city, but abundance peaked at similar temperatures in urban and historical datasets and tracked temperature on a decadal scale. Although urban habitats are highly modified, species response to a key abiotic factor, temperature, was consistent across urban and rural-forest ecosystems. Cities may be an appropriate but underused system for developing and testing hypotheses about biological effects of climate change. Future work should test the applicability of this model to other groups of organisms.

  16. Do cities simulate climate change? A comparison of herbivore response to urban and global warming

    USGS Publications Warehouse

    Youngsteadt, Elsa; Dale, Adam G.; Terando, Adam; Dunn, Robert R.; Frank, Steven D.

    2014-01-01

    Cities experience elevated temperature, CO2, and nitrogen deposition decades ahead of the global average, such that biological response to urbanization may predict response to future climate change. This hypothesis remains untested due to a lack of complementary urban and long-term observations. Here, we examine the response of an herbivore, the scale insect Melanaspis tenebricosa, to temperature in the context of an urban heat island, a series of historical temperature fluctuations, and recent climate warming. We survey M. tenebricosa on 55 urban street trees in Raleigh, NC, 342 herbarium specimens collected in the rural southeastern United States from 1895 to 2011, and at 20 rural forest sites represented by both modern (2013) and historical samples. We relate scale insect abundance to August temperatures and find that M. tenebricosa is most common in the hottest parts of the city, on historical specimens collected during warm time periods, and in present-day rural forests compared to the same sites when they were cooler. Scale insects reached their highest densities in the city, but abundance peaked at similar temperatures in urban and historical datasets and tracked temperature on a decadal scale. Although urban habitats are highly modified, species response to a key abiotic factor, temperature, was consistent across urban and rural-forest ecosystems. Cities may be an appropriate but underused system for developing and testing hypotheses about biological effects of climate change. Future work should test the applicability of this model to other groups of organisms.

  17. Do cities simulate climate change? A comparison of herbivore response to urban and global warming.

    PubMed

    Youngsteadt, Elsa; Dale, Adam G; Terando, Adam J; Dunn, Robert R; Frank, Steven D

    2015-01-01

    Cities experience elevated temperature, CO2 , and nitrogen deposition decades ahead of the global average, such that biological response to urbanization may predict response to future climate change. This hypothesis remains untested due to a lack of complementary urban and long-term observations. Here, we examine the response of an herbivore, the scale insect Melanaspis tenebricosa, to temperature in the context of an urban heat island, a series of historical temperature fluctuations, and recent climate warming. We survey M. tenebricosa on 55 urban street trees in Raleigh, NC, 342 herbarium specimens collected in the rural southeastern United States from 1895 to 2011, and at 20 rural forest sites represented by both modern (2013) and historical samples. We relate scale insect abundance to August temperatures and find that M. tenebricosa is most common in the hottest parts of the city, on historical specimens collected during warm time periods, and in present-day rural forests compared to the same sites when they were cooler. Scale insects reached their highest densities in the city, but abundance peaked at similar temperatures in urban and historical datasets and tracked temperature on a decadal scale. Although urban habitats are highly modified, species response to a key abiotic factor, temperature, was consistent across urban and rural-forest ecosystems. Cities may be an appropriate but underused system for developing and testing hypotheses about biological effects of climate change. Future work should test the applicability of this model to other groups of organisms. PMID:25163424

  18. Weather Research and Forecasting Model Sensitivity Comparisons for Warm Season Convective Initiation

    NASA Technical Reports Server (NTRS)

    Watson, Leela R.; Hoeth, Brian; Blottman, Peter F.

    2007-01-01

    Mesoscale weather conditions can significantly affect the space launch and landing operations at Kennedy Space Center (KSC) and Cape Canaveral Air Force Station (CCAFS). During the summer months, land-sea interactions that occur across KSC and CCAFS lead to the formation of a sea breeze, which can then spawn deep convection. These convective processes often last 60 minutes or less and pose a significant challenge to the forecasters at the National Weather Service (NWS) Spaceflight Meteorology Group (SMG). The main challenge is that a "GO" forecast for thunderstorms and precipitation at the Shuttle Landing Facility is required at the 90 minute deorbit decision for End Of Mission (EOM) and at the 30 minute Return To Launch Site (RTLS) decision. Convective initiation, timing, and mode also present a forecast challenge for the NWS in Melbourne, FL (MLB). The NWS MLB issues such tactical forecast information as Terminal Aerodrome Forecasts (TAF5), Spot Forecasts for fire weather and hazardous materials incident support, and severe/hazardous weather Watches, Warnings, and Advisories. Lastly, these forecasting challenges can also affect the 45th Weather Squadron (45 WS), which provides comprehensive weather forecasts for shuttle launch, as well as ground operations, at KSC and CCAFS. The need for accurate mesoscale model forecasts to aid in their decision making is crucial. This study specifically addresses the skill of different model configurations in forecasting warm season convective initiation. Numerous factors influence the development of convection over the Florida peninsula. These factors include sea breezes, river and lake breezes, the prevailing low-level flow, and convergent flow due to convex coastlines that enhance the sea breeze. The interaction of these processes produces the warm season convective patterns seen over the Florida peninsula. However, warm season convection remains one of the most poorly forecast meteorological parameters. To determine which

  19. 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.

  20. Intraoperative anesthetic complications.

    PubMed

    Milam, S B

    1987-01-01

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

  1. SU-E-T-537: Comparison of Intra-Operative Soft X-Rays to Low Energy Electron Beams for Treatment of Superficial Lesions

    SciTech Connect

    Chinsky, B; Diak, A; Gros, S; Sethi

    2014-06-01

    Purpose: Superficial soft x-ray applicators have recently been designed for use with existing intra-operative radiotherapy systems. These applicators may be used in treating superficial lesions which are conventionally treated with electron beams. The purpose of this abstract is to compare dose distributions of an intra-operative 50kV x-ray unit with low energy electrons for the treatment of superficial lesions. Methods: Dosimetric parameters for 1 and 3-cm diameter Intrabeam superficial x-ray applicators were measured with EBT3 Gafchromic film in a solid water phantom. Depth dose distributions and profiles (d=2, 5, 10 and 15mm) were obtained by prescribing a dose of 400cGy at 5mm depth below the phantom surface. Corresponding dose profiles for 6-MeV electrons were acquired from a Varian Clinac 21EX at 100 SSD. H and D calibration curves were generated for each modality for 0-800cGy. Results: Dose coverage, penumbra, dose uniformity, surface dose, and dose fall-off were examined. Compared to electrons, Intrabeam lateral dose coverage at 5mm depth was 70% larger with a much sharper (1/4) penumbra. Electron isodose levels bulged with depth, whereas Intrabeam isodose levels exhibited a convex cone shape. The Intrabeam dose profiles demonstrated horns in the dose distribution up to a 5mm depth and an exponential dose fall-off. Relative surface dose was higher for the Intrabeam applicators. Treatment times were comparable for both modalities. Conclusions: The very small penumbra of Intrabeam at shallow depths could be useful in treating superficial lesions adjacent to critical structures. The exponential dose fall-off of Intrabeam makes it appealing in the sparing of structures beyond the lesion. However, for lesions past a depth of 5mm, electrons would be desirable as they penetrate farther and provide skin sparing. Intrabeam may be preferable for sites that are difficult to treat with electrons due to mechanical and physical limitations.

  2. Comparison of surgical outcomes after anterior cervical discectomy and fusion: does the intra-operative use of a microscope improve surgical outcomes

    PubMed Central

    Elsamadicy, Aladine; Reiser, Elizabeth; Ziegler, Cole; Freischlag, Kyle; Cheng, Joseph; Bagley, Carlos A.

    2016-01-01

    Background The primary aim of this study was to assess and compare the complications profile as well as long-term clinical outcomes between patients undergoing an Anterior Cervical Discectomy and Fusion (ACDF) procedure with and without the use of an intra-operative microscope. Methods One hundred and forty adult patients (non-microscope cohort: 81; microscope cohort: 59) undergoing ACDF at a major academic medical center were included in this study. Enrollment criteria included available demographic, surgical and clinical outcome data. All patients had prospectively collected patient-reported outcomes measures and a minimum 2-year follow-up. Patients completed the neck disability index (NDI), short-form 12 (SF-12) and visual analog pain scale (VAS) before surgery, then at 3, 6, 12, and 24 months after surgery. Clinical outcomes and complication rates were compared between both patient cohorts. Results Baseline characteristics were similar between both cohorts. The mean ± standard deviation duration of surgery was longer in the microscope cohort (microscope: 169±34 minutes vs. non-microscope: 98±42 minutes, P<0.001). There was no significant difference between cohorts in the incidence of nerve root injury (P=0.99) or incidental durotomy (P=0.32). At 3 months post-operatively, both cohorts demonstrated similar improvement in VAS-neck pain (P=0.69), NDI (P=0.86), SF-12 PCS (P=0.84) and SF-12 MCS (P=0.75). At 2-year post-operatively, both the microscope and non-microscope cohorts demonstrated similar improvement from base line in NDI (microscope: 13.52±25.77 vs. non-microscope: 19.51±27.47, P<0.18), SF-12 PCS (microscope: 4.15±26.39 vs. non-microscope: 11.98±22.96, P<0.07), SF-12 MCS (microscope: 9.47±32.38 vs. non-microscope: 16.19±30.44, P<0.21). Interestingly at 2 years, the change in VAS neck pain score was significantly different between cohorts (microscope: 2.22±4.00 vs. non-microscope: 3.69±3.61, P<0.02). Conclusions Our study demonstrates that the

  3. Comparison of Oxidation and Microstructure of Warm-Sprayed and Cold-Sprayed Titanium Coatings

    NASA Astrophysics Data System (ADS)

    Kim, KeeHyun; Kuroda, Seiji; Watanabe, Makoto; Huang, RenZhong; Fukanuma, Hirotaka; Katanoda, Hiroshi

    2012-06-01

    Thick titanium coatings were prepared by the warm spraying (WS) and cold spraying (CS) processes to investigate the oxidation and microstructure of the coating layers. Prior to the coating formations, the temperature and velocity of in-flight titanium powder particles were numerically calculated. Significant oxidation occurred in the WS process using higher gas temperature conditions with low nitrogen flow rate, which is mixed to the flame jet of a high velocity oxy-fuel (HVOF) spray gun in order to control the temperature of the propellant gas. Oxidation, however, decreased strikingly as the nitrogen flow rate increased. In the CS process using nitrogen or helium as a propellant gas, little oxidation was observed. Even when scanning electron microscopy or an x-ray diffraction method did not detect oxides in the coating layers produced by WS using a high nitrogen flow rate or by CS using helium, the inert gas fusion method revealed minor increases of oxygen content from 0.01 to 0.2 wt.%. Most of the cross-sections of the coating layers prepared by conventional mechanical polishing looked dense. However, the cross-sections prepared by an ion-milling method revealed the actual microstructures containing small pores and unbounded interfaces between deposited particles.

  4. Comparison of the Effects on Dynamic Balance Ability of Warming up in Water Versus on the Ground.

    PubMed

    Lim, Kyoung Il; Hwnagbo, Gak; Nam, Hyung Chun; Cho, Yong Ho

    2014-04-01

    [Purpose] This research was designed to find out how the so-called "dynamic balance" is affected by doing different types of warm up exercises. In particular, the research is focused on the difference in the effect on dynamic Balance of warming up in water versus on the ground. [Subjects and Methods] Twenty healthy adults were the subjects of this study, with 10 people assigned each to two groups, one warming up in water and another warming up on the ground. The dynamic balance was measured for all subjects before the warming up. The group warming up on the ground conducted active stretching on the ground, and the group warming up in water conducted stretching in water by using water as resistance. [Results] The results indicate that warming up in water has a more powerful effect on a subject's dynamic balance than warming up on the ground. [Conclusion] The group warming up in water, who made use of the viscosity and flow of the water, showed better balance than the group warming up on the ground. Warming up in water, which entails an element of resistance, should be implemented in warm-up routines in the future.

  5. Intraoperative magnetic resonance imaging.

    PubMed

    Hall, Walter A; Truwit, Charles L

    2011-01-01

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

  6. Climatology of Warm Boundary Layer Clouds at the ARM SGP Site and Their Comparison to Models

    SciTech Connect

    Sengupta, Manajit; Clothiaux, Eugene E.; Ackerman, Thomas P.

    2004-12-01

    A four-year climatology (1997-2000) of warm boundary layer cloud properties is developed for the U.S. Department of Energy Atmospheric Radiation (ARM) Program Southern Great Plains (SGP) site. Parameters in the climatology include cloud liquid water path, cloud base height and surface solar flux. These parameters are retrieved from measurements produced by a dual-channel microwave radiometer, a millimeter-wave cloud radar, a micropulse lidar, a Belfort ceilometer, shortwave radiometers and atmospheric temperature profiles amalgamated from multiple sources, including radiosondes. No significant interannual differences are observed, but nighttime liquid water paths are consistently higher than daytime values. The summer months of June, July and August have the lowest liquid water paths and the highest cloud base heights. Model outputs of cloud liquid water paths from the European Center for Medium Range Weather Forecasting (ECMWF) model and the Early Eta Model for 104 Model Output Location Time Series (MOLTS) stations in the environs of the SGP central facility are compared to observations. The ECMWF and MOLTS mean and median liquid water paths are 3 and 4 times greater, respectively, than the observed values. The MOLTS data show lower liquid water paths in summer, which is consistent with observations, while the ECMWF data exhibit the opposite tendency. A parameterization of normalized cloud forcing that requires only cloud liquid water path and solar zenith angle is developed from the observations. The parameterization, which has a correlation coefficient of 0.81 with the observations, provides estimates of surface solar flux that are comparable to values obtained from explicit radiative transfer calculations based on plane-parallel theory. This parameterization is used to estimate the impact on the surface solar flux of differences in the liquid water paths between models and observations. Overall, there is a low bias of 50% in modeled normalized cloud forcing

  7. Comparison of implant quality between intraoperatively built custom-linked seeds and loose seeds in permanent prostate brachytherapy using sector analysis

    PubMed Central

    Katayama, Norihisa; Takemoto, Mitsuhiro; Takamoto, Atsushi; Ihara, Hiroki; Katsui, Kuniaki; Ebara, Shin; Nasu, Yasutomo; Kanazawa, Susumu

    2016-01-01

    We compared the implant quality of intraoperatively built custom-linked (IBCL) seeds with loose seeds in permanent prostate brachytherapy. Between June 2012 and January 2015, 64 consecutive prostate cancer patients underwent brachytherapy with IBCL seeds (n = 32) or loose seeds (n = 32). All the patients were treated with 144 Gy of brachytherapy alone. Brachytherapy was performed using a dynamic dose calculation technique. Computed tomography/magnetic resonance imaging fusion-based dosimetry was performed 1 month after brachytherapy. Post-implant dose–volume histogram (DVH) parameters, prostate sector dosimetry, operation time, seed migration, and toxicities were compared between the IBCL seed group and the loose seed group. A sector analysis tool was used to divide the prostate into six sectors (anterior and posterior sectors at the base, mid-gland, and apex). V100 (95.3% vs 89.7%; P = 0.014) and D90 (169.7 Gy vs 152.6 Gy; P = 0.013) in the anterior base sector were significantly higher in the IBCL seed group than in the loose seed group. The seed migration rate was significantly lower in the IBCL seed group than in the loose seed group (6% vs 66%; P < 0.001). Operation time per seed was significantly longer in the IBCL seed group than in the loose seed group (1.31 min vs 1.13 min; P = 0.003). Other post-implant DVH parameters and toxicities did not differ significantly between the two groups. Our study showed more dose coverage post-operatively in the anterior base prostate sector and less seed migration in IBCL seed implantation compared with loose seed implantation. PMID:26976125

  8. Comparison of metabolic and biomechanic responses to active vs. passive warm-up procedures before physical exercise.

    PubMed

    Brunner-Ziegler, Sophie; Strasser, Barbara; Haber, Paul

    2011-04-01

    Active warm-up before physical exercise is a widely accepted practice to enhance physical performance, whereas data on modalities to passively raise tissue temperature are rare. The study compared the effect of active vs. passive warm-up procedures before exercise on energy supply and muscle strength performance. Twenty young, male volunteers performed 3 spiroergometer-test series without prior warm-up and after either an active or passive warm-up procedure. Oxygen uptake (VO2), heart rate (HR), pH value, and lactate were determined at 80% of individual VO2max values and during recovery. Comparing no prior warm-up with passive warm-up, pH values were lower at the fourth test minute (p < 0.004), and lactate values were higher at the sixth and third minutes of recovery (p < 0.01 and p < 0.010, respectively), after no prior warm-up. Comparing active with passive warm-up, HR was lower, and VO2 values were higher at the fourth and sixth test minutes (p < 0.033 and p < 0.011, respectively, and p < 0.015 and p < 0.022, respectively) after active warm-up. Differentiation between active and passive warm-up was more pronounced than between either warm-up or no warm-up. Conditions that may promote improved performance were more present after active vs. passive warm-up. Thus, athletes may reach the metabolic steady state faster after active warm-up. PMID:20733525

  9. Formation and evolution of periglacial landforms in context of global warming: Comparison Earth-Mars

    NASA Astrophysics Data System (ADS)

    Séjourné, A.; Costard, F.; Gargani, J.; Marmo, C.

    2012-04-01

    potential ice-wedges and subsequent subsidence of the ground producing pits. The scalloped depressions are similar in shape and size to thermokarst lakes. They are thought to be due to degradation of ground-ice by melting or sublimation of ground-ice and subsidence of the ground. Our results show that the assemblage of landforms in Utopia Planitia indicates the presence of an ice-rich permafrost like on Earth. We suggest that this permafrost were formed during cold climatic periods and then were degraded during a relatively recent global warming. Our results show that the permafrost was degraded during a high obliquity periods of Mars. But the question is how major climate-changes could occur on Mars. Mars is thought to have undergone important variations in the orbital parameters during the last 10 Myr dramatically changing the climate. Therefore, Utopia Planitia is probably a marker of one of the last major climate change that occurred on Mars.

  10. Tidal variability during stratospheric sudden warming in 2009: Comparison between GAIA model and COSMIC and TIMED/SABER observations

    NASA Astrophysics Data System (ADS)

    Jin, Hidekatsu; Miyoshi, Yasunobu; Fujiwara, Hitoshi; Shinagawa, Hiroyuki; Pancheva, Dora; Mukhtarov, Plamen

    2012-07-01

    We compare results from a whole atmosphere-ionosphere coupled model, GAIA, and from the COSMIC and TIMED/SABER observations during 2008/2009 northern winter season. The GAIA model has assimilated meteorological reanalysis data by a nudging method. The comparison shows excellent agreements in the major features from the stratosphere to the ionosphere including the growth and decay of the major stratospheric sudden warming (SSW) event in 2009. During the major SSW period, a pronounced semidiurnal variation in the F-region electron density and its local-time phase shift similar to the previous observations are reproduced by the model and COSMIC observation. The model suggests that the TEC variation is caused by an enhanced semidiurnal variation in the EXB drift, which is probably related to an amplified semidiurnal migrating tide (SW2) in the lower thermosphere. The model and TIMED/SABER observation show that the SW2 tide amplifies at low latitudes from the stratosphere to the thermosphere as well as the phase variation. Possible mechanisms will be discussed in the presentation.

  11. Comparison between natural Rain drop size distributions and corresponding models near equilibrium state during warm rain

    NASA Astrophysics Data System (ADS)

    Barthes, Laurent; Mallet, Cécile

    2010-05-01

    fragments droplets produced when small drops and large drops collide is overestimate. As new parameterization of LL82 is not possible due to the lack of new sufficient large experimental dataset, we have simply tried in the present study to 'compensate' the problem previously mentioned by replacing the coalescence/breakup model proposed in LL82 by another one in which the breakup process is less dominant. In order to evaluate the relevance of this modification, some of the DSD parameters such as slope, mean volume diameter, and relation between moments are calculated, and comparisons with experimental DSD are made. Simulations at equilibrium lead to a DSD tail with a slope of 23 cm-1 and a mean volume diameter equal to 2.5 mm. These values are in good agreements with experimental data. Similarly, the linear relationship between No* and the rainfall rate is also in good agreement. In the last part, the modified parameterization is then used to study the evolution of an initially gamma-like DSD in a 1D vertical rain shaft. References Barros, A. P., O. P. Prat, P. Shrestha, F. Y. Testik, and L. F. Bliven, 2008. Revisiting Low and List (1982): evaluation of raindrop collision using laboratory observations and modeling. Journal of the Atmospheric Sciences. Vol. 65(9), pp. 2983-2993. Hu, Z., and R. C. Srivastava: 1995: Evolution of raindrop size distribution by coalescence, breakup, and evaporation: Theory and observations. J. Atmos. Sci., 52, 1761-1783. Low, T. B. and R. List, 1982a: Collision, coalescence, and breakup of raindrops. Part I: Experimentally established coalescence efficiencies and fragment size distributions in breakup. J. Atmos. Sci., 39, 1591-1606. ___ 1982b: Collision, coalescence, and breakup of raindrops. Part II: Parameterization of fragment size distributions. J. Atmos. Sci., 39, 1607-1618. McFarquhar, G. M, 2004: A new representation of collision-induced breakup of raindrops and its implications for the shapes of raindrop size distributions, J. Atmos. Sci

  12. Dosimetry for electron Intra-Operative RadioTherapy: Comparison of output factors obtained through alanine/EPR pellets, ionization chamber and Monte Carlo-GEANT4 simulations for IORT mobile dedicate accelerator

    NASA Astrophysics Data System (ADS)

    Marrale, Maurizio; Longo, Anna; Russo, Giorgio; Casarino, Carlo; Candiano, Giuliana; Gallo, Salvatore; Carlino, Antonio; Brai, Maria

    2015-09-01

    In this work a comparison between the response of alanine and Markus ionization chamber was carried out for measurements of the output factors (OF) of electron beams produced by a linear accelerator used for Intra-Operative Radiation Therapy (IORT). Output factors (OF) for conventional high-energy electron beams are normally measured using ionization chamber according to international dosimetry protocols. However, the electron beams used in IORT have characteristics of dose per pulse, energy spectrum and angular distribution quite different from beams usually used in external radiotherapy, so the direct application of international dosimetry protocols may introduce additional uncertainties in dosimetric determinations. The high dose per pulse could lead to an inaccuracy in dose measurements with ionization chamber, due to overestimation of ks recombination factor. Furthermore, the electron fields obtained with IORT-dedicated applicators have a wider energy spectrum and a wider angular distribution than the conventional fields, due to the presence of electrons scattered by the applicator's wall. For this reason, a dosimetry system should be characterized by a minimum dependence from the beam energy and from angle of incidence of electrons. This become particularly critical for small and bevelled applicators. All of these reasons lead to investigate the use of detectors different from the ionization chamber for measuring the OFs. Furthermore, the complete characterization of the radiation field could be accomplished also by the use of Monte Carlo simulations which allows to obtain detailed information on dose distributions. In this work we compare the output factors obtained by means of alanine dosimeters and Markus ionization chamber. The comparison is completed by the Monte Carlo calculations of OFs determined through the use of the Geant4 application "iort _ therapy" . The results are characterized by a good agreement of response of alanine pellets and Markus

  13. Intraoperative monitoring of evoked potentials.

    PubMed

    Raudzens, P A

    1982-01-01

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

  14. Future perspectives in intraoperative imaging.

    PubMed

    Jolesz, F A

    2003-01-01

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

  15. Comparison of warm and cold years on the southeastern Bering Sea shelf and some implications for the ecosystem

    NASA Astrophysics Data System (ADS)

    Stabeno, Phyllis J.; Kachel, Nancy B.; Moore, Sue E.; Napp, Jeffrey M.; Sigler, Michael; Yamaguchi, Atsushi; Zerbini, Alexandre N.

    2012-06-01

    The southeastern, middle shelf of the Bering Sea has exhibited extreme variability in sea ice extent, temperature, and the distribution and abundance of species at multiple trophic levels over the past four decades. From 1972-2000, there was high interannual variability of areal extent of sea ice during spring (March-April). In 2000, this shifted to a 5-year (2001-2005) period of low ice extent during spring, which transitioned to a 4-year (2007-2010) period of extensive sea ice. High (low) areal extent of sea ice in spring was associated with cold (warm) water column temperatures for the following 6-7 months. The ocean currents also differed between warm and cold years. During cold years, the monthly-mean currents over the shelf were largely westward, while in warm years the direction of currents was more variable, with northward flow during December-February and relatively weak flow during the remainder of the year. The types and abundance of zooplankton differed sharply between warm and cold years. This was especially true during the prolonged warm period (2001-2005) and cold period (2007-2010), and was less evident during the years of high interannual variability. During the warm period, there was a lack of large copepods and euphausiids over the shelf; however, their populations rebounded during cold period. Small crustacean zooplankton taxa did not appear to vary between and warm and cold years. For both walleye pollock and Pacific cod, year-class strength (recruitment) was low during the prolonged warm period, but improved during the following cold period. Year-class strength did not appear to vary as a function of warm and cold years during the period of high year-to-year variability. Also, recruitment of arrowtooth flounder (a predator of pollock and cod) did not appear influenced by the warm or cold years. Finally, the distribution and relative abundance of fin whales appeared to differ in warm and cold years, with fewer whales on the southeastern, middle

  16. Intraoperative MRI and functional mapping.

    PubMed

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

    2011-01-01

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

  17. [Intraoperative OCT in ophthalmic microsurgery].

    PubMed

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

    2016-05-01

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

  18. [Intraoperative OCT in ophthalmic microsurgery].

    PubMed

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

    2016-05-01

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

  19. Sea surface temperatures of the mid-Piacenzian Warm Period: A comparison of PRISM3 and HadCM3

    USGS Publications Warehouse

    Dowsett, H.J.; Haywood, A.M.; Valdes, P.J.; Robinson, M.M.; Lunt, D.J.; Hill, D.J.; Stoll, D.K.; Foley, K.M.

    2011-01-01

    It is essential to document how well the current generation of climate models performs in simulating past climates to have confidence in their ability to project future conditions. We present the first global, in-depth comparison of Pliocene sea surface temperature (SST) estimates from a coupled ocean-atmosphere climate model experiment and a SST reconstruction based on proxy data. This enables the identification of areas in which both the climate model and the proxy dataset require improvement. In general, the fit between model-produced SST anomalies and those formed from the available data is very good. We focus our discussion on three regions where the data-model anomaly exceeds 2 ??C 1) In the high latitude North Pacific, a systematic model error may result in anomalies that are too cold. Also, the deeper Pliocene thermocline may cause disagreement along the California margin; either the upwelling in the model is too strong or the modeled thermocline is not deep enough. 2) In the North Atlantic, the model predicts cooling in the center of a data-based warming trend that steadily increases with latitude from +. 1.5 ??C to >+ 6 ??C. The discrepancy may arise because the modeled North Atlantic Current is too zonal compared to reality, which is reinforced by the lowering of the altitude of the Pliocene Western Cordillera Mountains. In addition, the model's use of modern bathymetry in the higher latitudes may have led the model to underestimate the northward penetration of warmer surface water into the Arctic. 3) Finally, though the data and model show good general agreement across most of the Southern Ocean, a few locations show offsets due to the modern land-sea mask used in the model. Additional considerations could account for many of the modest data-model anomalies, such as differences between calibration climatologies, the oversimplification of the seasonal cycle, and differences between SST proxies (i.e. seasonality and water depth). New SST estimates from

  20. Active layer warming and deepening at Thule, Greenland during past decade: a comparison of a Polar Desert and a Polar Semi-desert site

    NASA Astrophysics Data System (ADS)

    Sletten, R. S.; Hagedorn, B.; Hallet, B.; Burnham, J. L.

    2013-12-01

    Microclimate and soil temperature/moisture monitoring at a Polar Desert and a Polar Semi-Desert site at Thule, Greenland reveals recent warming trends and distinct differences between these two sites. Approximately 5 C of warming occurred at the Polar Desert site from 2004 to 2009, while the Polar Semi-desert site warmed only about 3.5 C. Since 2009, the temperatures remain higher but stable. This warming trend is also reflected in the active layer, both in warming of the soil and in deepening of the active layer. Trends in soil temperatures and active layer depth are controlled substantially by the snow cover. For the Polar Semi-desert site, soil temperatures are measured both under natural snow accumulation conditions and under enhanced snow accumulation where a snow fence was installed. The insulating effect of the snow cover is effective and results in significantly warmer winter soils, as has been shown in other artificial snow cover studies. The warmer winter soils may allow greater respiration during the transition seasons thereby releasing more of the accumulated soil carbon in these sites than that we have previously documented. The trends in temperature and moisture may in part be controlled by the higher wind velocities at the Polar Desert site. These conditions are likely to be dominant controls on the ecosystem, along with differences in lithology which affects the cryoturbation of the soils. This in-depth microclimate study, along with our studies of the soils and soil water chemistry provides a detailed comparison of the adjacent ecosystems and may allow us to better predict how slight changes in climatic conditions may influence these systems and their subsequent feedback on carbon cycling.

  1. 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

  2. Global Warming.

    ERIC Educational Resources Information Center

    Hileman, Bette

    1989-01-01

    States the foundations of the theory of global warming. Describes methodologies used to measure the changes in the atmosphere. Discusses steps currently being taken in the United States and the world to slow the warming trend. Recognizes many sources for the warming and the possible effects on the earth. (MVL)

  3. Comparison of two fluid warming devices for maintaining body core temperature during living donor liver transplantation: Level 1 H-1000 vs. Fluid Management System 2000

    PubMed Central

    Han, Sangbin; Choi, Junghee; Ko, Justin Sangwook; Gwak, Misook; Lee, Suk-Koo

    2014-01-01

    Background Rapid fluid warming has been a cardinal measure to maintain normothermia during fluid resuscitation of hypovolemic patients. A previous laboratory simulation study with different fluid infusion rates showed that a fluid warmer using magnetic induction is superior to a warmer using countercurrent heat exchange. We tested whether the simulation-based result is translated into the clinical liver transplantation. Methods Two hundred twenty recipients who underwent living donor liver transplantation between April 2009 and October 2011 were initially screened. Seventeen recipients given a magnetic induction warmer (FMS2000) were matched 1 : 1 with those given a countercurrent heat exchange warmer (Level-1 H-1000) based on propensity score. Matched variables included age, gender, body mass index, model for end-stage liver disease score, graft size and time under anesthesia. Core temperatures were taken at predetermined time points. Results Level-1 and FMS groups had comparable core temperature throughout the surgery from skin incision, the beginning/end of the anhepatic phase to skin closure. (P = 0.165, repeated measures ANOVA). The degree of core temperature changes within the dissection, anhepatic and postreperfusion phase were also comparable between the two groups. The minimum intraoperative core temperature was also comparable (Level 1, 35.6℃ vs. FMS, 35.4℃, P = 0.122). Conclusions A countercurrent heat exchange warmer and magnetic induction warmer displayed comparable function regarding the maintenance of core temperature and prevention of hypothermia during living donor liver transplantation. The applicability of the two devices in liver transplantation needs to be evaluated in various populations and clinical settings. PMID:25368785

  4. Comparison of net global warming potential and greenhouse gas intensity affected by management practices in two dryland cropping sites

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Little is known about the effect of management practices on net global warming potential (GWP) and greenhouse gas intensity (GHGI) that account for all sources and sinks of greenhouse gas (GHG) emissions in dryland cropping systems. The objective of this study was to compare the effect of a combinat...

  5. [Intraoperative Visual Evoked Potential Monitoring].

    PubMed

    Hayashi, Hironobu; Kawaguchi, Masahiko

    2015-05-01

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

  6. Intraoperative laparoscopic complications for urological cancer procedures

    PubMed Central

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

    2015-01-01

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

  7. Comparison of false-negative/positive results of intraoperative evoked potential monitoring between no and partial neuromuscular blockade in patients receiving propofol/remifentanil-based anesthesia during cerebral aneurysm clipping surgery: A retrospective analysis of 685 patients.

    PubMed

    Kim, Sung-Hoon; Jin, Seok-Joon; Karm, Myong-Hwan; Moon, Young-Jin; Jeong, Hye-Won; Kim, Jae-Won; Ha, Seung-Il; Kim, Joung-Uk

    2016-08-01

    Although the elicited responses of motor evoked potential (MEP) monitoring are very sensitive to suppression by anesthetic agents and muscle relaxants, the use of neuromuscular blockade (NMB) during MEP monitoring is still controversial because of serious safety concerns and diagnostic accuracy. Here, we evaluated the incidence of unacceptable movement and compared false-negative MEP results between no and partial NMB during cerebral aneurysm clipping surgery. We reviewed patient medical records for demographic data, anesthesia regimen, neurophysiology event logs, MEP results, and clinical outcomes. Patients were divided into 2 groups according to the intraoperative use of NMB: no NMB group (n = 276) and partial NMB group (n = 409). We compared the diagnostic accuracy of MEP results to predict postoperative outcomes between both groups. Additionally, we evaluated unwanted patient movement during MEP monitoring in both groups. Of the 685 patients, 622 (90.8%) manifested no intraoperative changes in MEP and no postoperative motor deficits. Twenty patients showed postoperative neurologic deficits despite preserved intraoperative MEP. False-positive MEP results were 3.6% in the no NMB group and 3.9% in the partial NMB group (P = 1.00). False-negative MEP results were 1.1% in the no NMB group and 4.2% in the partial NMB group (P = 0.02). No spontaneous movement or spontaneous respiration was observed in either group. Propofol/remifentanil-based anesthesia without NMB decreases the stimulation intensity of MEPs, which may reduce the false-negative ratio of MEP monitoring during cerebral aneurysm surgery. Our anesthetic protocol enabled reliable intraoperative MEP recording and patient immobilization during cerebral aneurysm clipping surgery. PMID:27559984

  8. Comparison of false-negative/positive results of intraoperative evoked potential monitoring between no and partial neuromuscular blockade in patients receiving propofol/remifentanil-based anesthesia during cerebral aneurysm clipping surgery: A retrospective analysis of 685 patients.

    PubMed

    Kim, Sung-Hoon; Jin, Seok-Joon; Karm, Myong-Hwan; Moon, Young-Jin; Jeong, Hye-Won; Kim, Jae-Won; Ha, Seung-Il; Kim, Joung-Uk

    2016-08-01

    Although the elicited responses of motor evoked potential (MEP) monitoring are very sensitive to suppression by anesthetic agents and muscle relaxants, the use of neuromuscular blockade (NMB) during MEP monitoring is still controversial because of serious safety concerns and diagnostic accuracy. Here, we evaluated the incidence of unacceptable movement and compared false-negative MEP results between no and partial NMB during cerebral aneurysm clipping surgery. We reviewed patient medical records for demographic data, anesthesia regimen, neurophysiology event logs, MEP results, and clinical outcomes. Patients were divided into 2 groups according to the intraoperative use of NMB: no NMB group (n = 276) and partial NMB group (n = 409). We compared the diagnostic accuracy of MEP results to predict postoperative outcomes between both groups. Additionally, we evaluated unwanted patient movement during MEP monitoring in both groups. Of the 685 patients, 622 (90.8%) manifested no intraoperative changes in MEP and no postoperative motor deficits. Twenty patients showed postoperative neurologic deficits despite preserved intraoperative MEP. False-positive MEP results were 3.6% in the no NMB group and 3.9% in the partial NMB group (P = 1.00). False-negative MEP results were 1.1% in the no NMB group and 4.2% in the partial NMB group (P = 0.02). No spontaneous movement or spontaneous respiration was observed in either group. Propofol/remifentanil-based anesthesia without NMB decreases the stimulation intensity of MEPs, which may reduce the false-negative ratio of MEP monitoring during cerebral aneurysm surgery. Our anesthetic protocol enabled reliable intraoperative MEP recording and patient immobilization during cerebral aneurysm clipping surgery.

  9. Comparison of the morphine-sparing effect of intraoperative dexmedetomidine with and without loading dose following general anesthesia in multiple-fracture patients: A prospective, randomized, controlled clinical trial.

    PubMed

    Zhao, Jin-Ning; Kong, Min; Qi, Bin; Ge, Dong-Jian

    2016-08-01

    Intraoperative dexmedetomidine (DEX) with or without loading dose both promote morphine-sparing effect in patient-controlled analgesia on postoperative acute pain. However, the contribution of the loading dose to this effect is largely unknown, especially in long-lasting surgeries. The present study was designed to investigate the role of a loading dose of DEX in this morphine-sparing effect in multiple-fracture patients following general anesthesia.Eighty-six patients scheduled multiple-fracture surgeries under general anesthesia were allocated into 3 groups which were maintained with propofol/remifentanil/Ringer solution (PRR), propofol/remifentanil/DEX with (PRDw), or without (PRDo) DEX loading dose before induction, respectively. Time to first morphine request and 24-hour morphine consumption was monitored. Pain intensity was evaluated with visual analog scale.During the first 24 hours following surgery, patients in the PRDw/o group showed increased time to first request of postoperative morphine and decreased total morphine consumption as compared with PRR patients. There was no significant difference with respect to these parameters between patients from the PRDw and PRDo groups. More patients from the PRDw groups experienced intraoperative bradycardia when compared to those from the PRR or PRDo group.This randomized controlled trial indicates that the morphine-sparing effect of intraoperative DEX was not affected by a loading dose in long-time surgeries. PMID:27537587

  10. Comparison through a LCA evaluation analysis of food waste disposal options from the perspective of global warming and resource recovery.

    PubMed

    Kim, Mi-Hyung; Kim, Jung-Wk

    2010-09-01

    This study evaluated feed manufacturing including dry feeding and wet feeding, composting, and landfilling for food waste disposal options from the perspective of global warming and resource recovery. The method of the expanded system boundaries was employed in order to compare different by-products. The whole stages of disposal involved in the systems such as separate discharge, collection, transportation, treatment, and final disposal, were included in the system boundary and evaluated. The Global Warming Potential generated from 1tonne of food wastes for each disposal system was analyzed by the life cycle assessment method. The results showed that 200kg of CO(2)-eq could be produced from dry feeding process, 61kg of CO(2)-eq from wet feeding process, 123kg of CO(2)-eq from composting process, and 1010kg of CO(2)-eq from landfilling. Feed manufacturing and composting, the common treatment methods currently employed, have been known to be environment friendlier than other methods. However, this study shows that they can negatively affect the environment if their by-products are not appropriately utilized as intended.

  11. Innovative therapies: intraoperative intracavitary chemotherapy.

    PubMed

    Chang, Michael Y; Sugarbaker, David J

    2004-11-01

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

  12. Comparison of different cooling regimes within a shortened liquid cooling/warming garment on physiological and psychological comfort during exercise

    NASA Technical Reports Server (NTRS)

    Leon, Gloria R.; Koscheyev, Victor S.; Coca, Aitor; List, Nathan

    2004-01-01

    The aim of this study was to compare the effectiveness of different cooling regime intensities to maintain physiological and subjective comfort during physical exertion levels comparable to that engaged in during extravehicular activities (EVA) in space. We studied eight subjects (six males, two females) donned in our newly developed physiologically based shortened liquid cooling/warming garment (SLCWG). Rigorous (condition 1) and mild (condition 2) water temperature cooling regimes were compared at physical exertion levels comparable to that performed during EVA to ascertain the effectiveness of a lesser intensity of cooling in maintaining thermal comfort, thus reducing energy consumption in the portable life support system. Exercise intensity was varied across stages of the session. Finger temperature, rectal temperature, and subjective perception of overall body and hand comfort were assessed. Finger temperature was significantly higher in the rigorous cooling condition and showed a consistent increase across exercise stages, likely due to the restriction of heat extraction because of the intensive cold. In the mild cooling condition, finger temperature exhibited an overall decline with cooling, indicating greater heat extraction from the body. Rectal temperature was not significantly different between conditions, and showed a steady increase over exercise stages in both rigorous and mild cooling conditions. Ratings of overall comfort were 30% higher (more positive) and more stable in mild cooling (p<0.001). The mild cooling regime was more effective than rigorous cooling in allowing the process of heat exchange to occur, thus maintaining thermal homeostasis and subjective comfort during physical exertion.

  13. Influence of Grape Composition on Red Wine Ester Profile: Comparison between Cabernet Sauvignon and Shiraz Cultivars from Australian Warm Climate.

    PubMed

    Antalick, Guillaume; Šuklje, Katja; Blackman, John W; Meeks, Campbell; Deloire, Alain; Schmidtke, Leigh M

    2015-05-13

    The relationship between grape composition and subsequent red wine ester profile was examined. Cabernet Sauvignon and Shiraz, from the same Australian very warm climate vineyard, were harvested at two different stages of maturity and triplicate wines were vinified. Grape analyses focused on nitrogen and lipid composition by measuring 18 amino acids by HPLC-FLD, 3 polyunsaturated fatty acids, and 6 C6-compounds derived from lipid degradation by GC-MS. Twenty esters and four higher alcohols were analyzed in wines by HS-SPME-GC-MS. Concentrations of the ethyl esters of branched acids were significantly affected by grape maturity, but the variations were inconsistent between cultivars. Small relative variations were observed between wines for ethyl esters of fatty acids, whereas higher alcohol acetates displayed the most obvious differences with concentrations ranging from 1.5- to 26-fold higher in Shiraz than in Cabernet Sauvignon wines regardless of the grape maturity. Grape analyses revealed the variations of wine ester composition might be related to specific grape juice nitrogen composition and lipid metabolism. To the authors' knowledge the present study is the first to investigate varietal differences in the ester profiles of Shiraz and Cabernet Sauvignon wines made with grapes harvested at different maturity stages.

  14. 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.

  15. 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

  16. Comparison greenhouse gas (GHG) emissions and global warming potential (GWP) effect of energy use in different wheat agroecosystems in Iran.

    PubMed

    Yousefi, Mohammad; Mahdavi Damghani, Abdolmajid; Khoramivafa, Mahmud

    2016-04-01

    The aims of this study were to determine energy requirement and global warming potential (GWP) in low and high input wheat production systems in western of Iran. For this purpose, data were collected from 120 wheat farms applying questionnaires via face-to-face interviews. Results showed that total energy input and output were 60,000 and 180,000 MJ ha(-1) in high input systems and 14,000 and 56,000 MJ ha(-1) in low input wheat production systems, respectively. The highest share of total input energy in high input systems recorded for electricity power, N fertilizer, and diesel fuel with 36, 18, and 13 %, respectively, while the highest share of input energy in low input systems observed for N fertilizer, diesel fuel, and seed with 32, 31, and 27 %. Energy use efficiency in high input systems (3.03) was lower than of low input systems (3.94). Total CO2, N2O, and CH4 emissions in high input systems were 1981.25, 31.18, and 1.87 kg ha(-1), respectively. These amounts were 699.88, 0.02, and 0.96 kg ha(-1) in low input systems. In high input wheat production systems, total GWP was 11686.63 kg CO2eq ha(-1) wheat. This amount was 725.89 kg CO2eq ha(-1) in low input systems. The results show that 1 ha of high input system will produce greenhouse effect 17 times of low input systems. So, high input production systems need to have an efficient and sustainable management for reducing environmental crises such as change climate.

  17. Comparison greenhouse gas (GHG) emissions and global warming potential (GWP) effect of energy use in different wheat agroecosystems in Iran.

    PubMed

    Yousefi, Mohammad; Mahdavi Damghani, Abdolmajid; Khoramivafa, Mahmud

    2016-04-01

    The aims of this study were to determine energy requirement and global warming potential (GWP) in low and high input wheat production systems in western of Iran. For this purpose, data were collected from 120 wheat farms applying questionnaires via face-to-face interviews. Results showed that total energy input and output were 60,000 and 180,000 MJ ha(-1) in high input systems and 14,000 and 56,000 MJ ha(-1) in low input wheat production systems, respectively. The highest share of total input energy in high input systems recorded for electricity power, N fertilizer, and diesel fuel with 36, 18, and 13 %, respectively, while the highest share of input energy in low input systems observed for N fertilizer, diesel fuel, and seed with 32, 31, and 27 %. Energy use efficiency in high input systems (3.03) was lower than of low input systems (3.94). Total CO2, N2O, and CH4 emissions in high input systems were 1981.25, 31.18, and 1.87 kg ha(-1), respectively. These amounts were 699.88, 0.02, and 0.96 kg ha(-1) in low input systems. In high input wheat production systems, total GWP was 11686.63 kg CO2eq ha(-1) wheat. This amount was 725.89 kg CO2eq ha(-1) in low input systems. The results show that 1 ha of high input system will produce greenhouse effect 17 times of low input systems. So, high input production systems need to have an efficient and sustainable management for reducing environmental crises such as change climate. PMID:26690584

  18. Intraoperative radiotherapy: the Japanese experience. [Betatron

    SciTech Connect

    Abe, M.; Takahashi, M.

    1981-07-01

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

  19. Intraoperative Ultrasound in the Treatment of Breast Cancer.

    PubMed

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

    2013-10-01

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

  20. Analgesics and ENT surgery. A clinical comparison of the intraoperative, recovery and postoperative effects of buprenorphine, diclofenac, fentanyl, morphine, nalbuphine, pethidine and placebo given intravenously with induction of anaesthesia.

    PubMed Central

    van den Berg, A A; Honjol, N M; Prabhu, N V; Datta, S; Rozario, C J; Muraleedaran, R; Savva, D

    1994-01-01

    1. Vomiting and restlessness following ENT and eye surgery are undesirable, and may be related to the emetic and analgesic effects of any analgesic given to augment anaesthesia during surgery. 2. To rationalise the choice of analgesic for routine ENT surgery we examined the intraoperative, recovery and postoperative effects following the administration of either buprenorphine (3.0 to 4.5 micrograms kg-1), diclofenac (1 mg kg-1), fentanyl (1.5 to 2.0 micrograms kg-1), morphine (0.1 to 0.15 mg kg-1), nalbuphine (0.1 to 0.15 mg kg-1), pethidine (1.0 to 1.5 mg kg-1) or saline (as control) given with the induction of anaesthesia in 374 patients. A standardised anaesthetic technique with controlled ventilation using 0.6-0.8% isoflurane in nitrous oxide and oxygen was employed. The study population constituted 7 similar groups of patients. 3. Intraoperatively, their effects on heart rate and blood pressure, airway pressure and intraocular pressure, were similar. This implies, most surprisingly, that neither their analgesic nor their histamine releasing effects were clinically evident during surgery. By prolonging the time to extubation at the end of anaesthesia, only buprenorphine, fentanyl, morphine and pethidine provided evidence of intraoperative respiratory depression. 4. Postoperatively, buprenorphine was associated with severe respiratory depression, prolonged somnolence, profound analgesia and the highest emesis rate. Diclofenac exhibited no sedative, analgesic, analgesic sparing, emetic or antipyretic effects. Fentanyl provided no sedative or analgesic effects, but was mildly emetic. Morphine provided poor sedation and analgesia, delayed the requirement for re-medication and was highly emetic. Nalbuphine and pethidine produced sedation with analgesia during recovery, a prolonged time to re-medication and a mild emetic effect. None provided evidence, from analysis of postoperative re-medication times and analgesic consumption, of any pre-emptive analgesic effect. 5

  1. Global Warming?

    ERIC Educational Resources Information Center

    Eichman, Julia Christensen; Brown, Jeff A.

    1994-01-01

    Presents information and data on an experiment designed to test whether different atmosphere compositions are affected by light and temperature during both cooling and heating. Although flawed, the experiment should help students appreciate the difficulties that researchers face when trying to find evidence of global warming. (PR)

  2. 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

  3. Efficacy of intraoperative neurophysiological monitoring.

    PubMed

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

    1995-01-01

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

  4. 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.

  5. Refractory intraoperative hypotension with elevated serum tryptase

    PubMed Central

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

    2015-01-01

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

  6. 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.

  7. [Intraoperative monitoring of visual evoked potentials].

    PubMed

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

    2006-03-01

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

  8. Comparison of the dynamical response of low latitude middle atmosphere to the major stratospheric warming events in the Northern and Southern Hemispheres

    NASA Astrophysics Data System (ADS)

    Bhagavathiammal, G. J.; Sathishkumar, S.; Sridharan, S.; Gurubaran, S.

    2016-08-01

    This study presents comparison of low-latitude dynamical responses to boreal 2008/09 and austral 2002 winter Major Stratospheric Warming (MSW) events, as both events are of vortex split type. During these winters, planetary wave (PW) variability and changes in low-latitude circulation are examined using European Center for Medium Range Weather Forecasting (ECMWF) reanalysis (ERA)-interim data sets and mesospheric wind data acquired by the MF radars at Tirunelveli (8.7°N) and Rarotonga (22°S). Eliassen-Palm diagnostic is used to provide an evidence for the lateral PW energy propagation from high to low-latitudes during both the MSW events. The PW flux reaches much lower latitudes during the boreal event than during the austral event. The low-latitude westward winds at stratospheric heights are stronger (weaker) during the boreal (austral) MSW. Weak (strong) PW wave activity at low latitude mesospheric heights during boreal (austral) MSW indicates the influence of low-latitude stratospheric westward winds on the vertical propagation of PW to low-latitude mesosphere.

  9. Global warming

    NASA Astrophysics Data System (ADS)

    Houghton, John

    2005-06-01

    'Global warming' is a phrase that refers to the effect on the climate of human activities, in particular the burning of fossil fuels (coal, oil and gas) and large-scale deforestation, which cause emissions to the atmosphere of large amounts of 'greenhouse gases', of which the most important is carbon dioxide. Such gases absorb infrared radiation emitted by the Earth's surface and act as blankets over the surface keeping it warmer than it would otherwise be. Associated with this warming are changes of climate. The basic science of the 'greenhouse effect' that leads to the warming is well understood. More detailed understanding relies on numerical models of the climate that integrate the basic dynamical and physical equations describing the complete climate system. Many of the likely characteristics of the resulting changes in climate (such as more frequent heat waves, increases in rainfall, increase in frequency and intensity of many extreme climate events) can be identified. Substantial uncertainties remain in knowledge of some of the feedbacks within the climate system (that affect the overall magnitude of change) and in much of the detail of likely regional change. Because of its negative impacts on human communities (including for instance substantial sea-level rise) and on ecosystems, global warming is the most important environmental problem the world faces. Adaptation to the inevitable impacts and mitigation to reduce their magnitude are both necessary. International action is being taken by the world's scientific and political communities. Because of the need for urgent action, the greatest challenge is to move rapidly to much increased energy efficiency and to non-fossil-fuel energy sources.

  10. [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.

  11. Intraoperative assessment of margins in breast conserving therapy: a systematic review.

    PubMed

    Butler-Henderson, Kerryn; Lee, Andy H; Price, Roger I; Waring, Kaylene

    2014-04-01

    Approximately one quarter of patients undergoing breast conserving therapy for breast cancer will require a second operation to achieve adequate clearance of the margins. A number of techniques to assess margins intraoperatively have been reported. This systematic review examines current intraoperative methods for assessing margin status. The final pathology status, statistical measures including accuracy of tumour margin assessment, average time impact on the procedure and second operation rate, were used as criteria for comparison between studies. Although pathological methods, such as frozen section and imprint cytology performed well, they added on average 20-30 min to operation times. An ultrasound probe allows accurate examination of the margins and delivers results in a timely manner, yet it has a limited role with DCIS where calcification is present and in multifocal cancer. Further research is required in other intraoperative margin assessment techniques, such as mammography, radiofrequency spectroscopy and optical coherence tomography.

  12. Incidence of Inadvertent Intraoperative Hypothermia and Its Risk Factors in Patients Undergoing General Anesthesia in Beijing: A Prospective Regional Survey

    PubMed Central

    Deng, Xiaoming; Fan, Ting; Fu, Runqiao; Geng, Wanming; Guo, Ruihong; He, Nong; Li, Chenghui; Li, Lei; Li, Min; Li, Tianzuo; Tian, Ming; Wang, Geng; Wang, Lei; Wang, Tianlong; Wu, Anshi; Wu, Di; Xue, Xiaodong; Xu, Mingjun; Yang, Xiaoming; Yang, Zhanmin; Yuan, Jianhu; Zhao, Qiuhua; Zhou, Guoqing; Zuo, Mingzhang; Pan, Shuang; Zhan, Lujing; Yao, Min; Huang, Yuguang

    2015-01-01

    Background/Objective Inadvertent intraoperative hypothermia (core temperature <360 C) is a recognized risk in surgery and has adverse consequences. However, no data about this complication in China are available. Our study aimed to determine the incidence of inadvertent intraoperative hypothermia and its associated risk factors in a sample of Chinese patients. Methods We conducted a regional cross-sectional survey in Beijing from August through December, 2013. Eight hundred thirty patients who underwent various operations under general anesthesia were randomly selected from 24 hospitals through a multistage probability sampling. Multivariate logistic regression analyses were applied to explore the risk factors of developing hypothermia. Results The overall incidence of intraoperative hypothermia was high, 39.9%. All patients were warmed passively with surgical sheets or cotton blankets, whereas only 10.7% of patients received active warming with space heaters or electric blankets. Pre-warmed intravenous fluid were administered to 16.9% of patients, and 34.6% of patients had irrigation of wounds with pre-warmed fluid. Active warming (OR = 0.46, 95% CI 0.26–0.81), overweight or obesity (OR = 0.39, 95% CI 0.28–0.56), high baseline core temperature before anesthesia (OR = 0.08, 95% CI 0.04–0.13), and high ambient temperature (OR = 0.89, 95% CI 0.79–0.98) were significant protective factors for hypothermia. In contrast, major-plus operations (OR = 2.00, 95% CI 1.32–3.04), duration of anesthesia (1–2 h) (OR = 3.23, 95% CI 2.19–4.78) and >2 h (OR = 3.44, 95% CI 1.90–6.22,), and intravenous un-warmed fluid (OR = 2.45, 95% CI 1.45–4.12) significantly increased the risk of hypothermia. Conclusions The incidence of inadvertent intraoperative hypothermia in Beijing is high, and the rate of active warming of patients during operation is low. Concern for the development of intraoperative hypothermia should be especially high in patients undergoing major

  13. 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.

  14. 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.

  15. [Intraoperative injuries of the biliary tract].

    PubMed

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

    2008-01-01

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

  16. Rapid Intraoperative Molecular Characterization of Glioma

    PubMed Central

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

    2016-01-01

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

  17. Intraoperative monitoring of Jones tube function.

    PubMed

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

    1989-01-01

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

  18. Intraoperative aortic dissection in pediatric heart surgery.

    PubMed

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

    2006-06-01

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

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

    PubMed

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

    2016-01-01

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

  20. A comparison of least squares linear regression and measurement error modeling of warm/cold multipole correlation in SSC prototype dipole magnets

    SciTech Connect

    Pollock, D.; Kim, K.; Gunst, R.; Schucany, W.

    1993-05-01

    Linear estimation of cold magnetic field quality based on warm multipole measurements is being considered as a quality control method for SSC production magnet acceptance. To investigate prediction uncertainties associated with such an approach, axial-scan (Z-scan) magnetic measurements from SSC Prototype Collider Dipole Magnets (CDM`s) have been studied. This paper presents a preliminary evaluation of the explanatory ability of warm measurement multipole variation on the prediction of cold magnet multipoles. Two linear estimation methods are presented: least-squares regression, which uses the assumption of fixed independent variable (xi) observations, and the measurement error model, which includes measurement error in the xi`s. The influence of warm multipole measurement errors on predicted cold magnet multipole averages is considered. MSD QA is studying warm/cold correlation to answer several magnet quality control questions. How well do warm measurements predict cold (2kA) multipoles? Does sampling error significantly influence estimates of the linear coefficients (slope, intercept and residual standard error)? Is estimation error for the predicted cold magnet average small compared to typical variation along the Z-Axis? What fraction of the multipole RMS tolerance is accounted for by individual magnet prediction uncertainty?

  1. Global Warming: Physics and Facts

    SciTech Connect

    Levi, B.G.; Hafemeister, D.; Scribner, R.

    1992-05-01

    This report contains papers on: A tutorial on global atmospheric energetics and the greenhouse effect; global climate models: what and how; comparison of general circulation models; climate and the earth`s radiation budget; temperature and sea level change; short-term climate variability and predictions; the great ocean conveyor; trace gases in the atmosphere: temporal and spatial trends; the geochemical carbon cycle and the uptake of fossil fuel CO{sub 2}; forestry and global warming; the physical and policy linkages; policy implications of greenhouse warming; options for lowering US carbon dioxide emissions; options for reducing carbon dioxide emissions; and science and diplomacy: a new partnership to protect the environment.

  2. Global Warming: Physics and Facts

    SciTech Connect

    Levi, B.G. ); Hafemeister, D. , Washington, DC ); Scribner, R. )

    1992-01-01

    This report contains papers on: A tutorial on global atmospheric energetics and the greenhouse effect; global climate models: what and how; comparison of general circulation models; climate and the earth's radiation budget; temperature and sea level change; short-term climate variability and predictions; the great ocean conveyor; trace gases in the atmosphere: temporal and spatial trends; the geochemical carbon cycle and the uptake of fossil fuel CO{sub 2}; forestry and global warming; the physical and policy linkages; policy implications of greenhouse warming; options for lowering US carbon dioxide emissions; options for reducing carbon dioxide emissions; and science and diplomacy: a new partnership to protect the environment.

  3. Intraoperative tracking of aortic valve plane

    PubMed Central

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

    2013-01-01

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

  4. The Art of Intraoperative Glioma Identification

    PubMed Central

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

    2015-01-01

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

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

    PubMed

    Kiss, L

    2001-01-01

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

  6. Intraoperative ultrasound-assisted peripheral nerve surgery.

    PubMed

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

    2015-09-01

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

  7. Intraoperative identification of adrenal-renal fusion

    PubMed Central

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

    2015-01-01

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

  8. Virtual Intraoperative Cholangiogram Using WebCL

    PubMed Central

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

    2016-01-01

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

  9. Virtual Intraoperative Cholangiogram Using WebCL.

    PubMed

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

    2016-01-01

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

  10. Trabeculectomy with intraoperative retrobulbar triamcinolone acetonide.

    PubMed

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

    2009-01-01

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

  11. Intraoperative coronary artery dissection in fibromuscular dysplasia.

    PubMed

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

    2015-04-01

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

  12. Intraoperative lung ultrasound: A clinicodynamic perspective

    PubMed Central

    Mittal, Amit Kumar; Gupta, Namrata

    2016-01-01

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

  13. Intraoperative lung ultrasound: A clinicodynamic perspective

    PubMed Central

    Mittal, Amit Kumar; Gupta, Namrata

    2016-01-01

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

  14. Intraoperative lung ultrasound: A clinicodynamic perspective.

    PubMed

    Mittal, Amit Kumar; Gupta, Namrata

    2016-01-01

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

  15. Comparison of Shoulder Range of Motion, Strength, and Playing Time in Uninjured High School Baseball Pitchers Who Reside in Warm- and Cold-Weather Climates

    PubMed Central

    Kaplan, Kevin M.; ElAttrache, Neal S.; Jobe, Frank W.; Morrey, Bernard F.; Kaufman, Kenton R.; Hurd, Wendy J.

    2014-01-01

    Background There is an assumption that baseball athletes who reside in warm-weather climates experience larger magnitude adaptations in throwing shoulder motion and strength compared with their peers who reside in cold-weather climates. Hypotheses (1) The warm-weather climate (WWC) group would exhibit more pronounced shoulder motion and strength adaptations than the cold-weather climate (CWC) group, and (2) the WWC group would participate in pitching activities for a greater proportion of the year than the CWC group, with the time spent pitching predicting throwing shoulder motion and strength in both groups. Study Design Cross-sectional study; Level of evidence, 3. Methods One hundred uninjured high school pitchers (50 each WWC, CWC) were recruited. Rotational shoulder motion and isometric strength were measured and participants reported the number of months per year they pitched. To identify differences between groups, t tests were performed; linear regression was used to determine the influence of pitching volume on shoulder motion and strength. Results The WWC group pitched more months per year than athletes from the CWC group, with the number of months spent pitching negatively related to internal rotation motion and external rotation strength. The WWC group exhibited greater shoulder range of motion in all planes compared with the CWC group, as well as significantly lower external rotation strength and external/internal rotation strength ratios. There was no difference in internal rotation strength between groups, nor a difference in the magnitude of side-to-side differences for strength or motion measures. Conclusion Athletes who reside in cold- and warm-weather climates exhibit differences in throwing shoulder motion and strength, related in part to the number of months spent participating in pitching activities. The amount of time spent participating in pitching activities and the magnitude of range of motion and strength adaptations in athletes who reside

  16. 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.

  17. 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.

  18. Muscle relaxant use during intraoperative neurophysiologic monitoring.

    PubMed

    Sloan, Tod B

    2013-02-01

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

  19. Self-inflicted nail-gun injury with cranial penetration and use of intraoperative computed tomography

    PubMed Central

    Carnevale, Joseph A.; Morrison, John F.; Choi, David B.; Klinge, Petra M.; Cosgrove, G. Rees; Oyelese, Adetokunbo A.

    2016-01-01

    Background: Management of penetrating cranial trauma remains a high acuity and imaging intense neurosurgical disorder. Imaging of vital structures, including angiography, is typically conducted to understand the proximity of vital structures in comparison to a foreign body and prepare for intraoperative complications such as hemorrhage. Preservation of function following initial injury in cases where minimal neurological deficit exists is essential. Case Description: Here, we present a case using intraoperative computed tomography to assist in early detection and resolution of hemorrhage in the surgical management of an intact patient with self-inflicted penetrating cranial trauma. Conclusions: This method may aid in early detection of hemorrhage and prevention of consequential neurological deterioration or emergent need for secondary surgery. PMID:27213112

  20. Warm Up with Skill.

    ERIC Educational Resources Information Center

    Hoyle, R. J.; Smith, Robert F.

    1989-01-01

    Too little time is often spent on warm-up activities in the school or recreation class. Warm-ups are often perfunctory and unimaginative. Several suggestions are made for warm-up activities that incorporate both previously learned and new skills, while preparing the body for more vigorous activity. (IAH)

  1. Comparison between whole-body vibration, light-emitting diode, and cycling warm-up on high-intensity physical performance during sprint bicycle exercise.

    PubMed

    Teles, Maria C; Fonseca, Ivana A T; Martins, Jeanne B; de Carvalho, Marielle M; Xavier, Murilo; Costa, Sidney J; de Avelar, Núbia C P; Ribeiro, Vanessa G C; Salvador, Fabiano S; Augusto, Leonardo; Mendonça, Vanessa A; Lacerda, Ana C R

    2015-06-01

    The purpose of this study was to compare the effects of light-emitting diode (LED) irradiation and whole-body vibration (WBV) delivered either in isolation or combination (LED + WBV), warm-up (WU), and a control (C) treatment on performance during a sprint bicycle exercise. Ten cyclists performed a 30-second sprint cycle test under these conditions. The LED light was applied at 4 points bilaterally. Whole-body vibration consisted of 5 minutes of squats associated with WBV. LED + WBV consisted of WBV followed by LED therapy. Warm-up consisted of 17 minutes of moderate-intensity bicycle exercise. Control consisted of 10 minutes at rest. Blood lactate (BL) and ammonia (BA) levels and skin temperature (ST) were determined. Peak power (842 ± 117 vs. 800 ± 106 vs. 809 ± 128 W [p = 0.02 and p = 0.01]), relative power (12.1 ± 1.0 vs. 11.5 ± 0.9 vs. 11.6 ± 1.0 W·kg [p = 0.02 and p = 0.02]), and relative work (277 ± 23 vs. 263 ± 24 vs. 260 ± 23 J·kg [p = 0.02 and p = 0.003]) were higher in the WU group compared with the control and LED groups. In the LED + WBV group, peak (833 ± 115 vs. 800 ± 106 W [p = 0.02]) and relative (11.9 ± 0.9 vs. 11.5 ± 0.9 W·kg [p = 0.02]) power were higher than those in the control group, and relative work (272 ± 22 vs. 260 ± 23 J·kg [p = 0.02]) were improved compared with the LED group. There were no differences for BL, BA, and ST. The findings of this study confirmed the effectiveness of a warm-up as a preparatory activity and demonstrated that LED + WBV and WBV were as effective as WU in improving cyclist performance during a sprint bicycle exercise. PMID:25764492

  2. Comparison between whole-body vibration, light-emitting diode, and cycling warm-up on high-intensity physical performance during sprint bicycle exercise.

    PubMed

    Teles, Maria C; Fonseca, Ivana A T; Martins, Jeanne B; de Carvalho, Marielle M; Xavier, Murilo; Costa, Sidney J; de Avelar, Núbia C P; Ribeiro, Vanessa G C; Salvador, Fabiano S; Augusto, Leonardo; Mendonça, Vanessa A; Lacerda, Ana C R

    2015-06-01

    The purpose of this study was to compare the effects of light-emitting diode (LED) irradiation and whole-body vibration (WBV) delivered either in isolation or combination (LED + WBV), warm-up (WU), and a control (C) treatment on performance during a sprint bicycle exercise. Ten cyclists performed a 30-second sprint cycle test under these conditions. The LED light was applied at 4 points bilaterally. Whole-body vibration consisted of 5 minutes of squats associated with WBV. LED + WBV consisted of WBV followed by LED therapy. Warm-up consisted of 17 minutes of moderate-intensity bicycle exercise. Control consisted of 10 minutes at rest. Blood lactate (BL) and ammonia (BA) levels and skin temperature (ST) were determined. Peak power (842 ± 117 vs. 800 ± 106 vs. 809 ± 128 W [p = 0.02 and p = 0.01]), relative power (12.1 ± 1.0 vs. 11.5 ± 0.9 vs. 11.6 ± 1.0 W·kg [p = 0.02 and p = 0.02]), and relative work (277 ± 23 vs. 263 ± 24 vs. 260 ± 23 J·kg [p = 0.02 and p = 0.003]) were higher in the WU group compared with the control and LED groups. In the LED + WBV group, peak (833 ± 115 vs. 800 ± 106 W [p = 0.02]) and relative (11.9 ± 0.9 vs. 11.5 ± 0.9 W·kg [p = 0.02]) power were higher than those in the control group, and relative work (272 ± 22 vs. 260 ± 23 J·kg [p = 0.02]) were improved compared with the LED group. There were no differences for BL, BA, and ST. The findings of this study confirmed the effectiveness of a warm-up as a preparatory activity and demonstrated that LED + WBV and WBV were as effective as WU in improving cyclist performance during a sprint bicycle exercise.

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

    PubMed

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

    1984-10-01

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

  4. 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

  5. Intraoperative arterial oxygenation in obese patients.

    PubMed Central

    Vaughan, R W; Wise, L

    1976-01-01

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

  6. [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.

  7. 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.

  8. Intraoperative neuromonitoring in major vascular surgery.

    PubMed

    So, V C; Poon, C C M

    2016-09-01

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

  9. 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.

  10. Intraoperative, real-time, functional MRI.

    PubMed

    Gering, D T; Weber, D M

    1998-01-01

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

  11. Electroencephalographic responses to intraoperative subthalamic stimulation.

    PubMed

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

    2006-10-01

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

  12. [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.

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

    PubMed

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

    2012-01-18

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

  14. Intraoperative patient information handover between anesthesia providers

    PubMed Central

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

    2014-01-01

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

  15. 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.

  16. WWTP design in warm climates - guideline comparison and parameter adaptation for a full-scale activated sludge plant using mass balancing.

    PubMed

    Walder, C; Lindtner, S; Proesl, A; Klegraf, F; Weissenbacher, N

    2013-01-01

    The ATV-A-131 guideline and the design approach published in 'Wastewater Engineering, Treatment and Reuse (WE)' are widely used for the design of activated sludge plants. They are both based on simplified steady-state assumptions tailored to the boundary conditions of temperate climates. Using design guidelines beyond the designated temperature range may lead to inappropriate results. The objectives of this paper are (1) to summarise temperature relevant differences between ATV-A-131 and WE; (2) to show the related design components; and (3) to demonstrate a procedure for design parameter adaptation for a full-scale activated sludge plant located in a warm climate region. To gain steady-state data required for wastewater treatment plant (WWTP) design according to ATV-A-131 and WE, full-scale plant data were acquired for a period of 6 months as a basis for analyses and adaptation. Mass balances were calculated for the verification of the measurements and for analysing excess sludge production. The two approaches showed relevant temperature related differences. WE default application resulted in lower deviation in the mass balance results for excess sludge production. However, with the adaptation of the heterotrophic decay rates for both approaches and the inert organic and mineral solids fraction additionally for ATV-A-131, a good fit to the observed excess sludge production could be achieved.

  17. High-global warming potential F-gas emissions in California: comparison of ambient-based versus inventory-based emission estimates, and implications of refined estimates.

    PubMed

    Gallagher, Glenn; Zhan, Tao; Hsu, Ying-Kuang; Gupta, Pamela; Pederson, James; Croes, Bart; Blake, Donald R; Barletta, Barbara; Meinardi, Simone; Ashford, Paul; Vetter, Arnie; Saba, Sabine; Slim, Rayan; Palandre, Lionel; Clodic, Denis; Mathis, Pamela; Wagner, Mark; Forgie, Julia; Dwyer, Harry; Wolf, Katy

    2014-01-21

    To provide information for greenhouse gas reduction policies, the California Air Resources Board (CARB) inventories annual emissions of high-global-warming potential (GWP) fluorinated gases, the fastest growing sector of greenhouse gas (GHG) emissions globally. Baseline 2008 F-gas emissions estimates for selected chlorofluorocarbons (CFC-12), hydrochlorofluorocarbons (HCFC-22), and hydrofluorocarbons (HFC-134a) made with an inventory-based methodology were compared to emissions estimates made by ambient-based measurements. Significant discrepancies were found, with the inventory-based emissions methodology resulting in a systematic 42% under-estimation of CFC-12 emissions from older refrigeration equipment and older vehicles, and a systematic 114% overestimation of emissions for HFC-134a, a refrigerant substitute for phased-out CFCs. Initial, inventory-based estimates for all F-gas emissions had assumed that equipment is no longer in service once it reaches its average lifetime of use. Revised emission estimates using improved models for equipment age at end-of-life, inventories, and leak rates specific to California resulted in F-gas emissions estimates in closer agreement to ambient-based measurements. The discrepancies between inventory-based estimates and ambient-based measurements were reduced from -42% to -6% for CFC-12, and from +114% to +9% for HFC-134a. PMID:24328112

  18. Intraoperative urinary cyclic AMP monitoring in primary hyperparathyroidism.

    PubMed Central

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

    1993-01-01

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

  19. Comparison of scarab grub populations and associated pathogens and parasitoids in warm- or cool-season grasses used on transitional zone golf courses.

    PubMed

    Redmond, Carl T; Williams, David W; Potter, Daniel A

    2012-08-01

    Seven different turfgrass species or mixes used on golf courses in the United States' transitional climatic zone were maintained as randomized and replicated plots in separate stands mowed at fairway (1.6 cm) or rough (6.4 cm) cutting heights and sampled in autumn to assess the density and species composition of scarab grubs; incidence of disease and parasitism thereof; and extent of turf damage from foraging insectivorous skunks, Mephitis mephitis. Influence of grass species on parasitism by spring or autumn-active tiphiid wasps was further assessed on implanted grubs in open enclosures. Masked chafers (Cyclocephala spp.) were three-fold more abundant than Japanese beetle, Popillia japonica Newman, grubs in plots of Zoysia and Cynodon sp. mowed at fairway height, and P. japonica were five-fold more abundant than masked chafer grubs in cool-season turf plots mowed at rough height. Phyllophaga spp. accounted for <1% of grubs in the samples. Milky disease bacteria (Paenibacillus sp.) were the predominant pathogens of Cyclocephala spp., followed by Serratia sp. bacteria and gregarines (Stictospora cf. villani). Cyclocephala grub densities, milky disease incidence (25%), and parasitism by the native tiphiid Tiphia pygidialis Alien (10-12%) were especially high in zoysiagrass. Japanese beetle grubs were infected by Paenibacillus, Serratia, Stictospora, and microsporidia (Ovavesicula sp.), but incidence of individual pathogens was relatively low (<6%) and similar among grasses within each stand. Few nematode-infected grubs were found. Skunk damage was mainly in the cool-season fairway-height grasses, probably reflecting difficulty in foraging in the much tougher stolons and rhizomes of the warm season turfgrasses. The degree of natural suppression of scarab grubs provided by endemic pathogens or parasitoids is unlikely to be compromised by the grass species used on a particular site. PMID:22928312

  20. Discontinuation of Living Donor Liver Transplantation due to Donor's Intraoperative Latex-Induced Anaphylactic Shock

    PubMed Central

    Shinoda, Masahiro; Tanabe, Minoru; Nagao, Keisuke; Kitago, Minoru; Fujisaki, Hiroto; Odaira, Masanori; Kawachi, Shigeyuki; Itano, Osamu; Obara, Hideaki; Matsubara, Kentaro; Shimojima, Naoki; Fuchimoto, Yasushi; Hoshino, Ken; Amagai, Masayuki; Kuroda, Tatsuo; Kitagawa, Yuko

    2012-01-01

    We report on a 33-year-old female liver donor candidate who developed intraoperative latex-induced anaphylactic shock during surgery for living donor transplantation. She was the mother of the organ recipient, who was a 9-year-old boy with biliary atresia. We planned extended lateral segmentectomy for her. Although we dissected the ligament around the left lobe, the systolic blood pressure suddenly dropped and her body became flushed and warm. We administered transfusion and an ephedrine injection to recover the blood pressure. Because she recovered after the treatment, we restarted the procedure. However, she went into shock again within a few minutes. We decided to discontinue the operation. Postoperative blood tests revealed an increase in IgE-RAST and basophil activation, suggesting that the anaphylactic shock was induced by latex. Because latex allergy has become a public health problem, this allergy should be kept in mind as a potential donor operation risk. PMID:23294079

  1. [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.

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

    PubMed

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

    2015-02-01

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

  3. 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.

  4. 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.

  5. Intraoperative Electroretinograms before and after Core Vitrectomy

    PubMed Central

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

    2016-01-01

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

  6. Intraoperative determination and display of cortical function

    NASA Astrophysics Data System (ADS)

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

    1997-05-01

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

  7. A dosimetry intercomparison phantom for intraoperative radiotherapy.

    PubMed

    Armoogum, Kris; Watson, Colin

    2008-01-01

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

  8. 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

  9. Thin-Profile Transducers for Intraoperative Hemostasis

    NASA Astrophysics Data System (ADS)

    Zderic, Vesna; Mera, Thomas; Vaezy, Shahram

    2005-03-01

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

  10. [Intraoperative radiotherapy in malignant bone tumors].

    PubMed

    Yamamuro, T; Kotoura, Y

    1993-06-01

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

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

    PubMed

    Jahangiri, Faisal R

    2015-09-01

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

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

    PubMed

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

    2016-09-01

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

  13. Warm autoimmune hemolytic anemia.

    PubMed

    Naik, Rakhi

    2015-06-01

    Warm autoimmune hemolytic anemia (AIHA) is defined as the destruction of circulating red blood cells (RBCs) in the setting of anti-RBC autoantibodies that optimally react at 37°C. The pathophysiology of disease involves phagocytosis of autoantibody-coated RBCs in the spleen and complement-mediated hemolysis. Thus far, treatment is aimed at decreasing autoantibody production with immunosuppression or reducing phagocytosis of affected cells in the spleen. The role of complement inhibitors in warm AIHA has not been explored. This article addresses the diagnosis, etiology, and treatment of warm AIHA and highlights the role of complement in disease pathology.

  14. 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

  15. A light blanket for intraoperative photodynamic therapy

    NASA Astrophysics Data System (ADS)

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

    2009-06-01

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

  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. Effects of warming therapy on pressure ulcers--a randomized trial.

    PubMed

    Scott, E M; Leaper, D J; Clark, M; Kelly, P J

    2001-05-01

    Postoperative pressure ulcers are a common and expensive problem. Intraoperative hypothermia also is a common problem and may have a connection with impaired tissue viability. Researchers in this study hypothesized that intraoperative control of hypothermia may reduce the incidence of postoperative pressure ulcers. A randomized clinical trial (n = 338) was used to test the effects of using forced air warming therapy versus standard care. Results indicated an absolute risk reduction in pressure ulcers of 4.8% (i.e., 10.4% to 5.6%) with a relative risk reduction of 46% in patients who received warming therapy. Although not reaching statistical significance, the clinical significance of almost halving the pressure ulcer rate is important. A correlation between body temperature and postoperative pressure ulcers was established.

  19. Warming of patients during Caesarean section: a telephone survey.

    PubMed

    Woolnough, M J; Hemingway, C; Allam, J; Cox, M; Yentis, S M

    2009-01-01

    We contacted the duty obstetric anaesthetist in 219 of the 220 consultant-led maternity units in the UK (99.5%) and asked about departmental and individual practice regarding temperature management during Caesarean section. Warming during elective Caesarean section was routine in 35 units (16%). Intravenous fluid warmers were available in 213 units (97%), forced air warmers were available in 211 (96%) and warming mattresses were available in 42 (19%). Only 18 (8%) departments had specific guidelines for temperature management during Caesarean section. Personal intra-operative practice was variable, although all of those contacted would initiate some form of active temperature management after a mean (SD) volume of blood loss of 1282 (404) ml, length of surgery of 78 (24) min, or core body temperature (if measured) of median (IQR [range]), 36 (35.5-36 [34-37.2]) degrees C. PMID:19087007

  20. 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

  1. Intraoperative Flap Complications in LASIK Surgery Performed by Ophthalmology Residents

    PubMed Central

    Romero-Diaz-de-Leon, Lorena; Serna-Ojeda, Juan Carlos; Navas, Alejandro; Graue-Hernández, Enrique O.; Ramirez-Miranda, Arturo

    2016-01-01

    Purpose: To report the rate of flap-related complications in LASIK surgery performed by in-training ophthalmology residents and to analyze the risk factors for these complications. Methods: We analyzed 273 flap dissections in 145 patients from March 2013 to February 2014. We included all LASIK surgeries performed by 32 ophthalmology residents using a Moria M2 microkeratome. All the flap-related complications were noted. Comparison between both groups with and without complications was performed with an independent Student's t-test and relative risks were calculated. Results: There were 19 flap-related complications out of the 273 flap dissections (6.95%). The most common complication was incomplete flap dissection (n = 10; 3.66%), followed by free-cap (n = 5; 1.83%), and flap-buttonhole (n = 2; 0.73%). There was no significant difference between the complicated and uncomplicated cases in terms of the right versus the left eye, pachymetry results, white-to-white diameter, and spherical equivalent. But this difference was significant for mean keratometry (P = 0.008), K-min (P = 0.01), and K-max (P = 0.03) between these groups. Final visual acuity after rescheduling laser treatment was similar in both groups. Relative risks for flap-related complications were 2.03 for the first LASIK surgery (CI 95% 0.64 to 6.48; P = 0.22) and 1.26 (CI 95% 0.43 to 3.69; P = 0.66) for the surgeon's flap-related complications. Female gender presented an odds ratio of 2.48 (CI 95% 0.68 to 9.00; P = 0.16) for complications. Conclusion: Flap-related complications are common intraoperative event during LASIK surgery performed by in-training ophthalmologists. Keratometries and surgeon's first procedure represent a higher probability for flap related complications than some other biometric parameters of patient's eye.

  2. Warm and Cool Dinosaurs.

    ERIC Educational Resources Information Center

    Mannlein, Sally

    2001-01-01

    Presents an art activity in which first grade students draw dinosaurs in order to learn about the concept of warm and cool colors. Explains how the activity also helped the students learn about the concept of distance when drawing. (CMK)

  3. Draft global warming study

    SciTech Connect

    Not Available

    1990-01-01

    The 1990 Resource Program Global Warming Study examines potential Bonneville Power Administration (BPA) resource alternatives related to the risk of global warming. The study evaluates strategies for reducing net carbon emissions, and identifies the net carbon contribution of certain resource strategies designed to reduce those emissions. Carbon dioxide (CO{sub 2}) is the greenhouse gas'' most associated with electricity production. The main purpose of the global warming study is to identify possible courses of action that BPA might take to reduce its contributions to the risk of global warming and to estimate the efficacy and costs of each approach. The principal measure of effectiveness is the reduction in total atmospheric carbon emissions compared to a base case. 13 refs., 2 tabs.

  4. Reconciling Warming Trends

    NASA Technical Reports Server (NTRS)

    Schmidt, Gavin A.; Shindell, Drew T.; Tsigaridis, Konstantinos

    2014-01-01

    Climate models projected stronger warming over the past 15 years than has been seen in observations. Conspiring factors of errors in volcanic and solar inputs, representations of aerosols, and El NiNo evolution, may explain most of the discrepancy.

  5. Warm Hands and Feet

    NASA Technical Reports Server (NTRS)

    1976-01-01

    Comfort Products, Inc. was responsible for the cold weather glove and thermal boots, adapted from a spacesuit design that kept astronauts warm or cool in the temperature extremes of the Apollo Moon Mission. Gloves and boots are thermally heated. Batteries are worn inside wrist of glove or sealed in sole of skiboot and are rechargeable hundreds of times. They operate flexible resistance circuit which is turned on periodically when wearer wants to be warm.

  6. Polar Warming Drivers

    NASA Astrophysics Data System (ADS)

    McDunn, T. L.; Bougher, S. W.; Mischna, M. A.; Murphy, J. R.

    2012-12-01

    Polar warming is a dynamically induced temperature enhancement over mid-to-high latitudes that results in a reversed (poleward) meridional temperature gradient. This phenomenon was recently characterized over the 40-90 km altitude region [1] based on nearly three martian years of Mars Climate Sounder observations [2, 3]. Here we investigate which forcing mechanisms affect the magnitude and distribution of the observed polar warming by conducting simulations with the Mars Weather Research and Forecasting General Circulation Model [4, 5]. We present simulations confirming the influence topography [6] and dust loading [e.g., 7] have upon polar warming. We then present simulations illustrating the modulating influence gravity wave momentum deposition exerts upon polar warming, consistent with previous modeling studies [e.g., 8]. The results of this investigation suggest the magnitude and distribution of polar warming in the martian middle atmosphere is modified by gravity wave activity and that the characteristics of the gravity waves that most significantly affect polar warming vary with season. References: [1] McDunn, et al., 2012 (JGR), [2]Kleinböhl, et al., 2009 (JGR), [3] Kleinböhl, et al., 2011 (JQSRT), [4] Richardson, et al., 2007 (JGR), [5] Mischna, et al., 2011 (Planet. Space Sci.), [6] Richardson and Wilson, 2002 (Nature), [7] Haberle, et al., 1982 (Icarus), [8] Barnes, 1990 (JGR).

  7. The Effects of Local Warming on Surgical Site Infection

    PubMed Central

    Dellinger, E. Patchen; Weber, James; Swenson, Ron Edward; Kent, Christopher D.; Swanson, Paul E.; Harmon, Kurt; Perrin, Margot

    2015-01-01

    Abstract Background: Surgical site infections (SSI) account for a major proportion of hospital-acquired infections. They are associated with longer hospital stay, readmissions, increased costs, mortality, and morbidity. Reducing SSI is a goal of the Surgical Care Improvement Project and identifying interventions that reduce SSI effectively is of interest. In a single-blinded randomized controlled trial (RCT) we evaluated the effect of localized warming applied to surgical incisions on SSI development and selected cellular (immune, endothelial) and tissue responses (oxygenation, collagen). Methods: After Institutional Review Board approval and consent, patients having open bariatric, colon, or gynecologic-oncologic related operations were enrolled and randomly assigned to local incision warming (6 post-operative treatments) or non-warming. A prototype surgical bandage was used for all patients. The study protocol included intra-operative warming to maintain core temperature ≥36°C and administration of 0.80 FIO2. Patients were followed for 6 wks for the primary outcome of SSI determined by U.S. Centers for Disease Control (CDC) criteria and ASEPSIS scores (additional treatment; presence of serous discharge, erythema, purulent exudate, and separation of the deep tissues; isolation of bacteria; and duration of inpatient stay). Tissue oxygen (PscO2) and samples for cellular analyses were obtained using subcutaneous polytetrafluoroethylene (ePTFE) tubes and oxygen micro-electrodes implanted adjacent to the incision. Cellular and tissue ePTFE samples were evaluated using flow cytometry, immunohistochemistry, and Sircol™ collagen assay (Biocolor Ltd., Carrickfergus, United Kingdom). Results: One hundred forty-six patients participated (n=73 per group). Study groups were similar on demographic parameters and for intra-operative management factors. The CDC defined rate of SSI was 18%; occurrence of SSI between groups did not differ (p=0.27). At 2 wks, warmed

  8. 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.

  9. 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

  10. Climate change between the Medieval Warm Period and the Little Ice Age: Model-data comparison between CMIP5/PMIP3 last millennium simulations and available temperature proxy records

    NASA Astrophysics Data System (ADS)

    Charpentier Ljungqvist, Fredrik; Zhang, Qiong; Sundqvist, Hanna S.; Brattström, Gudrun; Moberg, Anders

    2014-05-01

    We present a model-data comparison between the CMIP5/PMIP3 last millennium simulations and available individual temperature proxy records from across the globe. Our focus is to investigate the agreement in amplitude of the simulated and the reconstructed temperature difference between the Medieval Warm Period (MWP, here defined as AD 950-1250) and the Little Ice Age (LIA, here defined as AD 1400-1700). An emphasis is placed on analysing to what extent the high latitude and continental amplification of the temperature signal is the same in the model simulations as in the proxies. We further discuss to what extent the models have captured the spatial signatures that is shown in the proxy data. We have collected 125 calibrated proxy records - representing either annual mean, winter or summer temperature - extending back to at least AD 950. The proxies include data from a wide range of archives: ice-cores, marine and terrestrial sediments, tree-rings, speleothems and historical records. Only proxies with at least two observations per century were included. We calculated the amplitude of change between the MWP and the LIA in the individual proxy records using the temperature calibrations by the original authors. The last millennium simulations from 8 different models in CMIP5 database are used to compare with the proxy records. This model-data comparison reveals that the ensemble mean and median of the models mostly underestimate the amplitude of temperature difference between the MWP and the LIA as estimated from the proxy records at those locations where proxy records exist. The relative lack of proxy data from the tropics and the Southern Hemisphere, however, precludes a fully comprehensive model-data comparison. We also note large differences between the model simulations both in amplitude of the temperature change and in their spatial patterns. The use of an ensemble mean or median of the model simulations emphasizes the averaged signature within the model ensemble

  11. 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.

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

    PubMed

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

    2016-08-01

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

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

    PubMed

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

    2013-01-01

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

  14. Indocyanine green for intraoperative localization of ureter.

    PubMed

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

    2014-10-01

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

  15. Quantitative Intraoperative Torsional Forced Duction Test

    PubMed Central

    Jung, Jae Ho; Holmes, Jonathan M.

    2015-01-01

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

  16. Warm up to the idea: Global warming is here

    SciTech Connect

    Lynch, C.F.

    1996-07-01

    This article summarizes recent information about global warming as well as the history of greenhouse gas emissions which have lead to more and more evidence of global warming. The primary source detailed is the second major study report on global warming by the Intergovernmental Panel on climate change. Along with comments about the environmental effects of global warming such as coastline submersion, the economic, social and political aspects of alleviating greenhouse emissions and the threat of global warming are discussed.

  17. Long range global warming

    SciTech Connect

    Rolle, K.C.; Pulkrabek, W.W.; Fiedler, R.A.

    1995-12-31

    This paper explores one of the causes of global warming that is often overlooked, the direct heating of the environment by engineering systems. Most research and studies of global warming concentrate on the modification that is occurring to atmospheric air as a result of pollution gases being added by various systems; i.e., refrigerants, nitrogen oxides, ozone, hydrocarbons, halon, and others. This modification affects the thermal radiation balance between earth, sun and space, resulting in a decrease of radiation outflow and a slow rise in the earth`s steady state temperature. For this reason the solution to the problem is perceived as one of cleaning up the processes and effluents that are discharged into the environment. In this paper arguments are presented that suggest, that there is a far more serious cause for global warming that will manifest itself in the next two or three centuries; direct heating from the exponential growth of energy usage by humankind. Because this is a minor contributor to the global warming problem at present, it is overlooked or ignored. Energy use from the combustion of fuels and from the output of nuclear reactions eventually is manifest as warming of the surroundings. Thus, as energy is used at an ever increasing rate the consequent global warming also increases at an ever increasing rate. Eventually this rate will become equal to a few percent of solar radiation. When this happens the earth`s temperature will have risen by several degrees with catastrophic results. The trends in world energy use are reviewed and some mathematical models are presented to suggest future scenarios. These models can be used to predict when the global warming problem will become undeniably apparent, when it will become critical, and when it will become catastrophic.

  18. 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.

  19. 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

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

    PubMed

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

    2015-02-11

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

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

    PubMed

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

    2014-01-01

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

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

    PubMed

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

    2014-01-01

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

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

    PubMed Central

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

    2010-01-01

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

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

    PubMed

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

    2003-12-01

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

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

    SciTech Connect

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

    2007-09-01

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

  6. 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.

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

    PubMed

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

    2016-01-01

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

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

    PubMed

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

    2016-03-01

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

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

    PubMed

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

    2015-06-01

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

  10. 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

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

    PubMed

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

    2016-01-01

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

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

    PubMed

    Güldner, Andreas; Gama de Abreu, Marcelo

    2015-09-01

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

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

    PubMed Central

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

    2016-01-01

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

  14. Model predicts global warming

    NASA Astrophysics Data System (ADS)

    Wainger, Lisa A.

    Global greenhouse warming will be clearly identifiable by the 1990s, according to eight scientists who have been studying climate changes using computer models. Researchers at NASA's Goddard Space Flight Center, Goddard Institute for Space Studies, New York, and the Massachusetts Institute of Technology, Cambridge, say that by the 2010s, most of the globe will be experiencing “substantial” warming. The level of warming will depend on amounts of trace gases, or greenhouse gases, in the atmosphere.Predictions for the next 70 years are based on computer simulations of Earth's climate. In three runs of the model, James Hansen and his colleagues looked at the effects of changing amounts of atmospheric gases with time.

  15. CT-assisted stereotactic brain biopsy: value of intraoperative frozen section diagnosis.

    PubMed Central

    Colbassani, H J; Nishio, S; Sweeney, K M; Bakay, R A; Takei, Y

    1988-01-01

    In 100 recent CT-guided brain biopsies, the value of intraoperative histologic examination using frozen section technique was evaluated. In 87 of these cases, the biopsy was performed stereotactically. In the remaining 13 cases, a CT-guided free hand technique was used. Of the 100 biopsies performed, adequate tissue for histopathologic diagnosis was obtained in 97, and in three the biopsy was nondiagnostic. In 61 procedures the initial biopsy specimen was adequate for diagnosis. Two specimens were required in 25 and in the remaining cases it was necessary to obtain three to four biopsy specimens before a definitive diagnosis could be made. Ultimately, the histologic diagnosis was made on frozen section examination in 93 of the cases. The lesions identified were neoplastic disease in 83 cases, vascular disease in seven, infectious disease in five, demyelinating disease in one, and radiation necrosis in one. Comparison between the frozen section diagnosis and the final diagnosis based on the permanent sections revealed that they matched in 89 cases (92%). Of the 83 cases of neoplasms the exact grade of malignancy was determined by frozen section to make a final diagnosis revealed that even if the specimen volume was less than 2 mm3, the biopsy was generally successful. The disadvantages of the small sample size obtained through needle biopsy are best overcome by careful targeting and assessment of sample quality by intraoperative frozen section examinations, which will give the definitive diagnosis in most of the cases without paraffin-embedded sections. Images PMID:3283295

  16. Factors influencing intraoperative blood loss in orthognathic surgery.

    PubMed

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

    2016-09-01

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

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

    PubMed

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

    2005-04-01

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

  18. 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.

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

    PubMed

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

    2005-04-01

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

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

    PubMed

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

    1995-01-01

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

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

    PubMed

    Theodotou, B C; Powers, S K

    1986-08-01

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

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

    PubMed

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

    2015-12-01

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

  3. 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.

  4. Laser Doppler imaging for intraoperative human brain mapping.

    PubMed

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

    2009-02-15

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

  5. 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

  6. Warm and Cool Cityscapes

    ERIC Educational Resources Information Center

    Jubelirer, Shelly

    2012-01-01

    Painting cityscapes is a great way to teach first-grade students about warm and cool colors. Before the painting begins, the author and her class have an in-depth discussion about big cities and what types of buildings or structures that might be seen in them. They talk about large apartment and condo buildings, skyscrapers, art museums,…

  7. A novel silicon array designed for intraoperative charged particle imaging.

    PubMed

    Tornai, Martin P; Patt, Bradley E; Iwanczyk, Jan S; Tull, Carolyn R; MacDonald, Lawrence R; Hoffman, Edward J

    2002-11-01

    A novel Si-PIN imaging array is under investigation for a charged particle (beta, positron, or alpha) sensitive intraoperative camera to be used for (residual) tumor identification during surgery. This class of collimator-less nuclear imaging device has a higher signal response for direct interactions than its scintillator-optical detector-based counterparts. Monte Carlo simulations with 635 keV betas were performed, yielding maximum and projected ranges of 1.64 and 0.55 mm in Si. Up to 90% of these betas were completely absorbed in the first 0.30 mm. Based on these results, 300 microm thick prototype Si detector arrays were designed in a 16 x 16 crossed-grid arrangement with 0.8 mm wide orthogonal strips on 1.0 mm pitch. A NIM- and CAMAC-based high-density data acquisition and processing system was used to collect the list mode data. The system was calibrated by comparisons of measured spectra to energy deposition simulations or by direct measurement of various >100 keV conversion electron or beta emitters. Mean electronic noise per strip was <3.6 keV FWHM at room temperature. When detecting positrons, which have an accompanying 511 keV annihilation background, the flood irradiated beta/gamma ratio was approximately 40, indicating that beta images could be made without the use of background rejection techniques. The intrinsic spatial resolution corresponds to the 1 x 1 mm2 pixel size, and measurements of beta emitting point and line sources yielded FWHM resolutions of 1.5 (lateral) and 2.5 mm (diagonal), respectively, with the larger widths due to particle range blurting effects. Deconvolution of the finite source size yielded intrinsic resolutions that corresponded to the image pixel size. Transmission images of circle and line phantoms with various hole sizes and pitch were resolved with either pure beta or positron irradiation without a background correction. This novel semiconductor imaging device facilitates high charged particle and low gamma sensitivity

  8. 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

  9. -induced continental warming

    NASA Astrophysics Data System (ADS)

    Kamae, Youichi; Watanabe, Masahiro; Kimoto, Masahide; Shiogama, Hideo

    2014-11-01

    In this the second of a two-part study, we examine the physical mechanisms responsible for the increasing contrast of the land-sea surface air temperature (SAT) in summertime over the Far East, as observed in recent decades and revealed in future climate projections obtained from a series of transient warming and sensitivity experiments conducted under the umbrella of the Coupled Model Intercomparison Project phase 5. On a global perspective, a strengthening of land-sea SAT contrast in the transient warming simulations of coupled atmosphere-ocean general circulation models is attributed to an increase in sea surface temperature (SST). However, in boreal summer, the strengthened contrast over the Far East is reproduced only by increasing atmospheric CO2 concentration. In response to SST increase alone, the tropospheric warming over the interior of the mid- to high-latitude continents including Eurasia are weaker than those over the surrounding oceans, leading to a weakening of the land-sea SAT contrast over the Far East. Thus, the increasing contrast and associated change in atmospheric circulation over East Asia is explained by CO2-induced continental warming. The degree of strengthening of the land-sea SAT contrast varies in different transient warming scenarios, but is reproduced through a combination of the CO2-induced positive and SST-induced negative contributions to the land-sea contrast. These results imply that changes of climate patterns over the land-ocean boundary regions are sensitive to future scenarios of CO2 concentration pathways including extreme cases.

  10. Plant community responses to experimental warming across the tundra biome.

    PubMed

    Walker, Marilyn D; Wahren, C Henrik; Hollister, Robert D; Henry, Greg H R; Ahlquist, Lorraine E; Alatalo, Juha M; Bret-Harte, M Syndonia; Calef, Monika P; Callaghan, Terry V; Carroll, Amy B; Epstein, Howard E; Jónsdóttir, Ingibjörg S; Klein, Julia A; Magnússon, Borgthór; Molau, Ulf; Oberbauer, Steven F; Rewa, Steven P; Robinson, Clare H; Shaver, Gaius R; Suding, Katharine N; Thompson, Catharine C; Tolvanen, Anne; Totland, Ørjan; Turner, P Lee; Tweedie, Craig E; Webber, Patrick J; Wookey, Philip A

    2006-01-31

    Recent observations of changes in some tundra ecosystems appear to be responses to a warming climate. Several experimental studies have shown that tundra plants and ecosystems can respond strongly to environmental change, including warming; however, most studies were limited to a single location and were of short duration and based on a variety of experimental designs. In addition, comparisons among studies are difficult because a variety of techniques have been used to achieve experimental warming and different measurements have been used to assess responses. We used metaanalysis on plant community measurements from standardized warming experiments at 11 locations across the tundra biome involved in the International Tundra Experiment. The passive warming treatment increased plant-level air temperature by 1-3 degrees C, which is in the range of predicted and observed warming for tundra regions. Responses were rapid and detected in whole plant communities after only two growing seasons. Overall, warming increased height and cover of deciduous shrubs and graminoids, decreased cover of mosses and lichens, and decreased species diversity and evenness. These results predict that warming will cause a decline in biodiversity across a wide variety of tundra, at least in the short term. They also provide rigorous experimental evidence that recently observed increases in shrub cover in many tundra regions are in response to climate warming. These changes have important implications for processes and interactions within tundra ecosystems and between tundra and the atmosphere.

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

    PubMed

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

    1990-10-01

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

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

    PubMed

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

    2012-08-01

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

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

    PubMed Central

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

    2012-01-01

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

  14. 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

  15. Role of intraoperative transesophageal echocardiography in pediatric cardiac surgery

    PubMed Central

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

    2015-01-01

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

  16. 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.

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

    PubMed

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

    2015-11-01

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

  18. Teaching Global Warming

    NASA Astrophysics Data System (ADS)

    Hobson, Art

    2004-05-01

    Every citizen's education should include socially relevant science courses because, as the American Association for the Advancement of Science puts it, "Without a scientifically literate population, the outlook for a better world is not promising." I have developed a conceptual liberal-arts physics course that covers the major principles of classical physics, emphasizes modern/contemporary physics, and includes societal topics such as global warming, ozone depletion, transportation, exponential growth, scientific methodology, risk assessment, nuclear weapons, nuclear power, and the energy future. The societal topics, occupying only about 15% of the class time, appear to be the main cause of the surprising popularity of this course among non-scientists. I will outline some ideas for incorporating global warming into such a course or into any other introductory physics course. For further details, see my textbook Physics: Concepts and Connections (Prentice Hall, 3rd edition 2003).

  19. Warm Little Inflaton

    NASA Astrophysics Data System (ADS)

    Bastero-Gil, Mar; Berera, Arjun; Ramos, Rudnei O.; Rosa, João G.

    2016-10-01

    We show that inflation can naturally occur at a finite temperature T >H that is sustained by dissipative effects, when the inflaton field corresponds to a pseudo Nambu-Goldstone boson of a broken gauge symmetry. Similar to the Little Higgs scenarios for electroweak symmetry breaking, the flatness of the inflaton potential is protected against both quadratic divergences and the leading thermal corrections. We show that, nevertheless, nonlocal dissipative effects are naturally present and are able to sustain a nearly thermal bath of light particles despite the accelerated expansion of the Universe. As an example, we discuss the dynamics of chaotic warm inflation with a quartic potential and show that the associated observational predictions are in very good agreement with the latest Planck results. This model constitutes the first realization of warm inflation requiring only a small number of fields; in particular, the inflaton is directly coupled to just two light fields.

  20. Comparison of the efficacy of a forced-air warming system and circulating-water mattress on core temperature and post-anesthesia shivering in elderly patients undergoing total knee arthroplasty under spinal anesthesia

    PubMed Central

    Lee, Kyu Chang; Lee, Myeong Jong; Kim, Mi-Na; Kim, Ji-Sub; Lee, Won Sang; Lee, Jung Hwa

    2014-01-01

    Background In the present study, we compared changes in body temperature and the occurrence of shivering in elderly patients undergoing total knee arthroplasty under spinal anesthesia during warming with either a forced-air warming system or a circulating-water mattress. Methods Forty-six patients were randomly assigned to either the forced-air warming system (N = 23) or circulating-water mattress (N = 23) group. Core temperature was recorded using measurements at the tympanic membrane and rectum. In addition, the incidence and intensity of post-anesthesia shivering and verbal analogue score for thermal comfort were simultaneously assessed. Results Core temperature outcomes did not differ between the groups. The incidence (13.0 vs 43.5%, P < 0.05) and intensity (20/2/1/0/0 vs 13/5/3/2/0, P < 0.05) of post-anesthesia shivering was significantly lower in the forced-air system group than in the circulating-water mattress group. Conclusions The circulating-water mattress was as effective as the forced-air warming system for maintaining body temperature. However, the forced-air warming system was superior to the circulating-water mattress in reducing the incidence of post-anesthesia shivering. PMID:24910726

  1. Global genetic change tracks global climate warming in Drosophila subobscura.

    PubMed

    Balanyá, Joan; Oller, Josep M; Huey, Raymond B; Gilchrist, George W; Serra, Luis

    2006-09-22

    Comparisons of recent with historical samples of chromosome inversion frequencies provide opportunities to determine whether genetic change is tracking climate change in natural populations. We determined the magnitude and direction of shifts over time (24 years between samples on average) in chromosome inversion frequencies and in ambient temperature for populations of the fly Drosophila subobscura on three continents. In 22 of 26 populations, climates warmed over the intervals, and genotypes characteristic of low latitudes (warm climates) increased in frequency in 21 of those 22 populations. Thus, genetic change in this fly is tracking climate warming and is doing so globally.

  2. Intraoperative fluorescence vascular angiography: during tibial bypass.

    PubMed

    Perry, Diana; Bharara, Manish; Armstrong, David G; Mills, Joseph

    2012-01-01

    Preventing amputations in persons with lower extremity complications of diabetes is a complex endeavor, particularly in those with concomitant ischemia and tissue loss. Fluorescence angiography (Novadaq SPY system) may provide a tool for objective evaluations of tissue viability in the diabetic foot, which is an important indicator of the ability of the diabetic ulcer to heal adequately. The SPY system uses a low-power laser coupled with a charge-coupled device camera and indocyanine green (ICG) to sequence perfusion at the surface of the skin. We present an illustrated example of the potential utility of ICG fluorescence angiography (ICGFA) before and after vascular intervention in a high-risk limb. ICGFA appeared to reveal demarcation between viable and nonviable tissue and real-time perfusion, specifically capillary fill. ICGFA clarified the extent of necessary debridement and provided an immediate indication of improvement in regional perfusion status following revascularization. Future studies involving ICGFA may include pre- and postdebridement and closure perfusion, comparison of tissue perfusion pre- and post-endovascular therapy, and lower extremity flap viability. Future works will also address the consistency of results with ICGFA by analyzing a larger cohort of patients being treated by our unit. PMID:22401340

  3. Global Warming And Meltwater

    NASA Astrophysics Data System (ADS)

    Bratu, S.

    2012-04-01

    In order to find new approaches and new ideas for my students to appreciate the importance of science in their daily life, I proposed a theme for them to debate. They had to search for global warming information and illustrations in the media, and discuss the articles they found in the classroom. This task inspired them to search for new information about this important and timely theme in science. I informed my students that all the best information about global warming and meltwater they found would be used in a poster that would help us to update the knowledge base of the Physics laboratory. I guided them to choose the most eloquent images and significant information. Searching and working to create this poster, the students arrived to better appreciate the importance of science in their daily life and to critically evaluate scientific information transmitted via the media. In the poster we created, one can find images, photos and diagrams and some interesting information: Global warming refers to the rising average temperature of the Earth's atmosphere and oceans and its projected evolution. In the last 100 years, the Earth's average surface temperature increased by about 0.8 °C with about two thirds of the increase occurring over just the last three decades. Warming of the climate system is unequivocal, and scientists are more than 90% certain most of it is caused by increasing concentrations of greenhouse gases produced by human activities such as deforestation and burning fossil fuel. They indicate that during the 21st century the global surface temperature is likely to rise a further 1.1 to 2.9 °C for the lowest emissions scenario and 2.4 to 6.4 °C for the highest predictions. An increase in global temperature will cause sea levels to rise and will change the amount and pattern of precipitation, and potentially result in expansion of subtropical deserts. Warming is expected to be strongest in the Arctic and would be associated with continuing decrease of

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

    PubMed

    Gukop, Philemon; Chandrasekaran, Vankatachalam

    2015-12-01

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

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

    PubMed

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

    2001-03-01

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

  6. 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.

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

    PubMed

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

    2013-04-01

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

  8. 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

  9. 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.

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

    PubMed

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

    2013-10-01

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

  11. Toward Intraoperative Image-Guided Transoral Robotic Surgery.

    PubMed

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

    2013-09-01

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

  12. 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.

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

    PubMed

    Kawashima, T; Naraoka, S; Kakizaki, T

    2009-07-01

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

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

    PubMed

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

    1988-12-15

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

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

    PubMed

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

    2013-04-01

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

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

    PubMed

    Sanai, Nader; Berger, Mitchel S

    2010-02-01

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

  17. 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

  18. Intraoperative Functional Mapping and Monitoring during Glioma Surgery.

    PubMed

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

    2015-01-01

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

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

    PubMed

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

    2016-01-01

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

  20. Intraoperative positioning and care of the obese patient.

    PubMed

    Dybec, Robert B

    2004-01-01

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

  1. Intraoperative MRI in pediatric neurosurgery—an update

    PubMed Central

    2014-01-01

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

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

    PubMed

    Wirtz, C R

    2016-09-01

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

  3. Predictors of intraoperative-acquired surgical wound infections.

    PubMed

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

    1991-06-01

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

  4. Intraoperative brain tumor resection cavity characterization with conoscopic holography

    NASA Astrophysics Data System (ADS)

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

    2012-02-01

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

  5. A New Measure for Monitoring Intraoperative Somatosensory Evoked Potentials

    PubMed Central

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

    2014-01-01

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

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

    PubMed

    Wirtz, C R

    2016-09-01

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

  7. Intraoperative Brain Shift Compensation: Accounting for Dural Septa

    PubMed Central

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

    2013-01-01

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

  8. The role of intraoperative scrape cytology in vertebroplasty

    PubMed Central

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

    2016-01-01

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

  9. 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.

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

    PubMed Central

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

    2013-01-01

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

  11. 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

  12. Intraoperative augmented reality for minimally invasive liver interventions

    NASA Astrophysics Data System (ADS)

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

    2003-05-01

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

  13. 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.

  14. Evaluation of bacterial contamination on surgical drapes following use of the Bair Hugger(®) forced air warming system.

    PubMed

    Occhipinti, Lindsay L; Hauptman, Joe G; Greco, Justin J; Mehler, Stephen J

    2013-12-01

    This pilot study determined the rate of bacterial contamination on surgical drapes of small animal patients warmed intra-operatively with the Bair Hugger(®) forced air warming system compared to a control method. Surgical drapes of 100 patients undergoing clean surgical procedures were swabbed with aerobic culturettes at the beginning and end of surgery. Samples were cultured on Trypticase soy agar. Contamination of the surgical drapes was identified in 6/98 cases (6.1%). There was no significant difference in the number of contaminated surgical drapes between the Bair Hugger(®) and control groups (P = 0.47).

  15. Warm hilltop inflation

    SciTech Connect

    Sanchez, Juan Carlos Bueno; Dimopoulos, Konstantinos; Bastero-Gil, Mar; Berera, Arjun

    2008-06-15

    We study the low-temperature limit of warm inflation in a hilltop model. This limit remains valid up to the end of inflation, allowing an analytic description of the entire inflationary stage. In the weak dissipative regime, if the kinetic density of the inflaton dominates after inflation, low-scale inflation is attained with Hubble scale as low as 1 GeV. In the strong dissipative regime, the model satisfies the observational requirements for the spectral index with a mild tuning of the model parameters, while also overcoming the {eta}-problem of inflation. However, there is some danger of gravitino overproduction unless the particle content of the theory is large.

  16. FLATs: Warming Up - continuation

    NASA Astrophysics Data System (ADS)

    Calzetti, Daniela

    1997-07-01

    The purpose of this proposal is to monitor the flat fields during the interval between the end of science observations and the exhaustion of cryogen and subsequent warming of the dewar to > 100K. These flats will provide a monitor for particulate comtamination {GROT} and detector lateral position {from the coronagraphic spot and FDA vignetting}. They will provide some measure of relative {flat field} and absolute QE variation as a function of temperature. When stars are visible they might provide a limited degree of focus determination.

  17. FLATs: Warming Up

    NASA Astrophysics Data System (ADS)

    Calzetti, Daniela

    1997-07-01

    The purpose of this proposal is to monitor the flat fields during the interval between the end of science observations and the exhaustion of cryogen and subsequent warming of the dewar to > 100K. These flats will provide a monitor for particulate comtamination {GROT} and detector lateral position {from the coronagraphic spot and FDA vignetting}. They will provide some measure of relative {flat field} and absolute QE variation as a function of temperature. When stars are visible they might provide a limited degree of focus determination.

  18. Is Global Warming Accelerating?

    NASA Astrophysics Data System (ADS)

    Shukla, J.; Delsole, T. M.; Tippett, M. K.

    2009-12-01

    A global pattern that fluctuates naturally on decadal time scales is identified in climate simulations and observations. This newly discovered component, called the Global Multidecadal Oscillation (GMO), is related to the Atlantic Meridional Oscillation and shown to account for a substantial fraction of decadal fluctuations in the observed global average sea surface temperature. IPCC-class climate models generally underestimate the variance of the GMO, and hence underestimate the decadal fluctuations due to this component of natural variability. Decomposing observed sea surface temperature into a component due to anthropogenic and natural radiative forcing plus the GMO, reveals that most multidecadal fluctuations in the observed global average sea surface temperature can be accounted for by these two components alone. The fact that the GMO varies naturally on multidecadal time scales implies that it can be predicted with some skill on decadal time scales, which provides a scientific rationale for decadal predictions. Furthermore, the GMO is shown to account for about half of the warming in the last 25 years and hence a substantial fraction of the recent acceleration in the rate of increase in global average sea surface temperature. Nevertheless, in terms of the global average “well-observed” sea surface temperature, the GMO can account for only about 0.1° C in transient, decadal-scale fluctuations, not the century-long 1° C warming that has been observed during the twentieth century.

  19. Warm Inflation Model Building

    NASA Astrophysics Data System (ADS)

    Bastero-Gil, Mar; Berera, Arjun

    We review the main aspects of the warm inflation scenario, focusing on the inflationary dynamics and the predictions related to the primordial spectrum of perturbations, to be compared with the recent cosmological observations. We study in detail three different classes of inflationary models, chaotic, hybrid models and hilltop models, and discuss their embedding into supersymmetric models and the consequences for model building of the warm inflationary dynamics based on first principles calculations. Due to the extra friction term introduced in the inflaton background evolution generated by the dissipative dynamics, inflation can take place generically for smaller values of the field, and larger values of couplings and masses. When the dissipative dynamics dominates over the expansion, in the so-called strong dissipative regime, inflation proceeds with sub-Planckian inflaton values. Models can be naturally embedded into a supergravity framework, with SUGRA corrections suppressed by the Planck mass now under control, for a larger class of Kähler potentials. In particular, this provides a simpler solution to the "eta" problem in supersymmetric hybrid inflation, without restricting the Kähler potentials compatible with inflation. For chaotic models dissipation leads to a smaller prediction for the tensor-to-scalar ratio and a less tilted spectrum when compared to the cold inflation scenario. We find in particular that a small component of dissipation renders the quartic model now consistent with the current CMB data.

  20. [Air conditioning units and warm air blankets in the operating room].

    PubMed

    Kerwat, Klaus; Piechowiak, Karolin; Wulf, Hinnerk

    2013-01-01

    Nowadays almost all operating rooms are equipped with air conditioning (AC units). Their main purpose is climatization, like ventilation, moisturizing, cooling and also the warming of the room in large buildings. In operating rooms they have an additional function in the prevention of infections, especially the avoidance of postoperative wound infections. This is achieved by special filtration systems and by the creation of specific air currents. Since hypothermia is known to be an unambiguous factor for the development of postoperative wound infections, patients are often actively warmed intraoperatively using warm air blankets (forced-air warming units). In such cases it is frequently discussed whether such warm air blankets affect the performance of AC units by changing the air currents or whether, in contrast, have exactly the opposite effect. However, it has been demonstrated in numerous studies that warm air blankets do not have any relevant effect on the functioning of AC units. Also there are no indications that their use increases the rate of postoperative wound infections. By preventing the patient from experiencing hypothermia, the rate of postoperative wound infections can even be decreased thereby.

  1. Hypertensive phase and early complications after Ahmed glaucoma valve implantation with intraoperative subtenon triamcinolone acetonide

    PubMed Central

    Turalba, Angela V; Pasquale, Louis R

    2014-01-01

    Objective To evaluate intraoperative subtenon triamcinolone acetonide (TA) as an adjunct to Ahmed glaucoma valve (AGV) implantation. Design Retrospective comparative case series. Participants Forty-two consecutive cases of uncontrolled glaucoma undergoing AGV implantation: 19 eyes receiving intraoperative subtenon TA and 23 eyes that did not receive TA. Methods A retrospective chart review was performed on consecutive pseudophakic adult patients with uncontrolled glaucoma undergoing AGV with and without intraoperative subtenon TA injection by a single surgeon. Clinical data were collected from 42 eyes and analyzed for the first 6 months after surgery. Main outcome measures Primary outcomes included intraocular pressure (IOP) and number of glaucoma medications prior to and after AGV implantation. The hypertensive phase (HP) was defined as an IOP measurement of greater than 21 mmHg (with or without medications) during the 6-month postoperative period that was not a result of tube obstruction, retraction, or malfunction. Postoperative complications and visual acuity were analyzed as secondary outcome measures. Results Five out of 19 (26%) TA cases and 12 out of 23 (52%) non-TA cases developed the HP (P=0.027). Mean IOP (14.2±4.6 in TA cases versus [vs] 14.7±5.0 mmHg in non-TA cases; P=0.78), and number of glaucoma medications needed (1.8±1.3 in TA cases vs 1.6±1.1 in the comparison group; P=0.65) were similar between both groups at 6 months. Although rates of serious complications did not differ between the groups (13% in the TA group vs 16% in the non-TA group), early tube erosion (n=1) and bacterial endophthalmitis (n=1) were noted with TA but not in the non-TA group. Conclusions Subtenon TA injection during AGV implantation may decrease the occurrence of the HP but does not alter the ultimate IOP outcome and may pose increased risk of serious complications within the first 6 months of surgery. PMID:25050061

  2. RHIC warm-bore systems

    SciTech Connect

    Welch, K.M.

    1994-07-01

    Pressure profiles, in time, are calculated as a consequence of anticipated outgassing of various beam components (e.g., rf cavities, etc.) and warm-bore beam pipes. Gold beam lifetimes and transverse beam emittance growth are given for calculated average pressures. Examples of undesirable warm-bore conditions are presented such as contaminated experimental beam pipes and warm-bore magnets (i.e., DX). These examples may prove instructive. The methods used in making these calculations are presented in Section 2. They are applicable to all linear systems. The calculations given apply to the RHIC accelerator and more specifically to warm-bore regions of the machine.

  3. Warm waters, bleached corals

    SciTech Connect

    Roberts, L.

    1990-10-12

    Two researchers, Tom Goreau of the Discovery Laboratory in Jamaica and Raymond Hayes of Howard University, claim that they have evidence that nearly clinches the temperature connection to the bleached corals in the Caribbean and that the coral bleaching is an indication of Greenhouse warming. The incidents of scattered bleaching of corals, which have been reported for decades, are increasing in both intensity and frequency. The researchers based their theory on increased temperature of the seas measured by satellites. However, some other scientists feel that the satellites measure the temperature of only the top few millimeters of the water and that since corals lie on reefs perhaps 60 to 100 feet below the ocean surface, the elevated temperatures are not significant.

  4. Global warming challenge

    SciTech Connect

    Hengeveld, H. )

    1994-11-01

    Global warming will necessitate significant adjustments in Canadian society and its economy. In 1979, the Canadian federal government created its Canadian Climate Program (CCP) in collaboration with other agencies, institutions, and individuals. It sought to coordinate national efforts to understand global and regional climate, and to promote better use of the emerging knowledge. Much of the CCP-coordinated research into sources and sinks of greenhouse gases interfaces with other national and international programs. Other researchers have become involved in the Northern Wetlands Study, a cooperative United States-Canada initiative to understand the role of huge northern bogs and muskegs in the carbon cycle. Because of the need to understand how the whole, linked climate system works, climate modeling emerged as a key focus of current research. 35 refs., 4 figs.

  5. Global Warming on Triton

    NASA Technical Reports Server (NTRS)

    Elliot, J. L.; Hammel, H. B.; Wasserman, L. H.; Franz, O. G.; McDonald, S. W.; Person, M. J.; Olkin, C. B.; Dunham, E. J.; Spencer, J. R.; Stansberry, J. A.; Buie, M. W.; Pasachoff, J. M.; Babcock, B. A.; McConnochie, T. H.

    1998-01-01

    Triton, Neptune's largest moon, has been predicted to undergo significant seasonal changes that would reveal themselves as changes in its mean frost temperature. But whether this temperature should at the present time be increasing, decreasing or constant depends on a number of parameters (such as the thermal properties of the surface, and frost migration patterns) that are unknown. Here we report observations of a recent stellar occultation by Triton which, when combined with earlier results, show that Triton has undergone a period of global warming since 1989. Our most conservative estimates of the rate of temperature and surface-pressure increase during this period imply that the atmosphere is doubling in bulk every 10 years, significantly faster than predicted by any published frost model for Triton. Our result suggests that permanent polar caps on Triton play a c dominant role in regulating seasonal atmospheric changes. Similar processes should also be active on Pluto.

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

    PubMed

    Gallagher, Kaitlin; Vacchiano, Charles

    2014-06-01

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

  7. Diffuse, Warm Ionized Gas

    NASA Astrophysics Data System (ADS)

    Haffner, L. M.

    2002-05-01

    Over the past decade, new high-sensitivity observations have significantly advanced our knowledge of the diffuse, ionized gas in spiral galaxies. This component of the interstellar medium, often referred to as Warm Ionized Medium (WIM) or Diffuse Ionized Gas (DIG), plays an important role in the complex stellar-interstellar matter and energy cycle. In examining the distribution and physical properties of this gas, we learn not only about the conditions of the medium but also about processes providing heating and ionization in the halos of spiral galaxies. For the Milky Way, three new Hα surveys are available providing large sky coverage, arc-minute spatial resolution, and the ability to kinematically resolve this prominent optical emission line. These new, global views show that the Warm Ionized Medium of the Galaxy is ubiquitous as previously suspected, is rich with filamentary structure down to current resolution limits, and can be traced into the halo at large distances from the Galactic plane. Observations of additional optical emission lines are beginning to probe the physical conditions of the WIM. Early results suggest variations in the temperature and ionization state of the gas which are not adequately explained by Lyman continuum stellar photoionization alone. In parallel with this intensive work in the Milky Way have been numerous studies about the diffuse, ionized gas in other spiral galaxies. Here, deep, face-on spiral investigations provide some of the best maps of the global DIG distribution in a galaxy and begin to allow a probe of the local link between star formation and the powering of ionized gas. In addition, ionized gas has been traced out to impressive distances (z > 3 kpc) in edge-on spirals, revealing out large-scale changes in the physical conditions and kinematics of galactic halos.

  8. Interacting warm dark matter

    SciTech Connect

    Cruz, Norman; Palma, Guillermo; Zambrano, David; Avelino, Arturo E-mail: guillermo.palma@usach.cl E-mail: avelino@fisica.ugto.mx

    2013-05-01

    We explore a cosmological model composed by a dark matter fluid interacting with a dark energy fluid. The interaction term has the non-linear λρ{sub m}{sup α}ρ{sub e}{sup β} form, where ρ{sub m} and ρ{sub e} are the energy densities of the dark matter and dark energy, respectively. The parameters α and β are in principle not constrained to take any particular values, and were estimated from observations. We perform an analytical study of the evolution equations, finding the fixed points and their stability properties in order to characterize suitable physical regions in the phase space of the dark matter and dark energy densities. The constants (λ,α,β) as well as w{sub m} and w{sub e} of the EoS of dark matter and dark energy respectively, were estimated using the cosmological observations of the type Ia supernovae and the Hubble expansion rate H(z) data sets. We find that the best estimated values for the free parameters of the model correspond to a warm dark matter interacting with a phantom dark energy component, with a well goodness-of-fit to data. However, using the Bayesian Information Criterion (BIC) we find that this model is overcame by a warm dark matter – phantom dark energy model without interaction, as well as by the ΛCDM model. We find also a large dispersion on the best estimated values of the (λ,α,β) parameters, so even if we are not able to set strong constraints on their values, given the goodness-of-fit to data of the model, we find that a large variety of theirs values are well compatible with the observational data used.

  9. Local warming: daily temperature change influences belief in global warming.

    PubMed

    Li, Ye; Johnson, Eric J; Zaval, Lisa

    2011-04-01

    Although people are quite aware of global warming, their beliefs about it may be malleable; specifically, their beliefs may be constructed in response to questions about global warming. Beliefs may reflect irrelevant but salient information, such as the current day's temperature. This replacement of a more complex, less easily accessed judgment with a simple, more accessible one is known as attribute substitution. In three studies, we asked residents of the United States and Australia to report their opinions about global warming and whether the temperature on the day of the study was warmer or cooler than usual. Respondents who thought that day was warmer than usual believed more in and had greater concern about global warming than did respondents who thought that day was colder than usual. They also donated more money to a global-warming charity if they thought that day seemed warmer than usual. We used instrumental variable regression to rule out some alternative explanations.

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

    PubMed

    Mannell, Aylwyn; Wium, Brunton; Thatcher, Charles

    2014-08-08

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

  11. 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

  12. Intraoperative photodynamic therapy in laryngeal part of pharynx cancers

    NASA Astrophysics Data System (ADS)

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

    1996-12-01

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

  13. Intraoperative Neurophysiologic Monitoring: Basic Principles and Recent Update

    PubMed Central

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

    2013-01-01

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

  14. 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.

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

    PubMed

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

    2016-03-01

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

  16. A CASE OF GRANISETRON ASSOCIATED INTRAOPERATIVE CARDIAC ARREST.

    PubMed

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

    2016-02-01

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

  17. Does the Surgical Apgar Score Measure Intraoperative Performance?

    PubMed Central

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

    2008-01-01

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

  18. 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

  19. Intraoperative consultation for the retroperitoneum and adrenal glands.

    PubMed

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

    1985-08-01

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

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

    PubMed Central

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

    2009-01-01

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

  1. 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.

  2. 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.

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

    PubMed Central

    Halter, Ryan J.; Kim, Young-Joong

    2015-01-01

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

  4. 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.

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

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

    2016-05-01

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

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

    PubMed Central

    Gurleyik, Gunay

    2016-01-01

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

  8. Stereoscopic Integrated Imaging Goggles for Multimodal Intraoperative Image Guidance

    PubMed Central

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

    2015-01-01

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

  9. 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.

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

    PubMed

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

    2012-09-01

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

  11. Defining Sudden Stratospheric Warmings

    NASA Astrophysics Data System (ADS)

    Butler, Amy; Seidel, Dian; Hardiman, Steven; Butchart, Neal; Birner, Thomas; Match, Aaron

    2015-04-01

    The general form of the definition for Sudden Stratospheric Warmings (SSWs) is largely agreed to be a reversal of the temperature gradient and of the zonal circulation polewards of 60° latitude at the 10 hPa level, as developed by the World Meteorological Organization (WMO) in the 1960s and 1970s. However, the details of the definition and its calculation are ambiguous, resulting in inconsistent classifications of SSW events. These discrepancies are problematic for understanding the observed frequency and statistical relationships with SSWs, and for maintaining a robust metric with which to assess wintertime stratospheric variability in observations and climate models. To provide a basis for community-wide discussion, we examine how the SSW definition has changed over time and how sensitive the detection of SSWs is to the definition used. We argue that the general form of the SSW definition should be clarified to ensure that it serves current research and forecasting purposes, and propose possible ways to update the definition.

  12. Warm dense crystallography

    NASA Astrophysics Data System (ADS)

    Valenza, Ryan A.; Seidler, Gerald T.

    2016-03-01

    The intense femtosecond-scale pulses from x-ray free electron lasers (XFELs) are able to create and interrogate interesting states of matter characterized by long-lived nonequilibrium semicore or core electron occupancies or by the heating of dense phases via the relaxation cascade initiated by the photoelectric effect. We address here the latter case of "warm dense matter" (WDM) and investigate the observable consequences of x-ray heating of the electronic degrees of freedom in crystalline systems. We report temperature-dependent density functional theory calculations for the x-ray diffraction from crystalline LiF, graphite, diamond, and Be. We find testable, strong signatures of condensed-phase effects that emphasize the importance of wide-angle scattering to study nonequilibrium states. These results also suggest that the reorganization of the valence electron density at eV-scale temperatures presents a confounding factor to achieving atomic resolution in macromolecular serial femtosecond crystallography (SFX) studies at XFELs, as performed under the "diffract before destroy" paradigm.

  13. Warming up for Planck

    SciTech Connect

    Bartrum, Sam; Berera, Arjun; Rosa, João G. E-mail: ab@ph.ed.ac.uk

    2013-06-01

    The recent Planck results and future releases on the horizon present a key opportunity to address a fundamental question in inflationary cosmology of whether primordial density perturbations have a quantum or thermal origin, i.e. whether particle production may have significant effects during inflation. Warm inflation provides a natural arena to address this issue, with interactions between the scalar inflaton and other degrees of freedom leading to dissipative entropy production and associated thermal fluctuations. In this context, we present relations between CMB observables that can be directly tested against observational data. In particular, we show that the presence of a thermal bath warmer than the Hubble scale during inflation decreases the tensor-to-scalar ratio with respect to the conventional prediction in supercooled inflation, yielding r < 8|n{sub t}|, where n{sub t} is the tensor spectral index. Focusing on supersymmetric models at low temperatures, we determine consistency relations between the observables characterizing the spectrum of adiabatic scalar and tensor modes, both for generic potentials and particular canonical examples, and which we compare with the WMAP and Planck results. Finally, we include the possibility of producing the observed baryon asymmetry during inflation through dissipative effects, thereby generating baryon isocurvature modes that can be easily accommodated by the Planck data.

  14. Shyness Trajectories in Slow-to-Warm-Up Infants: Relations with Child Sex and Maternal Parenting

    ERIC Educational Resources Information Center

    Grady, Jessica Stoltzfus; Karraker, Katherine; Metzger, Aaron

    2012-01-01

    Little is known about slow-to-warm-up temperament in infancy. This study examined the trajectory of shyness in children who were slow-to-warm-up in infancy in comparison to children with other temperament profiles in infancy. Participants were 996 mothers and children in the NICHD SECC studied from 6 months to first grade. Latent growth curve…

  15. Feasibility assessment of the interactive use of a Monte Carlo algorithm in treatment planning for intraoperative electron radiation therapy.

    PubMed

    Guerra, Pedro; Udías, José M; Herranz, Elena; Santos-Miranda, Juan Antonio; Herraiz, Joaquín L; Valdivieso, Manlio F; Rodríguez, Raúl; Calama, Juan A; Pascau, Javier; Calvo, Felipe A; Illana, Carlos; Ledesma-Carbayo, María J; Santos, Andrés

    2014-12-01

    This work analysed the feasibility of using a fast, customized Monte Carlo (MC) method to perform accurate computation of dose distributions during pre- and intraplanning of intraoperative electron radiation therapy (IOERT) procedures. The MC method that was implemented, which has been integrated into a specific innovative simulation and planning tool, is able to simulate the fate of thousands of particles per second, and it was the aim of this work to determine the level of interactivity that could be achieved. The planning workflow enabled calibration of the imaging and treatment equipment, as well as manipulation of the surgical frame and insertion of the protection shields around the organs at risk and other beam modifiers. In this way, the multidisciplinary team involved in IOERT has all the tools necessary to perform complex MC dosage simulations adapted to their equipment in an efficient and transparent way. To assess the accuracy and reliability of this MC technique, dose distributions for a monoenergetic source were compared with those obtained using a general-purpose software package used widely in medical physics applications. Once accuracy of the underlying simulator was confirmed, a clinical accelerator was modelled and experimental measurements in water were conducted. A comparison was made with the output from the simulator to identify the conditions under which accurate dose estimations could be obtained in less than 3 min, which is the threshold imposed to allow for interactive use of the tool in treatment planning. Finally, a clinically relevant scenario, namely early-stage breast cancer treatment, was simulated with pre- and intraoperative volumes to verify that it was feasible to use the MC tool intraoperatively and to adjust dose delivery based on the simulation output, without compromising accuracy. The workflow provided a satisfactory model of the treatment head and the imaging system, enabling proper configuration of the treatment planning

  16. Impact of intraoperative hypotension and blood pressure fluctuations on early postoperative delirium after non-cardiac surgery†‡

    PubMed Central

    Hirsch, J.; DePalma, G.; Tsai, T. T.; Sands, L. P.; Leung, J. M.

    2015-01-01

    Introduction Postoperative delirium is common in older patients. Despite its prognostic significance, the pathophysiology is incompletely understood. Although many risk factors have been identified, no reversible factors, particularly ones potentially modifiable by anaesthetic management, have been identified. The goal of this prospective cohort study was to investigate whether intraoperative hypotension was associated with postoperative delirium in older patients undergoing major non-cardiac surgery. Methods Study subjects were patients >65 years of age, undergoing major non-cardiac surgery, who were enrolled in an ongoing prospective observational study of the pathophysiology of postoperative delirium. Intraoperative blood pressure was measured and predefined criteria were used to define hypotension. Delirium was measured by the Confusion Assessment Method on the first two postoperative days. Data were analysed using t-tests, two-sample proportion tests and ordered logistic regression multivariable models, including correction for multiple comparisons. Results Data from 594 patients with a mean age of 73.6 years (sd 6.2) were studied. Of these 178 (30%) developed delirium on day 1 and 176 (30%) on day 2. Patients developing delirium were older, more often female, had lower preoperative cognitive scores, and underwent longer operations. Relative hypotension (decreases by 20, 30, or 40%) or absolute hypotension [mean arterial pressure (MAP)<50 mm Hg] were not significantly associated with postoperative delirium, nor was the duration of hypotension (MAP<50 mm Hg). Conversely, intraoperative blood pressure variance was significantly associated with postoperative delirium. Discussion These results showed that increased blood pressure fluctuation, not absolute or relative hypotension, was predictive of postoperative delirium. PMID:25616677

  17. Recent warming of lake Kivu.

    PubMed

    Katsev, Sergei; Aaberg, Arthur A; Crowe, Sean A; Hecky, Robert E

    2014-01-01

    Lake Kivu in East Africa has gained notoriety for its prodigious amounts of dissolved methane and dangers of limnic eruption. Being meromictic, it is also expected to accumulate heat due to rising regional air temperatures. To investigate the warming trend and distinguish between atmospheric and geothermal heating sources, we compiled historical temperature data, performed measurements with logging instruments, and simulated heat propagation. We also performed isotopic analyses of water from the lake's main basin and isolated Kabuno Bay. The results reveal that the lake surface is warming at the rate of 0.12°C per decade, which matches the warming rates in other East African lakes. Temperatures increase throughout the entire water column. Though warming is strongest near the surface, warming rates in the deep waters cannot be accounted for solely by propagation of atmospheric heat at presently assumed rates of vertical mixing. Unless the transport rates are significantly higher than presently believed, this indicates significant contributions from subterranean heat sources. Temperature time series in the deep monimolimnion suggest evidence of convection. The progressive deepening of the depth of temperature minimum in the water column is expected to accelerate the warming in deeper waters. The warming trend, however, is unlikely to strongly affect the physical stability of the lake, which depends primarily on salinity gradient.

  18. Recent Warming of Lake Kivu

    PubMed Central

    Katsev, Sergei; Aaberg, Arthur A.; Crowe, Sean A.; Hecky, Robert E.

    2014-01-01

    Lake Kivu in East Africa has gained notoriety for its prodigious amounts of dissolved methane and dangers of limnic eruption. Being meromictic, it is also expected to accumulate heat due to rising regional air temperatures. To investigate the warming trend and distinguish between atmospheric and geothermal heating sources, we compiled historical temperature data, performed measurements with logging instruments, and simulated heat propagation. We also performed isotopic analyses of water from the lake's main basin and isolated Kabuno Bay. The results reveal that the lake surface is warming at the rate of 0.12°C per decade, which matches the warming rates in other East African lakes. Temperatures increase throughout the entire water column. Though warming is strongest near the surface, warming rates in the deep waters cannot be accounted for solely by propagation of atmospheric heat at presently assumed rates of vertical mixing. Unless the transport rates are significantly higher than presently believed, this indicates significant contributions from subterranean heat sources. Temperature time series in the deep monimolimnion suggest evidence of convection. The progressive deepening of the depth of temperature minimum in the water column is expected to accelerate the warming in deeper waters. The warming trend, however, is unlikely to strongly affect the physical stability of the lake, which depends primarily on salinity gradient. PMID:25295730

  19. Delayed flowering and global warming

    NASA Astrophysics Data System (ADS)

    Cook, B. I.; Wolkovich, E. M.; Parmesan, C.

    2011-12-01

    Within general trends toward earlier spring, observed cases of species and ecosystems that have not advanced their phenology, or have even delayed it, appear paradoxical, especially when made in temperate regions experiencing significant warming. The typical interpretation of this pattern has been that non-responders are insensitive to relatively small levels of warming over the past 40 years, while species showing delays are often viewed as statistical noise or evidence for unknown confounding factors at play. However, plant physiology studies suggest that when winter chilling (vernalization) is required to initiate spring development, winter warming may retard spring events, masking expected advances caused by spring warming. Here, we analyzed long-term data on phenology and seasonal temperatures from 490 species on two continents and demonstrate that 1) apparent non-responders are indeed responding to warming, but their responses to winter and spring warming are opposite in sign, 2) observed trends in first flowering date depend strongly on the magnitude of a given species' response to autumn/winter versus spring warming, and 3) inclusion of these effects strongly improves hindcast predictions of long-term flowering trends. With a few notable exceptions, climate change research has focused on the overall mean trend towards phenological advance, minimizing discussion of apparently non-responding species. Our results illuminate an under-studied source of complexity in wild species responses and support the need for models incorporating diverse environmental cues in order to improve predictability of species responses to anthropogenic climate change.

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

    PubMed

    Lorenz, M; Renella, R R

    1989-01-01

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

  1. Amplified Arctic warming by phytoplankton under greenhouse warming

    PubMed Central

    Park, Jong-Yeon; Kug, Jong-Seong; Bader, Jürgen; Rolph, Rebecca; Kwon, Minho

    2015-01-01

    Phytoplankton have attracted increasing attention in climate science due to their impacts on climate systems. A new generation of climate models can now provide estimates of future climate change, considering the biological feedbacks through the development of the coupled physical–ecosystem model. Here we present the geophysical impact of phytoplankton, which is often overlooked in future climate projections. A suite of future warming experiments using a fully coupled ocean−atmosphere model that interacts with a marine ecosystem model reveals that the future phytoplankton change influenced by greenhouse warming can amplify Arctic surface warming considerably. The warming-induced sea ice melting and the corresponding increase in shortwave radiation penetrating into the ocean both result in a longer phytoplankton growing season in the Arctic. In turn, the increase in Arctic phytoplankton warms the ocean surface layer through direct biological heating, triggering additional positive feedbacks in the Arctic, and consequently intensifying the Arctic warming further. Our results establish the presence of marine phytoplankton as an important potential driver of the future Arctic climate changes. PMID:25902494

  2. Amplified Arctic warming by phytoplankton under greenhouse warming.

    PubMed

    Park, Jong-Yeon; Kug, Jong-Seong; Bader, Jürgen; Rolph, Rebecca; Kwon, Minho

    2015-05-12

    Phytoplankton have attracted increasing attention in climate science due to their impacts on climate systems. A new generation of climate models can now provide estimates of future climate change, considering the biological feedbacks through the development of the coupled physical-ecosystem model. Here we present the geophysical impact of phytoplankton, which is often overlooked in future climate projections. A suite of future warming experiments using a fully coupled ocean-atmosphere model that interacts with a marine ecosystem model reveals that the future phytoplankton change influenced by greenhouse warming can amplify Arctic surface warming considerably. The warming-induced sea ice melting and the corresponding increase in shortwave radiation penetrating into the ocean both result in a longer phytoplankton growing season in the Arctic. In turn, the increase in Arctic phytoplankton warms the ocean surface layer through direct biological heating, triggering additional positive feedbacks in the Arctic, and consequently intensifying the Arctic warming further. Our results establish the presence of marine phytoplankton as an important potential driver of the future Arctic climate changes.

  3. Weird Warm Spot on Exoplanet

    NASA Video Gallery

    This animation illustrates an unexpected warm spot on the surface of a gaseous exoplanet. NASA's Spitzer Space Telescope discovered that the hottest part of the planet, shown here as bright, orange...

  4. Usefulness of Intraoperative Continuous Infusion of Tranexamic Acid during Emergency Surgery for Type A Acute Aortic Dissection

    PubMed Central

    Yamanaka, Kazuo; Iwakura, Atsushi; Hirose, Keiichi; Nakatsuka, Daisuke; Kusuhara, Takayoshi; Ikarashi, Jin

    2014-01-01

    Purpose: We investigated the influence of intraoperative continuous tranexamic acid (TA) infusion on the amount of blood transfusion required in emergency surgery for type A acute aortic dissection. Methods: The study was based on the data of 55 consecutive patients who underwent surgery for type A acute aortic dissection. The patients were divided into 2 groups for comparison: Group T, consisting of 26 patients who received intraoperative continuous infusion of TA, and Group N, consisting of 29 patients who did not receive TA infusion during the surgery. Results: The mean amounts of blood transfusion required during and after surgery were compared between the 2 groups: they were 10.5 ± 8.7 and 16.2 ± 10.0 units of mannitol-adenine-phosphate-added red cell concentrate, 9.3 ± 8.6 and 17.1 ± 10.0 units of fresh frozen plasma, and 20.4 ± 12.2 and 29.7 ± 14.9 units of platelet concentrate, respectively, in Groups T and N. Thus, the amount of each of these blood products required was significantly reduced in Group T. Conclusions: During emergency surgery for type A acute aortic dissection, continuous infusion of TA resulted in a significant reduction in the amount of blood transfusion required. PMID:24583703

  5. Separating Contributions from Anthropogenic Warming and from Natural Oscillations to Global Warming

    NASA Astrophysics Data System (ADS)

    Konrad Stips, Adolf; Macias, Diego; Garcia-Gorriz, Elisa

    2014-05-01

    During the past five decades, global air temperatures have been warming at a rather high rate (IPCC-2013) resulting in scientific and social concern. This warming trend is observed in field data sampling and model simulations and affects both air temperatures over land and over the ocean. However, the warming rate changes with time and this has led to question the causes underlying the observed trends. Here, we analyze recent measured and modeled data on global mean surface air temperature anomalies (GMTA) covering the last 160 years using spectral techniques. The spectral analysis of the measured data does show a strong secular trend (ST) and a clear multidecadal sinusoidal oscillation (MDV) that resembles the Atlantic Multidecadal Oscillation (AMO). The observed acceleration of the warming during the period from 1970 to 2000 therefore appears to be caused by a superimposition of anthropogenic-induced warming (~60%) with the positive phase of a multidecadal oscillation (~40%), while the recent slowdown (hiatus) of this tendency is likely due to a shift in the MDV phase. It has been proposed that this change in the MDV phase could mask the effect of global warming in the forthcoming decades and our analysis indicates that this is quite likely, the current hiatus being already a manifestation of this phenomenon. Most current generation global circulation models (CMIP5) do not reproduce this MDV and are missing the actual temperature hiatus. Therefore, it is less likely that such models could correctly forecast the temperature evolution during the coming decades. We propose here to use the climate dynamics that is inherent in the GMTA data to forecast temperatures until 2100. These forecasts, based on the analyzed secular trend and the multidecadal oscillations are indeed capable of reproducing the actual hiatus and generally result, in comparison to CMIP5 forecasts, in much lower temperature increases for 2100 of only about 1oC. Global mean air temperatures could be

  6. 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.

  7. 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.

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

    PubMed

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

    2013-03-01

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

  9. Intraoperative interstitial microwave-induced hyperthermia and brachytherapy.

    PubMed

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

    1985-09-01

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

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

    PubMed

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

    2015-01-01

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

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

    PubMed

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

    2015-01-01

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

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

    PubMed

    Tsuboyama, T; Toguchida, J; Kotoura, Y; Kasahara, K; Hiraoka, M; Nakamura, T

    2000-01-01

    The outcome following intra-operative radiation therapy in the treatment of osteosarcoma in the extremity in 33 patients was evaluated for oncological and functional results. Local recurrence occurred in seven cases, six of which were in a non-irradiated region, indicating inappropriate planning of the radiation field. Twenty-one patients underwent either prosthetic replacement (14) or amputation (7). Irradiated tumours were left in situ in the remaining 12 patients. In this latter group no degenerative joint changes were observed radiologically. Twenty-six patients experienced local complications, of which fracture of the irradiated bone was the most significant. Associated intramedullary nailing showed encouraging results in preventing fracture. Although IORT is effective for the local control of osteosarcoma in extremities, critical patient selection and improvements of treatment protocol are required in order to obtain a satisfactory outcome.

  13. Neurophysiologic intraoperative monitoring of the glossopharyngeal and vagus nerves.

    PubMed

    Singh, Rajdeep; Husain, Aatif M

    2011-12-01

    Neurophysiologic intraoperative monitoring (NIOM) of the glossopharyngeal and vagus nerves (CN IX and X) is often used during surgeries involving the lower brain stem. Although both of these nerves contain sensory, autonomic, and motor fibers, it is the motor fibers that are most amenable to NIOM. CN IX supplies the stylopharyngeus muscle, and CN X supplies striated muscles in the soft palate, pharynx, and larynx. Monitoring of these CN can be performed by monitoring free running and stimulated electromyography (EMG) from the stylopharyngeus muscle (CN IX) and the vocal cords (CN X). Various surface and needle electrodes can be used to monitor these muscle groups. When CN IX is monitored, CN X should also be monitored, as it is often needed to differentiate when CN IX is selectively activated. Data are accumulating noting the use of monitoring these CN in tumor surgeries involving the lower brain stem. PMID:22146360

  14. Theory and Simulation of Warm Dense Matter Targets

    SciTech Connect

    Barnard, J J; Armijo, J; More, R M; Friedman, A; Kaganovich, I; Logan, B G; Marinak, M M; Penn, G E; Sefkow, A B; Santhanam, P; Wurtele, J S

    2006-07-13

    We present simulations and analysis of the heating of warm dense matter foils by ion beams with ion energy less than one MeV per nucleon to target temperatures of order one eV. Simulations were carried out using the multi-physics radiation hydrodynamics code HYDRA and comparisons are made with analysis and the code DPC. We simulate possible targets for a proposed experiment at LBNL (the so-called Neutralized Drift Compression Experiment, NDCXII) for studies of warm dense matter. We compare the dynamics of ideally heated targets, under several assumed equation of states, exploring dynamics in the two-phase (fluid-vapor) regime.

  15. Interactive intraoperative localization using an infrared-based system.

    PubMed

    Zamorano, L J; Nolte, L; Kadi, A M; Jiang, Z

    1993-10-01

    We discuss new methods of localizing and treating brain lesions for both the conventional method of a base-ring fixed to the patient's skull (referred to as frame-based procedures) and the new method of frameless procedures (no base ring). Frame-based procedures are used for finding a precise instrument position during neurosurgical procedures, such as stereotactic biopsy of deep-seated lesions, placing electrodes for functional stereotaxis or catheters with radioactive seeds for brachytherapy, or even the placement of a stereotactic retractor or endoscope for removal or internal decompression of lesions. In such procedures, the intraoperative image localization of instruments becomes useful as it tracks instruments as they travel through the preplanned trajectory. Additional intraoperative digitization of surgical instruments, e.g., bipolar suction, biopsy forceps, microscope, ultrasound probe, etc, can be achieved during the stereotactic resection of eloquent areas or deep intracranial lesions by adding an infrared-based system. Frameless procedures broaden the range of surgical approaches, image guidance planning, and operative procedures, since no ring is attached to the patient's head which might interfere with the surgical approach, and offers logistic advantages in scheduling diagnostic studies. Frameless diagnostic studies employ anatomical markers and/or surface matching techniques for data registration in the computer software surgical preplanning program. This simplifies scheduling of the procedures since the image study does not need to be acquired the same day as surgery. Frameless diagnostic studies allow for the use of more than one type of imaging data for planning and optimization of surgical procedures, and greatly improve patient tolerance and comfort during these procedures and during surgery, as compared with frame-based procedures.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7905601

  16. Positron detection for the intraoperative localisation of cancer deposits

    PubMed Central

    Burian, Maria; Meisetschläger, Günther; Stein, Hubert J.; Ziegler, Sibylle; Nährig, Jörg; Picchio, Maria; Buck, Andreas; Siewert, Joerg R.; Schwaiger, Markus

    2007-01-01

    Purpose The study investigated the feasibility of a positron-sensitive hand-held detector system for the intraoperative localisation of tumour deposits resulting from intravenous [18F]FDG administration. Methods A total of 17 patients (12 receiving preoperative [18F]FDG PET imaging) with various histologically proven malignancies were included. Radioactivity from tumours and surrounding normal tissue was measured on average 3 h after administration of 36–110 MBq [18F]FDG and the tumour-to-background (T/B) ratio was calculated. In addition, phantom studies were performed to evaluate the spatial resolution and sensitivity of the probe. Results All known targeted tumour sites were identified by the positron probe. T/B ratios were generally high, with a mean T/B ratio of 6.6, allowing easy identification of most tumour sites. In one case of a hepatic metastasis, the T/B ratio of 1.34 was below expectations, since the preoperative [18F]FDG PET scan was positive. The probe was instrumental in the localisation of three additional tumour lesions (two lymph nodes, one anastomotic ring) that were not immediately apparent at surgery. Phantom studies revealed that [18F]FDG-containing gel (simulating tumour tissue), having 10 times more [18F]FDG than surrounding “normal” background gel, was clearly detectable in quantities as low as 15 mg. As measured in two cases, the absorbed radiation doses ranged from 2.5 to 8.6 μSv/h for the surgical team to 0.8 μSv/h for the aesthetician. Conclusion [18F]FDG-accumulating tumour tissues can be localised with positron probes intraoperatively with a low radiation burden to the patient and medical personnel. The methodology holds promise for further clinical testing. PMID:17431612

  17. [The role of intraoperative flowmetry in surgery of cerebral aneurysms].

    PubMed

    Shekhtman, O D; Éliava, Sh Sh; Shakhnovich, V A; Pilipenko, Iu V

    2011-01-01

    Aim of the study was to assess the capabilities of intraoperative ultrasonic flowmetry in cerebral aneurysm surgery for prevention and immediate correction of cerebral ischemia. Ultrasonic flowmeter (Model HT313/323, "ransonic Systems Inc.", USA) was used during surgery in patients with complicated, large and giant aneurysms for evaluation of cerebral blood flow in main arteries (internal carotid, anterior and middle cerebral) and their branches (branches of M2-M3 and A2 segments). The series included 20 adult patients (13 male and 7 female) operated in Burdenko Moscow Neurosurgery Institute during 2008-2011 years. Mean age was 47.4 +/- 8.6 years. Giant aneurysms (> 2.5 cm) were present in 12 (60%) patients, large (1.5-2.5 cm)--in 5 (25%). Aneurysms of internal carotid artery were found in 8 cases. 1 female patient was operated on giant aneurysm of anterior cerebral--anterior communicating artery. In 4 (20%) cases significant alterations of blood flow were registered after clipping (> 25% according to initial), the changes were not visible. This allowed to correct the position of clips. In 2 surgeries ('low' paraclinoid aneurysms) the collateral flow was sufficient during temporary clipping, this allowed trapping of aneurysms with good neurological outcome. In 3 cases flowmeter was used to evaluate blood flow after extracranial-intracranial bypass. Ultrasonic flowmetry is a simple, reproducible and safe technique for intraoperative assessment of blood flow. Despite visual sufficiency of arteries flowmetry allows detection of surgically significant alterations of blood flow after clipping. PMID:22066255

  18. Tolerance of canine anastomoses to intraoperative radiation therapy

    SciTech Connect

    Tepper, J.E.; Sindelar, W.; Travis, E.L.; Terrill, R.; Padikal, T.

    1983-07-01

    Radiation has been given intraoperatively to various abdominal structures in dogs, using a fixed horizontal 11 MeV electron beam at the Armed Forces Radiobiologic Research Institute. Animals were irradiated with single doses of 2000, 3000 and 4500 rad to a field which extended from the bifurcation of the aorta to the rib cage. All animals were irradiated during laparotomy under general anesthesia. Because the clinical use of intraoperative radiotherapy in cancer treatment will occasionally require irradiation of anastomosed large vessels and blind loops of bowel, the tolerance of aortic anastomoses and the suture lines of blind loops of jejunum to irradiation were studied. Responses in these experiments were scored at times up to one year after irradiation. In separate experiments both aortic and intestinal anastomoses were performed on each animal for evaluation of short term response. The dogs with aortic anastomoses showed adequate healing at all doses with no evidence of suture line weakening. On long-term follow-up one animal (2000 rad) had stenosis at the anastomosis and one animal (4500 rad) developed an arteriovenous fistula. Three of the animals that had an intestinal blind loop irradiated subsequently developed intussusception, with the irradiated loop acting as the lead point. One week after irradiation, bursting pressure of an intestinal blind loop was normal at 3000 rad, but markedly decreased at 4500 rad. No late complications were noted after the irradiation of the intestinal anastomosis. No late complicatons were observed after irradiation of intestinal anastomoses, but one needs to be cautious with regards to possible late stenosis at the site of an irradiated vascular anastomosis.

  19. Treatment of symptomatic intraosseous pneumatocyst using intraoperative navigation.

    PubMed

    Formby, Peter M; Kang, Daniel G; Potter, Benjamin K; Forsberg, Jonathan A

    2015-03-01

    Intraosseous pneumatocysts are benign air-containing lesions that are most often found in the spine and pelvis and are nearly always treated nonoperatively. Although rarely clinically symptomatic, studies have shown pneumatocysts to be present in up to 10% of computed tomography (CT) scans of the pelvis and spine. Radiographic characteristics of these lesions include a localized collection of gas with a thin sclerotic rim, no bony destruction, no soft tissue masses, and no medullary abnormalities. Computed tomography is the diagnostic study of choice, with Hounsfield units ranging from -580 to -950, showing a gas-containing lesion. Few studies have described the management of symptomatic pneumatocysts, and all reported cases concern underwater divers, presumably because of greater pressure cycling and barotrauma encountered while underwater diving. The goal of this report is to describe the intraoperative CT-guided navigation and percutaneous injection of calcium sulfate-calcium phosphate composite bone graft substitute material for the treatment of a symptomatic pneumatocyst in the ilium of a Navy dive instructor. The patient reported a 1-year history of increasing buttock pain with increased depth of diving, consistently reproduced by diving past a depth of 20 to 30 feet. To the authors' knowledge, this is the first description in the English literature of the operative treatment of an intraosseous pneumatocyst of the ilium. The use of intraoperative CT guidance permitted accurate percutaneous localization, decompression, and filling of the lesion with synthetic bone graft substitute, with complete early relief of symptoms. At 6-month follow up, the patient had reached diving depths of 170 feet without pain. PMID:25760515

  20. Single-trial detection for intraoperative somatosensory evoked potentials monitoring.

    PubMed

    Hu, L; Zhang, Z G; Liu, H T; Luk, K D K; Hu, Y

    2015-12-01

    Abnormalities of somatosensory evoked potentials (SEPs) provide effective evidence for impairment of the somatosensory system, so that SEPs have been widely used in both clinical diagnosis and intraoperative neurophysiological monitoring. However, due to their low signal-to-noise ratio (SNR), SEPs are generally measured using ensemble averaging across hundreds of trials, thus unavoidably producing a tardiness of SEPs to the potential damages caused by surgical maneuvers and a loss of dynamical information of cortical processing related to somatosensory inputs. Here, we aimed to enhance the SNR of single-trial SEPs using Kalman filtering and time-frequency multiple linear regression (TF-MLR) and measure their single-trial parameters, both in the time domain and in the time-frequency domain. We first showed that, Kalman filtering and TF-MLR can effectively capture the single-trial SEP responses and provide accurate estimates of single-trial SEP parameters in the time domain and time-frequency domain, respectively. Furthermore, we identified significant correlations between the stimulus intensity and a set of indicative single-trial SEP parameters, including the correlation coefficient (between each single-trial SEPs and their average), P37 amplitude, N45 amplitude, P37-N45 amplitude, and phase value (at the zero-crossing points between P37 and N45). Finally, based on each indicative single-trial SEP parameter, we investigated the minimum number of trials required on a single-trial basis to suggest the existence of SEP responses, thus providing important information for fast SEP extraction in intraoperative monitoring. PMID:26557929

  1. Single-trial detection for intraoperative somatosensory evoked potentials monitoring.

    PubMed

    Hu, L; Zhang, Z G; Liu, H T; Luk, K D K; Hu, Y

    2015-12-01

    Abnormalities of somatosensory evoked potentials (SEPs) provide effective evidence for impairment of the somatosensory system, so that SEPs have been widely used in both clinical diagnosis and intraoperative neurophysiological monitoring. However, due to their low signal-to-noise ratio (SNR), SEPs are generally measured using ensemble averaging across hundreds of trials, thus unavoidably producing a tardiness of SEPs to the potential damages caused by surgical maneuvers and a loss of dynamical information of cortical processing related to somatosensory inputs. Here, we aimed to enhance the SNR of single-trial SEPs using Kalman filtering and time-frequency multiple linear regression (TF-MLR) and measure their single-trial parameters, both in the time domain and in the time-frequency domain. We first showed that, Kalman filtering and TF-MLR can effectively capture the single-trial SEP responses and provide accurate estimates of single-trial SEP parameters in the time domain and time-frequency domain, respectively. Furthermore, we identified significant correlations between the stimulus intensity and a set of indicative single-trial SEP parameters, including the correlation coefficient (between each single-trial SEPs and their average), P37 amplitude, N45 amplitude, P37-N45 amplitude, and phase value (at the zero-crossing points between P37 and N45). Finally, based on each indicative single-trial SEP parameter, we investigated the minimum number of trials required on a single-trial basis to suggest the existence of SEP responses, thus providing important information for fast SEP extraction in intraoperative monitoring.

  2. Intraoperative Radiation Exposure During Revision Total Ankle Replacement.

    PubMed

    Roukis, Thomas S; Iceman, Kelli; Elliott, Andrew D

    2016-01-01

    Intraoperative C-arm image intensification is required for primary total ankle replacement implantation. Significant radiation exposure has been linked to these procedures; however, the radiation exposure during revision total ankle replacement remains unknown. Therefore, we sought to evaluate the radiation exposure encountered during revision total ankle replacement. The data from 41 patients were retrospectively analyzed from a prospective database: 19 Agility(™) to Agility(™); 4 Agility(™) to Custom Agility(™); 9 Agility(™) to INBONE(®) II; 5 Agility(™) to Salto Talaris(®) XT; 2 Scandinavian Total Ankle Replacement Prosthesis to Salto Talaris(®) XT; and 2 INBONE(®) I to INBONE(®) II revision total ankle replacements were performed. Two broad categories were identified: partial revision (Agility(™) to Agility(™), Agility(™) to Custom Agility(™), INBONE(®) I to INBONE(®) II) and complete conversion (Agility(™) to INBONE(®) II, Agility(™) to Salto Talaris(®) XT, Scandinavian Total Ankle Replacement Prosthesis to Salto Talaris(®) XT). The mean radiation exposure per case was significant at 3.49 ± 2.21 mGy. Complete conversions, specifically Agility(™) to INBONE(®) II, exhibited the greatest radiation exposure and C-arm time. Revision implant selection and revision type (complete or partial) directly contributed to radiation exposure. Accordingly, revision systems requiring less radiation exposure are preferable. Surgeons should strive to minimize intraoperative complications and limit additional procedures to those necessary, because both lead to additional radiation exposure.

  3. Computer assistance for intraoperative navigation in ENT surgery.

    PubMed

    Caversaccio; Freysinger

    2003-03-01

    The intraoperative need for exact orientation during interventions in the paranasal sinuses and the augmented need for navigational aids in lateral skull base surgery have lead to the development of computer-aided tools during the last fifteen years. These tools, which provide the position of a tool or a pointer in the patient's preoperative radiologic imaging, have quickly gained a wide acceptance for revision surgeries and the surgical treatment of complex pathologies in Ear-, Nose- and Throat (ENT-) surgery. Currently, the use of such systems is spreading from academic centers to smaller hospitals and will become a standard tool in the near future. We review the present state of computer-aided surgery (CAS) systems, based on our experience as clinical and research centers with a long experience in the field, provide some technological background information and, based on selected cases, show the merits of this technology. The systems we have been working with cover a wide variety of intraoperative navigational systems in ENT surgery (Easy Guide, MedScan II, MKM, SNN, STN, SurgiGATE ORL, Treon, VectorVision, Viewing Wand, [without claiming completeness]), and virtually the whole area of ENT surgeries: macroscopic, (video-)endoscopic and microscopic procedures. The 3D tracking technologies involved cover mechanical, optical (active and passive), magnetic and robotic principles. The visualization tools used are computer monitors, video monitors, head-up-displays and the microscope's oculars, thus spanning the area from pointer-systems to real navigators and a surgical telepresence demonstrator, implementing the majority of available patient-to-image referencing strategies. Clinically, the systems can be operated with an acceptable accuracy of around 1 mm, whereas in laboratory settings and in cadaver studies application accuracy may be pushed to its limits: the physical resolution of the radiologic imaging used for navigation.

  4. Intraoperative squash cytology of central nervous system lesions: a single center study of 326 cases.

    PubMed

    Jaiswal, Sushila; Vij, Mukul; Jaiswal, Awadhesh Kumar; Behari, Sanjay

    2012-02-01

    Cytology has been shown to be of great value in intraoperative consultations of central nervous system (CNS) pathology. Intraoperative smear cytology provides a rapid and reliable intraoperative diagnosis and guidance to the neurosurgeon during surgical resection and lesion targeting. It also helps the surgeon to monitor and modify the approach at surgery. The current study was undertaken to assess the accuracy and utility of intraoperative consultations for cytomorphological diagnosis by smear technique and correlate with histopathological diagnosis. A retrospective study of 326 cases of CNS intraoperative consultations was performed. Smears were prepared from the biopsy samples sent in isotonic saline for immediate processing and stained by the Haematoxylin and Eosin method. The cytomorphological features were noted and correlated with final histopathological diagnosis. Concordance between the intraoperative diagnosis and the final diagnosis was seen in 83.7% of cases. We demonstrated >95% accuracy for glioblastomas and >89% accuracy for meningiomas and schwannomas. A reduction of diagnostic accuracy was seen in oligodendrogliomas (60%) and anaplastic oligodendrogliomas (57.2%). Smear technique is a fairly accurate, relatively safe, rapid, simple, easily reproducible, and cost effective tool to diagnose brain tumors. Smear cytology is of great value in intraoperative consultation of CNS pathology.

  5. The Great Warming Brian Fagan

    NASA Astrophysics Data System (ADS)

    Fagan, B. M.

    2010-12-01

    The Great Warming is a journey back to the world of a thousand years ago, to the Medieval Warm Period. Five centuries of irregular warming from 800 to 1250 had beneficial effects in Europe and the North Atlantic, but brought prolonged droughts to much of the Americas and lands affected by the South Asian monsoon. The book describes these impacts of warming on medieval European societies, as well as the Norse and the Inuit of the far north, then analyzes the impact of harsh, lengthy droughts on hunting societies in western North America and the Ancestral Pueblo farmers of Chaco Canyon, New Mexico. These peoples reacted to drought by relocating entire communities. The Maya civilization was much more vulnerable that small-scale hunter-gatherer societies and subsistence farmers in North America. Maya rulers created huge water storage facilities, but their civilization partially collapsed under the stress of repeated multiyear droughts, while the Chimu lords of coastal Peru adapted with sophisticated irrigation works. The climatic villain was prolonged, cool La Niñalike conditions in the Pacific, which caused droughts from Venezuela to East Asia, and as far west as East Africa. The Great Warming argues that the warm centuries brought savage drought to much of humanity, from China to Peru. It also argues that drought is one of the most dangerous elements in today’s humanly created global warming, often ignored by preoccupied commentators, but with the potential to cause over a billion people to starve. Finally, I use the book to discuss the issues and problems of communicating multidisciplinary science to the general public.

  6. How well do cochlear implant intraoperative impedance measures predict postoperative electrode function?

    PubMed Central

    Goehring, Jenny L.; Hughes, Michelle L.; Baudhuin, Jacquelyn L.; Lusk, Rodney P.

    2012-01-01

    Objective Objectives were to: 1) evaluate the incidence of abnormal cochlear implant electrode impedance intraoperatively and at the initial activation, 2) identify the percentage of abnormalities that resolve by the initial activation, and 3) determine the incidence of normal intraoperative impedances that present as abnormal at the initial activation. Study Design Retrospective records review of intraoperative and postoperative cochlear implant electrode impedances. Setting Tertiary referral center. Patients Records were examined for 194 devices implanted in 165 pediatric and adult patients. Results Results indicate at least 1 open (OC) or short circuit (SC) in 12.4% (24/194) of devices intraoperatively, decreasing to 8.2% (16/194) postoperatively. OCs were more prevalent than SCs for intraoperative (92% vs. 8%) and postoperative (94% vs. 6%) intervals. Of the 3430 total electrodes, 78 had abnormal impedance intraoperatively. Sixty-four of those (82%) resolved by the postoperative interval (62 OC, 2 SC) while 14/78 (18%) remained abnormal postoperatively (12 OC, 2 SC). Six of 3430 (0.17%) electrodes had normal impedance intraoperatively but were abnormal postoperatively. Conclusions The incidence of SCs in the present study is likely underestimated due to poor sensitivity of monopolar coupling for detecting SCs. Intraoperative OCs have a high probability of resolving by the initial activation, particularly when contiguous electrodes are affected, and suggests limited need for the use of a backup device in these cases. Surgical technique and/or complications such as explant/reimplant or perilymphatic gushers may result in increased incidence of bubbles in the cochlea, and may play a role in abnormal intraoperative impedance results. PMID:23295726

  7. How warm days increase belief in global warming

    NASA Astrophysics Data System (ADS)

    Zaval, Lisa; Keenan, Elizabeth A.; Johnson, Eric J.; Weber, Elke U.

    2014-02-01

    Climate change judgements can depend on whether today seems warmer or colder than usual, termed the local warming effect. Although previous research has demonstrated that this effect occurs, studies have yet to explain why or how temperature abnormalities influence global warming attitudes. A better understanding of the underlying psychology of this effect can help explain the public's reaction to climate change and inform approaches used to communicate the phenomenon. Across five studies, we find evidence of attribute substitution, whereby individuals use less relevant but available information (for example, today's temperature) in place of more diagnostic but less accessible information (for example, global climate change patterns) when making judgements. Moreover, we rule out alternative hypotheses involving climate change labelling and lay mental models. Ultimately, we show that present temperature abnormalities are given undue weight and lead to an overestimation of the frequency of similar past events, thereby increasing belief in and concern for global warming.

  8. Distinguishing warming-induced drought from drought-induced warming

    NASA Astrophysics Data System (ADS)

    Roderick, M. L.; Yin, D.

    2015-12-01

    It is usually observed that temperatures, especially maximum temperatures are higher during drought. A very widely held public perception is that the increase in temperature is a cause of drought. This represents the warming-induced drought scenario. However, the agricultural and hydrologic scientific communities have a very different interpretation with drought being the cause of increasing temperature. In essence, those communities assume the warming is a surface feedback and their interpretation is for drought-induced warming. This is a classic cause-effect problem that has resisted definitive explanation due to the lack of radiative observations at suitable spatial and temporal scales. In this presentation we first summarise the observations and then use theory to untangle the cause-effect relationships that underlie the competing interpretations. We then show how satellite data (CERES, NASA) can be used to disentangle the cause-effect relations.

  9. Analysis of data from spacecraft (stratospheric warmings)

    NASA Technical Reports Server (NTRS)

    Anderson, A. D.

    1974-01-01

    Links between the upper atmosphere and the stratosphere were studied to explain stratospheric warmings, and to correlate the warmings with other terrestrial and solar phenomena. Physical mechanisms for warming, or which may act as a trigger are discussed along with solar and geophysical indices. Two stratospheric warming cases are analyzed.

  10. Active Movement Warm-Up Routines

    ERIC Educational Resources Information Center

    Walter, Teri; Quint, Ashleigh; Fischer, Kim; Kiger, Joy

    2011-01-01

    This article presents warm-ups that are designed to physiologically and psychologically prepare students for vigorous physical activity. An active movement warm-up routine is made up of three parts: (1) active warm-up movement exercises, (2) general preparation, and (3) the energy system. These warm-up routines can be used with all grade levels…

  11. Ion-ion dynamic structure factor of warm dense mixtures

    DOE PAGESBeta

    Gill, N. M.; Heinonen, R. A.; Starrett, C. E.; Saumon, D.

    2015-06-25

    In this study, the ion-ion dynamic structure factor of warm dense matter is determined using the recently developed pseudoatom molecular dynamics method [Starrett et al., Phys. Rev. E 91, 013104 (2015)]. The method uses density functional theory to determine ion-ion pair interaction potentials that have no free parameters. These potentials are used in classical molecular dynamics simulations. This constitutes a computationally efficient and realistic model of dense plasmas. Comparison with recently published simulations of the ion-ion dynamic structure factor and sound speed of warm dense aluminum finds good to reasonable agreement. Using this method, we make predictions of the ion-ionmore » dynamical structure factor and sound speed of a warm dense mixture—equimolar carbon-hydrogen. This material is commonly used as an ablator in inertial confinement fusion capsules, and our results are amenable to direct experimental measurement.« less

  12. Ion-ion dynamic structure factor of warm dense mixtures

    SciTech Connect

    Gill, N. M.; Heinonen, R. A.; Starrett, C. E.; Saumon, D.

    2015-06-25

    In this study, the ion-ion dynamic structure factor of warm dense matter is determined using the recently developed pseudoatom molecular dynamics method [Starrett et al., Phys. Rev. E 91, 013104 (2015)]. The method uses density functional theory to determine ion-ion pair interaction potentials that have no free parameters. These potentials are used in classical molecular dynamics simulations. This constitutes a computationally efficient and realistic model of dense plasmas. Comparison with recently published simulations of the ion-ion dynamic structure factor and sound speed of warm dense aluminum finds good to reasonable agreement. Using this method, we make predictions of the ion-ion dynamical structure factor and sound speed of a warm dense mixture—equimolar carbon-hydrogen. This material is commonly used as an ablator in inertial confinement fusion capsules, and our results are amenable to direct experimental measurement.

  13. Intraoperative platelet-rich plasma does not improve outcomes of total knee arthroplasty.

    PubMed

    Morishita, Masayuki; Ishida, Kazunari; Matsumoto, Tomoyuki; Kuroda, Ryosuke; Kurosaka, Masahiro; Tsumura, Nobuhiro

    2014-12-01

    This randomized controlled study was conducted to assess the effects of platelet-rich plasma (PRP) on outcomes of total knee arthroplasty (TKA). Forty patients who underwent unilateral TKA were evaluated prospectively; 20 received intraoperative PRP and 20 served as control subjects. The results showed no significant differences in reduction of bleeding, range of motion, swelling around the knee joint, muscle power recovery, pain, Knee Society Scores, and Knee Injury and Osteoarthritis Outcome Score between the 2 groups. Additionally, no distinct clinical characteristics were found in patients who received intraoperative PRP. Therefore, we conclude that intraoperative PRP does not improve outcomes of TKA.

  14. 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.

  15. Global warming and infectious disease.

    PubMed

    Khasnis, Atul A; Nettleman, Mary D

    2005-01-01

    Global warming has serious implications for all aspects of human life, including infectious diseases. The effect of global warming depends on the complex interaction between the human host population and the causative infectious agent. From the human standpoint, changes in the environment may trigger human migration, causing disease patterns to shift. Crop failures and famine may reduce host resistance to infections. Disease transmission may be enhanced through the scarcity and contamination of potable water sources. Importantly, significant economic and political stresses may damage the existing public health infrastructure, leaving mankind poorly prepared for unexpected epidemics. Global warming will certainly affect the abundance and distribution of disease vectors. Altitudes that are currently too cool to sustain vectors will become more conducive to them. Some vector populations may expand into new geographic areas, whereas others may disappear. Malaria, dengue, plague, and viruses causing encephalitic syndromes are among the many vector-borne diseases likely to be affected. Some models suggest that vector-borne diseases will become more common as the earth warms, although caution is needed in interpreting these predictions. Clearly, global warming will cause changes in the epidemiology of infectious diseases. The ability of mankind to react or adapt is dependent upon the magnitude and speed of the change. The outcome will also depend on our ability to recognize epidemics early, to contain them effectively, to provide appropriate treatment, and to commit resources to prevention and research.

  16. Warming early Earth and Mars

    SciTech Connect

    Kasting, J.F.

    1997-05-23

    Sagan and Chyba, in their article on page 1217 of this issue, have revived an old debate about how liquid water was maintained on early Earth and Mars despite a solar luminosity 25 to 30% lower than that at present. A theory that has been popular for some time is that greatly elevated concentrations of atmospheric COD produced by the action of the carbonate-silicate cycle, provided enough of a greenhouse effect to warm early Earth. However, Rye et al. have placed geochemical constraints on early atmospheric CO{sub 2} abundances that fall well below the levels needed to warm the surface. These constraints are based on the absence of siderite (FeCO{sub 3}) in ancient soil profiles-a negative and, hence, rather weak form of evidence- and apply to the time period 2.2 to 2.8 billion years ago, when Earth was already middle aged. Nonetheless, the soil data provide some indication that atmospheric CO{sub 2} levels may have been lower than previously thought. An even more serious problem arises if one tries to keep early Mars warm with CO{sub 2}. Model calculations predict that CO{sub 2} clouds would form on Mars in the upper troposphere, reducing the lapse rate and severely limiting the amount of surface warming. A suggestion that CO{sub 2} clouds may have warmed the planet radiatively has yet to be borne out by detailed calculations. 26 refs.

  17. Global warming: trends and effects.

    PubMed

    Tickell, C

    1993-01-01

    As animals we have been a remarkably successful species; but also as animals we are vulnerable to environmental, in particular climate change. Such change is accelerating as a result of human activity, and global warming may already be taking place. Although we can foresee the trends, we cannot yet be specific about the results. Change usually proceeds by steps rather than gradients. But warming would probably include new risks to human health and contribute to an increase in human displacement. Of course climate change is only one among other complex problems facing human society, but it is closely related to them all, including population increase, environmental degradation and loss of biodiversity. We cannot prevent global warming but we can anticipate and mitigate some of its worst effects. Peoples and governments still need persuading of the need for action and of the magnitude of the issue at stake.

  18. Cosmic Rays and Global Warming

    SciTech Connect

    Sloan, T.; Wolfendale, A. W.

    2008-01-24

    Some workers have claimed that the observed temporal correlations of (low level) terrestrial cloud cover with the cosmic ray intensity changes, due to solar modulation, are causal. The possibility arises, therefore, of a connection between cosmic rays and Global Warming. If true, the implications would be very great. We have examined this claim in some detail. So far, we have not found any evidence in support and so our conclusions are to doubt it. From the absence of corroborative evidence we estimate that less than 15% at the 95% confidence level, of the 11-year cycle warming variations are due to cosmic rays and less than 2% of the warming over the last 43 years is due to this cause. The origin of the correlation itself is probably the cycle of solar irradiance although there is, as yet, no certainty.

  19. Evaluating the Dominant Components of Warming in Pliocene Climate Simulations

    NASA Technical Reports Server (NTRS)

    Hill, D. J.; Haywood, A. M.; Lunt, D. J.; Hunter, S. J.; Bragg, F. J.; Contoux, C.; Stepanek, C.; Sohl, L.; Rosenbloom, N. A.; Chan, W.-L.; Kamae, Y.; Zhang, Z.; Abe-Ouchi, A.; Chandler, M. A.; Jost, A.; Lohmann, G.; Otto-Bliesner, B. L.; Ramstein, G.; Ueda, H.

    2014-01-01

    The Pliocene Model Intercomparison Project (PlioMIP) is the first coordinated climate model comparison for a warmer palaeoclimate with atmospheric CO2 significantly higher than pre-industrial concentrations. The simulations of the mid-Pliocene warm period show global warming of between 1.8 and 3.6 C above pre-industrial surface air temperatures, with significant polar amplification. Here we perform energy balance calculations on all eight of the coupled ocean-atmosphere simulations within PlioMIP Experiment 2 to evaluate the causes of the increased temperatures and differences between the models. In the tropics simulated warming is dominated by greenhouse gas increases, with the cloud component of planetary albedo enhancing the warming in most of the models, but by widely varying amounts. The responses to mid-Pliocene climate forcing in the Northern Hemisphere midlatitudes are substantially different between the climate models, with the only consistent response being a warming due to increased greenhouse gases. In the high latitudes all the energy balance components become important, but the dominant warming influence comes from the clear sky albedo, only partially offset by the increases in the cooling impact of cloud albedo. This demonstrates the importance of specified ice sheet and high latitude vegetation boundary conditions and simulated sea ice and snow albedo feedbacks. The largest components in the overall uncertainty are associated with clouds in the tropics and polar clear sky albedo, particularly in sea ice regions. These simulations show that albedo feedbacks, particularly those of sea ice and ice sheets, provide the most significant enhancements to high latitude warming in the Pliocene.

  20. Is there a Role for Preoperative Infusion or Intraoperative Cholangiography?

    PubMed Central

    Lau, W. Y.; Li, Arthur K. C.

    1997-01-01

    Background: There has been a resurgence of interest in recent years in preoperative infusion cholangiography (PIC). The role of routine PIC compared to routine intraoperative cholangiography (IOC) has not been clearly defined. Study design: In our department between 1985 and 1991, 1,042 of 1,576 consecutive patients with biliary calculous disease had elective cholecystectomy: 694 patients were prospectively scheduled for PIC, and 348 patients were randomly allocated to IOC. The patients in the PIC and IOC groups were similar with regard to age, history of biliopancreatic complications, and laboratory findings. The cost of PIC in Sweden is nearly five times greater than the cost of IOC. Results: Satisfactory opacification of the biliary system was obtained in 90.1 and 96.8 percent of patients who underwent PIC and IOC, respectively. Preoperative infusion cholangiography required support by IOC in 19.5 percent of patients. There were no statistically significant differences between the PIC and IOC groups with regard to the incidence (7 percent in both groups) of or positive predictive value (68 and 80 percent, respectively) for bile duct stones, rate of retained stones (6 and 20 percent, respectively), intraoperative (5.6 and 6.3 percent, respectively) or postoperative (13.3 and 15.9 percent, respectively) morbidity, or incidence of bile duct anomalies (0.9 and 0.3 percent, respectively). Median operative time was longer in .patients with (95 minutes) compared to those without (75 minutes) IOC (p<0.001). More postoperative complications occurred after bile duct exploration (26 of 75 patients) compared to cholecystectomy alone (114 of 917 patients, p<0.001). The 30-day mortality was zero. Minor bile duct injuries occurred in two patients (0.2 percent) at cholecystectomy, (one with and one without bile duct exploration). In no patient was the cholangiographic finding of a biliary anomaly crucial for the safe execution of cholecystectomy. Conclusions: In our study, PIC

  1. Results of intraoperative mitomycin C application in dacryocystorhinostomy

    PubMed Central

    Liao, S.; Kao, S.; Tseng, J.; Chen, M.; Hou, P.

    2000-01-01

    AIMS—To evaluate the long term results of intraoperative mitomycin C application in dacryocystorhinostomy (DCR) surgery compared with results of the conventional procedure.
METHODS—In this prospective randomised controlled study, a total of 88 eyes diagnosed with acquired nasolacrimal duct obstruction were randomly divided into a conventional DCR group and a mitomycin C group in which mitomycin C was used during DCR surgery. The surgical procedures in both groups were exactly the same, except that in the patients in the mitomycin C group, a piece of neurosurgical cottonoid soaked with 0.2 mg/ml mitomycin C was applied to the osteotomy site for 30 minutes. The results of the DCR surgeries were evaluated by objective findings such as irrigation and the height of tear meniscus and subjective symptoms by asking patients the condition of tearing improvement.
RESULTS—Among the 44 eyes in the mitomycin C group, 95.5% of patients remained totally symptom free after 10 months of follow up; while in the conventional group, 70.5% of patients were reported to be symptom free and 18% of patients to have an improvement in their symptoms. There was a significant difference between these two groups. As far as objective findings were concerned, there were 41 eyes in the mitomycin C group classified as having a normal and one eye with moderate tear meniscus level, compared with 32 eyes and seven eyes, respectively, in the conventional group. There was also a significant difference between these two groups. The non-patency rate in the mitomycin C group is 4.5% compared with 11.4% in the conventional group. There were no complications such as abnormal nasal bleeding, mucosal necrosis, or infection except one patient with delayed wound healing.
CONCLUSIONS—Intraoperative mitomycin C application is effective in increasing the success rate of DCR surgery in standard nasolacrimal duct obstruction, and no significant complications resulted from its use.

 PMID

  2. Characterizing Warm Molecular Hydrogen in Active Star-Forming Systems

    NASA Astrophysics Data System (ADS)

    Rangwala, Naseem

    2014-10-01

    Herschel observations of nearby star-forming galaxies have determined that the warm component of the molecular gas traced by the high-J CO lines dominates the luminosity (~90% of the total CO luminosity) and hence the energetics of the molecular ISM. At the temperatures (T = 300 - 2000 K) and densities (n_H < 1E6 per cubic cm) typically found in our survey, H2 emission is the dominant gas coolant, much more important than CO. A fundamental assumption of all analyses of CO emission has been that CO emission traces H2 over the entire range of physical conditions in the observed sources. However, a direct observational comparison of spatial distributions and kinematics of CO and H2 has never been made for the warm molecular gas. We propose to observe the warm H2, in S(1) and S(2) transitions, with the SOFIA-EXES instrument in a diverse sample of star-forming systems: NGC 253 (starburst nucleus), NGC 6240 (luminous infrared galaxy), NGC 1068 (Seyfert-2), and SgrB2(M)/(N) (Galactic hot cores). The primary goal is to compare these measurements with the warm CO (J = 6-5 transition) observed with the Atacama Large Millimeter Array (ALMA) to investigate differences in the kinematics and spatial distributions (for the extended targets) of the two molecules and thereby confirm whether CO is a reliable tracer of H2 in the warm gas.

  3. Global warming at the summit

    NASA Astrophysics Data System (ADS)

    Showstack, Randy

    During the recent summit meeting between Russian President Vladimir Putin and U.S. President Bill Clinton, the two leaders reaffirmed their concerns about global warming and the need to continue to take actions to try to reduce the threat.In a June 4 joint statement, they stressed the need to develop flexibility mechanisms, including international emissions trading, under the Kyoto Protocol to the United Nations Framework Convention on Climate Change. They also noted that initiatives to reduce the risk of greenhouse warming, including specific mechanisms of the Kyoto Protocol, could potentially promote economic growth.

  4. See the brain at work: intraoperative laser Doppler functional brain imaging

    NASA Astrophysics Data System (ADS)

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

    2009-07-01

    During open brain surgery we acquire perfusion images non-invasively using laser Doppler imaging. The regions of brain activity show a distinct signal in response to stimulation providing intraoperative functional brain maps of remarkably strong contrast.

  5. Intraoperative ERCP: What role does it have in the era of laparoscopic cholecystectomy?

    PubMed

    Rábago, Luis R; Ortega, Alejandro; Chico, Inmaculada; Collado, David; Olivares, Ana; Castro, Jose Luis; Quintanilla, Elvira

    2011-12-16

    In the treatment of patients with symptomatic cholelithiasis and choledocholithiasis (CBDS) detected during intraoperative cholangiography (IOC), or when the preoperative study of a patient at intermediate risk for CBDS cannot be completed due to the lack of imaging techniques required for confirmation, or if they are available and yield contradictory radiological and clinical results, patients can be treated using intraoperative endoscopic retrograde cholangiopancreatography (ERCP) during the laparoscopic treatment or postoperative ERCP if the IOC finds CBDS. The choice of treatment depends on the level of experience and availability of each option at each hospital. Intraoperative ERCP has the advantage of being a single-stage treatment and has a significant success rate, an easy learning curve, low morbidity involving a shorter hospital stay and lower costs than the two-stage treatments (postoperative and preoperative ERCP). Intraoperative ERCP is also a good salvage treatment when preoperative ERCP fails or when total laparoscopic management also fails.

  6. 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.

  7. The Dutch Linguistic Intraoperative Protocol: a valid linguistic approach to awake brain surgery.

    PubMed

    De Witte, E; Satoer, D; Robert, E; Colle, H; Verheyen, S; Visch-Brink, E; Mariën, P

    2015-01-01

    Intraoperative direct electrical stimulation (DES) is increasingly used in patients operated on for tumours in eloquent areas. Although a positive impact of DES on postoperative linguistic outcome is generally advocated, information about the neurolinguistic methods applied in awake surgery is scarce. We developed for the first time a standardised Dutch linguistic test battery (measuring phonology, semantics, syntax) to reliably identify the critical language zones in detail. A normative study was carried out in a control group of 250 native Dutch-speaking healthy adults. In addition, the clinical application of the Dutch Linguistic Intraoperative Protocol (DuLIP) was demonstrated by means of anatomo-functional models and five case studies. A set of DuLIP tests was selected for each patient depending on the tumour location and degree of linguistic impairment. DuLIP is a valid test battery for pre-, intraoperative and postoperative language testing and facilitates intraoperative mapping of eloquent language regions that are variably located. PMID:25526520

  8. Intraoperative ERCP: What role does it have in the era of laparoscopic cholecystectomy?

    PubMed Central

    Rábago, Luis R; Ortega, Alejandro; Chico, Inmaculada; Collado, David; Olivares, Ana; Castro, Jose Luis; Quintanilla, Elvira

    2011-01-01

    In the treatment of patients with symptomatic cholelithiasis and choledocholithiasis (CBDS) detected during intraoperative cholangiography (IOC), or when the preoperative study of a patient at intermediate risk for CBDS cannot be completed due to the lack of imaging techniques required for confirmation, or if they are available and yield contradictory radiological and clinical results, patients can be treated using intraoperative endoscopic retrograde cholangiopancreatography (ERCP) during the laparoscopic treatment or postoperative ERCP if the IOC finds CBDS. The choice of treatment depends on the level of experience and availability of each option at each hospital. Intraoperative ERCP has the advantage of being a single-stage treatment and has a significant success rate, an easy learning curve, low morbidity involving a shorter hospital stay and lower costs than the two-stage treatments (postoperative and preoperative ERCP). Intraoperative ERCP is also a good salvage treatment when preoperative ERCP fails or when total laparoscopic management also fails. PMID:22195234

  9. Use of BIS VISTA bilateral monitor for diagnosis of intraoperative seizures, a case report.

    PubMed

    Iturri Clavero, F; Tamayo Medel, G; de Orte Sancho, K; González Uriarte, A; Iglesias Martínez, A; Martínez Ruíz, A

    2015-12-01

    Changes in BIS (bispectral index) VISTA bilateral monitoring system associated with intraoperative episodes of generalized and focal seizures, during total intravenous anesthesia for resection of a left frontal parasagittal meningioma, are herein described.

  10. [Intraoperative complications of surgical treatment of cervical cancer stages I and II in FIGO].

    PubMed

    Kornovski, Y; Iamail, E; Ivanov, S; Kovachev, E

    2013-01-01

    With this study are presented the types of intraoperative complications and their frequency in radical hysterectomy and lymph node dissection (pelvic and paraaortic) as surgical treatment of 294 patients with invasive cervical cancer FIGO stages I and II.

  11. 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.

  12. Foundations for evidence-based intraoperative neurophysiological monitoring.

    PubMed

    Howick, Jeremy; Cohen, Bernard Allan; McCulloch, Peter; Thompson, Matthew; Skinner, Stanley A

    2016-01-01

    In this review, we recommend means to enhance the evidence-base for intraoperative neurophysiological monitoring (IONM). We address two preliminary issues: (1) whether IONM should be evaluated as a diagnostic test or an intervention, and (2) the state of the evidence for IONM (as presented in systematic reviews, for example). Three reasons may be suggested to evaluate at least some IONM applications as interventions (or as part of an "interventional cascade"). First, practical barriers limit our ability to measure IONM diagnostic accuracy. Second, IONM results are designed to be correlated with interventions during surgery. Third, IONM should improve patient outcomes when IONM-directed intervention alters the course of surgery. Observational evidence for IONM is growing yet more is required to understand the conditions under which IONM, in its variety of settings, can benefit patients. A multi-center observational cohort study would represent an important initial compromise between the pragmatic difficulties with conducting controlled trials in IONM and the Evidence-Based Medicine (EBM) view that large scale randomized trials are required. Such a cohort study would improve the evidence base and (if justified) provide the rationale for controlled trials.

  13. Intraoperative management of patients with heparin-induced thrombocytopenia.

    PubMed

    Kappa, J R; Fisher, C A; Todd, B; Stenach, N; Bell, P; Campbell, F; Ellison, N; Addonizio, V P

    1990-05-01

    For 11 patients with confirmed heparin-induced thrombocytopenia, we used reversible platelet inhibition with iloprost, a stable prostacyclin analogue, to permit safe heparin administration for cardiac (n = 9) or vascular (n = 2) operations. In vitro, iloprost (0.01 mumol/L) prevented both heparin-induced platelet aggregation and 14C-serotonin release in all patients. Therefore, intraoperatively, a continuous infusion of iloprost was started before administration of heparin and was continued until 15 minutes after administration of protamine. For cardiac patients, after heparin administration, the whole blood platelet count did not change (171,000 +/- 29,000/microL versus 174,000 +/- 29,000/microL, mean +/- standard error of the mean); no spontaneous platelet aggregation was observed, and plasma levels of the alpha-granule constituents platelet factor 4 and beta-thromboglobulin increased from 38 +/- 14 and 140 +/- 18 ng/mL to 591 +/- 135 and 235 +/- 48 ng/mL, respectively. Fibrinopeptide A levels actually decreased from 287 +/- 150 to 27 +/- 6 ng/mL. Furthermore, adenosine diphosphate-induced platelet activation was preserved, postoperative bleeding times were unchanged, and no heparin-related deaths occurred. Similar results were obtained in both vascular patients. We conclude that temporary platelet inhibition with iloprost now permits safe heparin administration in all patients with heparin-induced thrombocytopenia who require a cardiac or vascular operation. PMID:1692679

  14. Intraoperative magnetic resonance imaging for neurosurgical procedures: anesthetic implications.

    PubMed

    Henrichs, Bernadette; Walsh, Robert P

    2011-02-01

    Intraoperative magnetic resonance imaging (IMRI) for tumor resection allows a neurosurgeon to pinpoint the exact location of the tumor before resection and to navigate to the tumor after the incision is made. Although the anesthetic management is not substantially different from that for other neurosurgical procedures, strategies to keep the patient and operating room personnel safe can be challenging. Because of the risk of injury by the strong force of the magnet, safety precautions with respect to anesthetic delivery must be taken. Ferrous objects must be removed and kept outside the operating room. Only MRI-compatible equipment is allowed in the MRI operating room. This includes the anesthesia machine, anesthesia cart, intubating equipment, monitors, stethoscopes, poles for intravenous solutions, and body warmers. Surgical equipment and instruments must be MRI-compatible. Absolute contraindications to entering the MRI suite include pacemakers, cochlear implants, certain cranial aneurysm clips, and metal joints or implants. Goals of anesthesia delivery during IMRI procedures include the following: (1) promoting the safety of patients and staff, (2) preventing MRI-associated accidents, (3) identifying potential equipment-related hazards, (4) recognizing limitations of physiologic monitoring, and (5) acknowledging other potential hazards such as noise. PMID:21473229

  15. Robust nonrigid registration to capture brain shift from intraoperative MRI.

    PubMed

    Clatz, Olivier; Delingette, Hervé; Talos, Ion-Florin; Golby, Alexandra J; Kikinis, Ron; Jolesz, Ferenc A; Ayache, Nicholas; Warfield, Simon K

    2005-11-01

    We present a new algorithm to register 3-D preoperative magnetic resonance (MR) images to intraoperative MR images of the brain which have undergone brain shift. This algorithm relies on a robust estimation of the deformation from a sparse noisy set of measured displacements. We propose a new framework to compute the displacement field in an iterative process, allowing the solution to gradually move from an approximation formulation (minimizing the sum of a regularization term and a data error term) to an interpolation formulation (least square minimization of the data error term). An outlier rejection step is introduced in this gradual registration process using a weighted least trimmed squares approach, aiming at improving the robustness of the algorithm. We use a patient-specific model discretized with the finite element method in order to ensure a realistic mechanical behavior of the brain tissue. To meet the clinical time constraint, we parallelized the slowest step of the algorithm so that we can perform a full 3-D image registration in 35 s (including the image update time) on a heterogeneous cluster of 15 personal computers. The algorithm has been tested on six cases of brain tumor resection, presenting a brain shift of up to 14 mm. The results show a good ability to recover large displacements, and a limited decrease of accuracy near the tumor resection cavity.

  16. An orthopedic tissue adhesive for targeted delivery of intraoperative biologics.

    PubMed

    Simson, Jacob; Crist, Joshua; Strehin, Iossif; Lu, Qiaozhi; Elisseeff, Jennifer H

    2013-03-01

    Tissue adhesives can bind together damaged tissues and serve as tools to deliver and localize therapeutics to facilitate regeneration. One emerging therapeutic trend in orthopedics is the use of intraoperative biologics (IOB), such as bone marrow (BM) and platelet-rich plasma (PRP), to stimulate healing. Here, we introduce the application of the biomaterial chondroitin sulfate succinimidyl succinate (CS-NHS) to deliver IOB in a hydrogel adhesive. We demonstrate the biomaterial's ability to bind various tissue types and its cellular biocompatibility with encapsulated human mesenchymal stem cells (hMSCs). Further, we examine in detail the CS-NHS adhesive combined with BM aspirate for use in bone applications. hMSCs were encapsulated in CS-BM and cultured for 5 weeks in osteogenic medium. Quantitative RT-PCR demonstrated osteogenesis via upregulation of the osteogenic transcription factor Runx2 and bone markers alkaline phosphatase and osteocalcin. Significant deposition of calcium and osteocalcin was detected using biochemical, histological, and immunohistochemical techniques. Shear testing demonstrated that the CS-BM adhesive exhibited an adhesive strength approximately an order of magnitude stronger than fibrin glue and approaching that of a cyanoacrylate adhesive. These results indicate that CS-NHS is a promising delivery tool for IOB in orthopedic applications requiring a strong, degradable, and biocompatible adhesive that supports bone growth. PMID:23097279

  17. 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.

  18. 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.

  19. Intraoperative and external beam irradiation for locally advanced colorectal cancer.

    PubMed Central

    Gunderson, L L; Martin, J K; Bèart, R W; Nagorney, D M; Fieck, J M; Wieand, H S; Martinez, A; O'Connell, M J; Martenson, J A; McIlrath, D C

    1988-01-01

    In view of poor local control rates obtained with standard treatment, intraoperative radiation (IORT) using electrons was combined with external beam irradiation and surgical resection, with or without 5-fluorouracil (5FU), in 51 patients with locally advanced colorectal cancer (recurrent, 36 patients; primary, 15 patients). Patients received 4500-5500 cGy (rad) of fractionated, multiple field external beam irradiation and an IORT dose of 1000-2000 cGy. Thirty of 51 patients (59%) are alive and 22 patients (43%) are free of disease. In 44 patients at risk greater than or equal to 1 year, local progression within the IORT field has occurred in 1 of 44 (2%) and within the external beam field in 8 of 44 (18%). All local failures have occurred in patients with recurrence or with gross residual after partial resection, and the risk was less in patients who received 5FU during external irradiation (1 of 11, 9% vs. 6 of 31, 19%). The incidence of distant metastases is high in patients with recurrence, but subsequent peritoneal failures are infrequent. Acute and chronic tolerance have been acceptable, but peripheral nerve appears to be a dose-limiting structure. Randomized trials are needed to determine whether potential gains with IORT are real. PMID:3337561

  20. Intraoperative Squash Cytologic Features of Subependymal Giant Cell Astrocytoma.

    PubMed

    Nasit, Jitendra; Vaghsiya, Viren; Hiryur, Srilaxmi; Patel, Smita

    2016-01-01

    Subependymal giant cell astrocytoma (SEGA) is a low grade (WHO Grade I) tumor, usually seen in patients with tuberous sclerosis complex and commonly occurs at a lateral ventricular location. Intraoperative squash cytologic features can help in differentiating SEGA from gemistocytic astrocytoma (GA), giant cell glioblastoma and ependymoma, in proper clinical context and radiological findings, which may alter the surgical management. Here, we present a case of SEGA with squash cytologic findings and a review of cytology findings of SEGA presently available in the literature. Loose cohesive clusters of large polygonal cells containing an eccentric nucleus, evenly distributed granular chromatin, distinct to prominent nucleoli, and moderate to the abundant eosinophilic cytoplasm in a hair-like fibrillar background are the key cytologic features of SEGA. Other important features are moderate anisonucleosis and frequent binucleation and multinucleation. The absence of mitoses, necrosis, and vascular endothelial proliferation are important negative features. Other consistent features are cellular smears, few dispersed cells, few spindly strap-like cells, rare intranuclear cytoplasmic inclusion, and perivascular pseudorosettes. PMID:27013816

  1. Intraoperative Squash Cytologic Features of Subependymal Giant Cell Astrocytoma

    PubMed Central

    Nasit, Jitendra; Vaghsiya, Viren; Hiryur, Srilaxmi; Patel, Smita

    2016-01-01

    Subependymal giant cell astrocytoma (SEGA) is a low grade (WHO Grade I) tumor, usually seen in patients with tuberous sclerosis complex and commonly occurs at a lateral ventricular location. Intraoperative squash cytologic features can help in differentiating SEGA from gemistocytic astrocytoma (GA), giant cell glioblastoma and ependymoma, in proper clinical context and radiological findings, which may alter the surgical management. Here, we present a case of SEGA with squash cytologic findings and a review of cytology findings of SEGA presently available in the literature. Loose cohesive clusters of large polygonal cells containing an eccentric nucleus, evenly distributed granular chromatin, distinct to prominent nucleoli, and moderate to the abundant eosinophilic cytoplasm in a hair-like fibrillar background are the key cytologic features of SEGA. Other important features are moderate anisonucleosis and frequent binucleation and multinucleation. The absence of mitoses, necrosis, and vascular endothelial proliferation are important negative features. Other consistent features are cellular smears, few dispersed cells, few spindly strap-like cells, rare intranuclear cytoplasmic inclusion, and perivascular pseudorosettes. PMID:27013816

  2. Incorporation of surface-based deformations for updating images intraoperatively

    NASA Astrophysics Data System (ADS)

    Miga, Michael I.; Fitzpatrick, J. Michael; Galloway, Robert L., Jr.; Paulsen, Keith D.

    2001-05-01

    Patient-to-image misalignment becomes exacerbated by common surgical events such as brain sag, drug interactions, retraction, and resection. One strategy to remedy this mis- registration is to employ computational models in conjunction with low-cost intraoperatively-acquired data (e.g. surface tracking, and co-registered ultrasound) to deform preoperative imaging data to account for OR actions. In this paper, we present preliminary data from a cortical surface scanning system and study the impact of surface- based information on model-updates. Preliminary data is presented using a 3D laser scanning technology in conjunction with an iterative closest point (ICP) algorithm to register and track phantom and ex vivo data. Simulations are presented to analyze the direct use of displacement data versus modeling the underlying physical load in a clinical example of gravity-induced deformation. Results demonstrate dramatic differences in subsurface deformation fields highlighting that the nature of the surgical load (i.e. surface or body force) must be thoughtfully discriminated to accurately update images. Furthermore, the results suggest that the application of surface displacements to update image volumes must be consistent with the physical origin of deformation rather than applied in a direct interpolative sense.

  3. Dosimetry characteristics of metallic cones for intraoperative radiotherapy.

    PubMed

    Nyerick, C E; Ochran, T G; Boyer, A L; Hogstrom, K R

    1991-07-01

    Dosimetry data were obtained on the first dedicated linear accelerator of its type designed for electron intraoperative radiotherapy (IORT) within an operating room. The linear accelerator uses a high dose rate, 9 Gy.min-1, to reduce the treatment time. Its chrome-plated brass treatment cones, designed with straight ends and 22.5 degrees beveled ends, are not mechanically attached to the collimator head, but are aligned using a laser projection system. Dosimetry measurements were made for each combination of energy (6, 9, 12, 15, and 16 MeV), cone size (diameters range from 5 to 12 cm), and cone type (22.5 degrees beveled or straight). From these data, depth-dose curves, cone output, and air-gap correction factors were generated that allow the calculation of the monitor setting for delivering a prescribed dose at any depth for any irradiation condition (energy, cone, air gap). Isodose data were measured for every cone using film in a solid water phantom. Scatter off the inside wall of the cone resulted in peripheral dose horns near the surface that were energy and cone dependent, being as large as 120%.

  4. Dosimetry characteristics of metallic cones for intraoperative radiotherapy

    SciTech Connect

    Nyerick, C.E.; Ochran, T.G.; Boyer, A.L.; Hogstrom, K.R. )

    1991-07-01

    Dosimetry data were obtained on the first dedicated linear accelerator of its type designed for electron intraoperative radiotherapy (IORT) within an operating room. The linear accelerator uses a high dose rate, 9 Gy.min-1, to reduce the treatment time. Its chrome-plated brass treatment cones, designed with straight ends and 22.5 degrees beveled ends, are not mechanically attached to the collimator head, but are aligned using a laser projection system. Dosimetry measurements were made for each combination of energy (6, 9, 12, 15, and 16 MeV), cone size (diameters range from 5 to 12 cm), and cone type (22.5 degrees beveled or straight). From these data, depth-dose curves, cone output, and air-gap correction factors were generated that allow the calculation of the monitor setting for delivering a prescribed dose at any depth for any irradiation condition (energy, cone, air gap). Isodose data were measured for every cone using film in a solid water phantom. Scatter off the inside wall of the cone resulted in peripheral dose horns near the surface that were energy and cone dependent, being as large as 120%.

  5. Revision stapedectomy: intraoperative findings, results, and review of the literature.

    PubMed

    Han, W W; Incesulu, A; McKenna, M J; Rauch, S D; Nadol, J B; Glynn, R J

    1997-09-01

    Seventy-four revision stapedectomies performed consecutively over 10 years (1986 to 1995) were reviewed retrospectively. The most common intraoperative findings were incus erosion, prosthesis displacement, and oval window closure. Incus erosion was more frequently associated with multiple revisions. The postoperative results were reported using the conventional method (postoperative air minus preoperative bone) as well as the guidelines recently published by the American Academy of Otolaryngology--Head and Neck Surgery (postoperative air minus postoperative bone), with success rates of postoperative air-bone gap closure to within 10 dB after revision surgery of 51.6% and 45.6%, respectively. Patients with persistent conductive hearing loss (large residual air-bone gaps) after primary stapedectomy had poorer postrevision hearing results. Sensorineural hearing loss (defined as a drop in bone pure-tone average of more than 10 dB) occurred in four cases (5.4%). The number of revision surgeries, variations in operative techniques using laser or drill, and the ossicle to which the prosthesis was attached did not statistically affect the postoperative air-bone gaps. These results were compared with previously published data. PMID:9292601

  6. Evaluating the Safety of Intraoperative Antiarrhythmics in Pediatric Cardiac Surgery Patients.

    PubMed

    Beaty, Rachel S; Moffett, Brady S; Hall, Stuart; Kim, Jeffrey

    2015-10-01

    Cardiac arrhythmias occurring during the intraoperative period for cardiac surgery have been associated with excess morbidity and mortality. Several antiarrhythmics have been utilized for the management of intraoperative arrhythmias. These antiarrhythmic medications can cause undesirable adverse outcomes in the intensive care setting. The incidence and treatment of adult intraoperative arrhythmias have been studied. In addition, the prevalence, risk factors, and optimal treatment of pediatric postoperative arrhythmias have also been studied. However, the literature has not been published on intraoperative antiarrhythmia treatment during pediatric cardiac surgery. The purpose of this study was to determine the safety of intraoperative antiarrhythmic medications utilized in pediatric cardiac surgery patients. This was a retrospective review of all patients who received an intraoperative antiarrhythmic in the cardiovascular operating room at Texas Children's Hospital. Patients were included if they underwent cardiovascular surgery from November 2008 to July 2013 and were excluded if antiarrhythmics were given intraoperatively for other indications (i.e., esmolol for hypertension) or if patients were older than 18 years of age. Safety of antiarrhythmic treatment was determined by the absence or presence of adverse events. Control or recurrence of the arrhythmia was analyzed as a secondary measure to help determine antiarrhythmic efficacy. A total of 45 patients were identified (53.3 % male). Patients were a median of 0.52 years at the time of surgery. Primary surgery types were tetralogy of Fallot repair (n = 6; 13.3 %) and ventricular septal defect closure (n = 5, 11.1 %). Thirty-one patients (68.9 %) had documented adverse events after the administration of antiarrhythmics. Most of these adverse events occurred after the administration of amiodarone (n = 16; 51.6 %) followed by esmolol (n = 15; 48.4 %). Fifty-one percent of the arrhythmias resolved in the operating

  7. 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

  8. Risk factors for intraoperative calcar fracture in cementless total hip arthroplasty

    PubMed Central

    Miettinen, Simo S A; Mäkinen, Tatu J; Kostensalo, Inari; Mäkelä, Keijo; Huhtala, Heini; Kettunen, Jukka S; Remes, Ville

    2016-01-01

    Background and purpose — Intraoperative periprosthetic femoral fracture is a known complication of cementless total hip arthroplasty (THA). We determined the incidence of—and risk factors for—intraoperative calcar fracture, and assessed its influence on the risk of revision. Patients and methods — This retrospective analysis included 3,207 cementless THAs (in 2,913 patients). 118 intraoperative calcar fractures were observed in these hips (3.7%). A control group of 118 patients/hips without calcar fractures was randomly selected. The mean follow-up was 4.2 (1.8–8.0) years. Demographic data, surgical data, type of implant, and proximal femur morphology were evaluated to determine risk factors for intraoperative calcar fracture. Results — The revision rates in the calcar fracture group and the control group were 10% (95% CI: 5.9–17) and 3.4% (CI: 1.3–8.4), respectively. The revision rate directly related to intraoperative calcar fracture was 7.6%. The Hardinge approach and lower age were risk factors for calcar fracture. In the fracture group, 55 of 118 patients (47%) had at least one risk factor, while only 23 of118 patients in the control group (20%) had a risk factor (p = 0.001). Radiological analysis showed that in the calcar fracture group, there were more deviated femoral anatomies and proximal femur bone cortices were thinner. Interpretation — Intraoperative calcar fracture increased the risk of revision. The Hardinge approach and lower age were risk factors for intraoperative calcar fracture. To avoid intraoperative fractures, special attention should be paid when cementless stems are used with deviant-shaped proximal femurs and with thin cortices. PMID:26541230

  9. Warming up to solar energy

    SciTech Connect

    Biondo, B.

    1996-07-01

    Increasingly alarmed by threats to their financial security posed by an escalating number of weather-related catastrophes, major insurance companaies, particularly those in Europe and Asia, are starting to support a variety of measures that would slowe the production of grenhouse gases worlwide. As the insurance and banking industries turn their attention to global warming, investments in solar energy take on growing appeal.

  10. Visual evoked potentials for intraoperative neurophysiologic monitoring using total intravenous anesthesia.

    PubMed

    Wiedemayer, Helmut; Fauser, Barbara; Armbruster, W; Gasser, Thomas; Stolke, Dietmar

    2003-01-01

    Conflicting reports on the usefulness of intraoperative monitoring of visual function by means of visual evoked potentials (VEPs) initiated this study. In 32 patients without visual problems, VEPs were recorded to evaluate the reliability for intraoperative monitoring with total intravenous anesthesia. All patients underwent noncranial surgery. Using a standard technique, VEPs were recorded preoperatively in the awake patients and after induction of anesthesia during surgery. A total of 1436 intraoperative traces were recorded and analyzed. A minor prolongation of the P100 latency of 8% and a more pronounced attenuation of the P100-N145 amplitude of 60% were observed in the anesthetized patients. In most of the anesthetized patients, a stable recording of VEPs was not obtainable. In 4 patients (12.5%), clearly identifiable VEP peaks were detected in more than 90% of the traces recorded intraoperatively. In 88% of the patients, reproducible VEPs were obtained in less than 75% of the intraoperative traces only. We concluded that with standard recording techniques and total intravenous anesthesia, intraoperative VEP monitoring in surgically anesthetized patients is not reliable.

  11. Combined use of intraoperative indocyanine green and dynamic angiography in rotational vertebral artery occlusion.

    PubMed

    Chaudhry, Nauman S; Ambekar, Sudheer; Elhammady, Mohamed Samy; Riley, Jonathan P; Pradilla, Gustavo; Nogueira, Raul G; Ahmad, Faiz U

    2016-08-01

    Rotational vertebral artery occlusion, also known as bow hunter's syndrome, is a well-documented surgically amenable cause of vertebrobasilar insufficiency. Traditionally, patients have been imaged using dynamic rotational angiography. The authors sought to determine whether intraoperative indocyanine green (ICG) angiography could reliably assess the adequacy of surgical decompression of the vertebral artery (VA). The authors report two patients who presented with multiple transient episodes of syncope provoked by turning their head to the right. Rotational dynamic angiography revealed a dominant VA that became occluded with head rotation to the right side. The patients underwent successful surgical decompression of the VA via an anterior cervical approach. Intraoperative ICG angiography demonstrated patency of the VA with head rotation. This was further confirmed by intraoperative dynamic catheter angiography. To our knowledge, we present the first two cases of the use of ICG combined with intraoperative dynamic rotational angiography to document the adequacy of surgical decompression of the VA in a patient with rotational vertebral artery occlusion. Intraoperative ICG angiography is a useful adjunct and may potentially supplant the need for intraoperative catheter angiography. PMID:27041076

  12. Predictive roles of intraoperative blood glucose for post-transplant outcomes in liver transplantation.

    PubMed

    Park, Chul Soo

    2015-06-14

    Diabetogenic traits in patients undergoing liver transplantation (LT) are exacerbated intraoperatively by exogenous causes, such as surgical stress, steroids, blood transfusions, and catecholamines, which lead to intraoperative hyperglycemia. In contrast to the strict glucose control performed in the intensive care unit, no systematic protocol has been developed for glucose management during LT. Intraoperative blood glucose concentrations typically exceed 200 mg/dL in LT, and extreme hyperglycemia (> 300 mg/dL) is common during the neohepatic phase. Only a few retrospective studies have examined the relationship between intraoperative hyperglycemia and post-transplant complications, with reports of infectious complications or mortality. However, no prospective studies have been conducted regarding the influence of intraoperative hyperglycemia in LT on post-transplant outcome. In addition to absolute blood glucose values, the temporal patterns in blood glucose levels during LT may serve as prognostic features. Persistent neohepatic hyperglycemia (without a decline) throughout LT is a useful indicator of early graft dysfunction. Moreover, intraoperative variability in glucose levels may predict the need for reoperation for hemorrhage after LT. Thus, there is an urgent need for guidelines for glucose control in these patients, as well as prospective studies on the impact of glucose control on various post-transplant complications. This report highlights some of the recent studies related to perioperative blood glucose management focused on LT and liver disease. PMID:26078559

  13. Preliminary experience for the evaluation of the intraoperative graft patency with real color charge-coupled device camera system: an advanced device for simultaneous capturing of color and near-infrared images during coronary artery bypass graft.

    PubMed

    Handa, Takemi; Katare, Rajesh G; Sasaguri, Shiro; Sato, Takayuki

    2009-08-01

    We developed a new color charge-coupled device (CCD) camera for the intraoperative indocyanine green (ICG) angiography. This device consists of a combination of custom-made optical filters and an ultra-high sensitive CCD image sensor, which can detect simultaneously color and near-infrared (NIR) rays from 380 to 1200 nm. We showed a comparison between our system and other devices for the preliminary experience. We routinely performed both transit-time flowmetry (TFM) and color images for intraoperative assessment, thallium-scintigraphy for the early postoperative assessment, and then angiography after 1-year surgery. We also obtained intraoperative graft flows and images in 116 grafts. Although TFM indicated a graft patency, the CCD camera suspected perfusion failures in four grafts. Also the analysis of the ICG fluorescence intensity showed the significant hypoperfusion at the perfusion territory distal to the anastomosis (graft vs. perfusion territory; 230+/-26 vs. 156+/-13 a.u, P=0.02). When the CCD camera suspected a graft failure, CCD camera and angiography showed a comparable graft failure. The unique device that visualized ICG-enhanced structures against a background of natural myocardial color improved the visibility of abnormality in flow and perfusion. Our findings show that this device may become a standard intraoperative graft and perfusion assessment tool in coronary artery bypass graft (CABG). PMID:19423513

  14. Equatorial refuge amid tropical warming

    NASA Astrophysics Data System (ADS)

    Karnauskas, Kristopher B.; Cohen, Anne L.

    2012-07-01

    Upwelling across the tropical Pacific Ocean is projected to weaken in accordance with a reduction of the atmospheric overturning circulation, enhancing the increase in sea surface temperature relative to other regions in response to greenhouse-gas forcing. In the central Pacific, home to one of the largest marine protected areas and fishery regions in the global tropics, sea surface temperatures are projected to increase by 2.8°C by the end of this century. Of critical concern is that marine protected areas may not provide refuge from the anticipated rate of large-scale warming, which could exceed the evolutionary capacity of coral and their symbionts to adapt. Combining high-resolution satellite measurements, an ensemble of global climate models and an eddy-resolving regional ocean circulation model, we show that warming and productivity decline around select Pacific islands will be mitigated by enhanced upwelling associated with a strengthening of the equatorial undercurrent. Enhanced topographic upwelling will act as a negative feedback, locally mitigating the surface warming. At the Gilbert Islands, the rate of warming will be reduced by 0.7+/-0.3°C or 25+/-9% per century, or an overall cooling effect comparable to the local anomaly for a typical El Niño, by the end of this century. As the equatorial undercurrent is dynamically constrained to the Equator, only a handful of coral reefs stand to benefit from this equatorial island effect. Nevertheless, those that do face a lower rate of warming, conferring a significant advantage over neighbouring reef systems. If realized, these predictions help to identify potential refuges for coral reef communities from anticipated climate changes of the twenty-first century.

  15. Isolating Stratospheric Warmings -- Mesosphere to Troposphere

    NASA Astrophysics Data System (ADS)

    Coughlin, K.

    Stratospheric Warming events exhibit the most drastic changes seen in the stratosphere and yet the categorization of these events continues to be adhoc Understandably the definitions of major warming minor warmings and or Canadian warmings often depend on the scientific problem at hand And yet we show here that these events are statistically separated from the rest of the days in the winter stratosphere We show how warmings can be isolated and defined in a objective manner Furthermore we are then able to show the effect of these warmings from the mesosphere down to the troposphere

  16. Comparative effect of intraoperative propacetamol versus placebo on morphine consumption after elective reduction mammoplasty under remifentanil-based anesthesia: a randomized control trial [ISRCTN71723173].

    PubMed

    Binhas, Michèle; Decailliot, François; Rezaiguia-Delclaux, Saïda; Suen, Powen; Dumerat, Marc; François, Véronique; Combes, Xavier; Duvaldestin, Philippe

    2004-09-14

    BACKGROUND: Postoperative administration of paracetamol or its prodrug propacetamol has been shown to decrease pain with a morphine sparing effect. However, the effect of propacetamol administered intra-operatively on post-operative pain and early postoperative morphine consumption has not been clearly evaluated. In order to evaluate the effectiveness of analgesic protocols in the management of post-operative pain, a standardized anesthesia protocol without long-acting opioids is crucial. Thus, for ethical reasons, the surgical procedure under general anesthesia with remifentanil as the only intraoperative analgesic must be associated with a moderate predictable postoperative pain. METHODS: We were interested in determining the postoperative effect of propacetamol administered intraoperatively after intraoperative remifentanil. Thirty-six adult women undergoing mammoplasty with remifentanil-based anesthesia were randomly assigned to receive propacetamol 2 g or placebo one hour before the end of surgery. After remifentanil interruption and tracheal extubation in recovery room, pain was assessed and intravenous titrated morphine was given. The primary end-point was the cumulative dose of morphine administered in the recovery room. The secondary end-points were the pain score after tracheal extubation and one hour after, the delay for obtaining a Simplified Numerical Pain Scale (SNPS) less than 4, and the incidence of morphine side effects in the recovery room.For intergroup comparisons, categorical variables were compared using the chi-squared test and continuous variables were compared using the Student t test or Mann-Whitney U test, as appropriate. A p value less than 0.05 was considered as significant. RESULTS: In recovery room, morphine consumption was lower in the propacetamol group than in the placebo group (p = 0.01). Pain scores were similar in both groups after tracheal extubation and lower in the propacetamol group (p = 0.003) one hour after tracheal

  17. 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

  18. 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.

  19. 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.

  20. Intraoperative Near-Infrared Imaging Can Identify Pulmonary Nodules

    PubMed Central

    Okusanya, Olugbenga T.; Holt, David; Heitjan, Daniel; Deshpande, Charuhas; Venegas, Ollin; Jiang, Jack; Judy, Ryan; DeJesus, Elizabeth; Madajewski, Brian; Oh, Kenny; Albelda, Steven M.; Nie, Shuming; Singhal, Sunil

    2014-01-01

    Background Over 80,000 people undergo pulmonary resection for a lung nodule in the United States each year. Small nodules are frequently missed or difficult to find despite preoperative imaging. We hypothesized that near-infrared (NIR) imaging technology could be used to identify and locate lung nodules during surgery. Methods We enrolled 18 patients who were diagnosed with a pulmonary nodule that required resection. All patients had a fine-cut 1mm computed tomography scan preoperatively. The patients were given systemic 5 mg/kg indocyanine green (ICG) and then underwent an open thoracotomy 24 hours later. NIR imaging was used to identify the primary nodule and search for additional nodules that were not found by visual inspection or manual palpation of the ipsilateral lung. Results Manual palpation and visual inspection identified all 18 primary pulmonary nodules and no additional lesions. Intraoperative NIR imaging detected 16 out of the 18 primary nodules. NIR imaging also identified 5 additional subcentimeter nodules: 3 metastatic adenocarcinomas and 2 metastatic sarcomas. This technology could identify nodules as small as 0.2 cm and as deep as 1.3 cm from the pleural surface. This approach discovered 3 nodules that were in different lobes than the primary tumor. Nodule fluorescence was independent of size, metabolic activity, histology, tumor grade and vascularity. Conclusions This is the first-in-human demonstration of identifying pulmonary nodules during Thoracic surgery with NIR imaging without a priori knowledge of their location or existence. NIR imaging can detect pulmonary nodules during lung resections that are poorly visualized on computed tomography and difficult to discriminate on finger palpation. PMID:25106680

  1. Quantification of tumor fluorescence during intraoperative optical cancer imaging

    PubMed Central

    Judy, Ryan P.; Keating, Jane J.; DeJesus, Elizabeth M.; Jiang, Jack X.; Okusanya, Olugbenga T.; Nie, Shuming; Holt, David E.; Arlauckas, Sean P.; Low, Phillip S.; Delikatny, E. James; Singhal, Sunil

    2015-01-01

    Intraoperative optical cancer imaging is an emerging technology in which surgeons employ fluorophores to visualize tumors, identify tumor-positive margins and lymph nodes containing metastases. This study compares instrumentation to measure tumor fluorescence. Three imaging systems (Spectropen, Glomax, Flocam) measured and quantified fluorescent signal-to-background ratios (SBR) in vitro, murine xenografts, tissue phantoms and clinically. Evaluation criteria included the detection of small changes in fluorescence, sensitivity of signal detection at increasing depths and practicality of use. In vitro, spectroscopy was superior in detecting incremental differences in fluorescence than luminescence and digital imaging (Ln[SBR] = 6.8 ± 0.6, 2.4 ± 0.3, 2.6 ± 0.1, p = 0.0001). In fluorescent tumor cells, digital imaging measured higher SBRs than luminescence (6.1 ± 0.2 vs. 4.3 ± 0.4, p = 0.001). Spectroscopy was more sensitive than luminometry and digital imaging in identifying murine tumor fluorescence (SBR = 41.7 ± 11.5, 5.1 ± 1.8, 4.1 ± 0.9, p = 0.0001), and more sensitive than digital imaging at detecting fluorescence at increasing depths (SBR = 7.0 ± 3.4 vs. 2.4 ± 0.5, p = 0.03). Lastly, digital imaging was the most practical and least time-consuming. All methods detected incremental differences in fluorescence. Spectroscopy was the most sensitive for small changes in fluorescence. Digital imaging was the most practical considering its wide field of view, background noise filtering capability, and sensitivity to increasing depth. PMID:26563091

  2. 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.

  3. 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.

  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. Warming trends: Adapting to nonlinear change

    SciTech Connect

    Jonko, Alexandra K.

    2015-01-28

    As atmospheric carbon dioxide concentrations rise, some regions are expected to warm more than others. Research suggests that whether warming will intensify or slow down over time also depends on location.

  6. Trophic mismatch requires seasonal heterogeneity of warming.

    PubMed

    Straile, Dietmar; Kerimoglu, Onur; Peeters, Frank

    2015-10-01

    Climate warming has been shown to advance the phenology of species. Asynchronous changes in phenology between interacting species may disrupt feeding interactions (phenological mismatch), which could have tremendous consequences for ecosystem functioning. Long-term field observations have suggested asynchronous shifts in phenology with warming, whereas experimental studies have not been conclusive. Using proxy-based modeling of three trophic levels (algae, herbivores, and fish), we .show that asynchronous changes in phenology only occur if warming is seasonally heterogeneous, but not if warming is constant throughout the year. If warming is seasonally heterogeneous, the degree and even direction of asynchrony depends on the specific seasonality of the warming. Conclusions about phenological mismatches in food web interactions may therefore produce controversial results if the analyses do not distinguish between seasonally constant and seasonal specific warming. Furthermore, our results suggest that predicting asynchrony between interacting species requires reliable warming predictions that resolve sub-seasonal time scales. PMID:26649399

  7. Arctic climate change: Greenhouse warming unleashed

    NASA Astrophysics Data System (ADS)

    Mauritsen, Thorsten

    2016-04-01

    Human activity alters the atmospheric composition, which leads to global warming. Model simulations suggest that reductions in emission of sulfur dioxide from Europe since the 1970s could have unveiled rapid Arctic greenhouse gas warming.

  8. Intraoperative Optical Coherence Tomography-Assisted Descemet Membrane Endothelial Keratoplasty in the DISCOVER Study

    PubMed Central

    Cost, Brian; Goshe, Jeffrey M.; Srivastava, Sunil; Ehlers, Justis P.

    2015-01-01

    Purpose To investigate the utility of intraoperative optical coherence tomography (OCT) for Descemet Membrane Endothelial Keratoplasty (DMEK) surgery. Design Prospective consecutive interventional case series. Methods DISCOVER (NCT02423213) is a prospective consecutive interventional case series examining the feasibility and utility microscope-integrated intraoperative OCT in ophthalmic surgery. This report focuses on those eyes in the DISCOVER study undergoing DMEK surgery. The eight cases were the first DMEK cases performed by the primary surgeon (J.M.G.) with microscope integrated intraoperative OCT feedback (Rescan 700, Carl Zeiss Meditec). Qualitative OCT analysis was performed at multiple surgeon-defined time points, including host and donor tissue preparation, graft orientation, graft apposition, and tissue interface fluid dynamics. Results Correct graft orientation was confirmed by intraoperative OCT prior to unscrolling in 100% of cases. Seven of eight grafts were fully attached at the conclusion of surgery and on postoperative day one. One graft had a linear paracentral fixed area of interface separation corresponding to posterior stromal irregularities which was visible during surgery and unchanged on postoperative day one. Two eyes developed significant peripheral graft dehiscence visible by the first postoperative week. Both grafts were successfully re-attached with repeat gas injection. All eyes demonstrated improvement in best corrected visual acuity and there was a 100% graft survival rate at last follow-up (minimum = 4 months). Surgeon feedback indicated that intraoperative OCT provided valuable information in all eight cases. Conclusions Real-time intraoperative OCT can provide useful information, which may directly impact surgical decision-making during DMEK surgery. Intraoperative OCT may facilitate the transition for novice DMEK surgeons by increasing surgeon confidence and reducing the risk of iatrogenic graft failure. PMID:26026264

  9. Intraoperative monitoring of torsion to prevent vertical deviations during augmented vertical rectus transposition surgery

    PubMed Central

    Holmes, Jonathan M.; Hatt, Sarah R.; Leske, David A.

    2012-01-01

    Background Total transposition of the superior and inferior rectus muscle laterally, with augmentation sutures, may be complicated by induction of an undesirable vertical deviation. Induced vertical misalignment may be associated with changes in torsion. We have developed a simple method to monitor intraoperative torsion that may reduce the incidence of vertical deviations. Methods We reviewed consecutive cases of total abducens palsy or esotropic Duane syndrome treated with augmented lateral transposition of the superior and inferior rectus muscles, where the 12 o’clock and 6 o’clock intraoperative positions were initially marked with a dot at the limbus using a surgical pen. The location of the marks was monitored during tying of the augmentation sutures; changes in torsion were monitored intraoperatively. Results Records of 9 cases of augmented vertical rectus transposition were reviewed. Based on intraoperative assessment of torsion by observing the position of the preplaced limbal dots, the inferior rectus augmentation suture was tied less tightly than the superior rectus suture, leaving a gap of 1–3 mm between the inferior and lateral rectus muscles in 8 of 9 cases. The augmentation suture was totally removed in 1 case. Following these intraoperative adjustments, there was no induced intraoperative torsion, whereas further tightening of the inferior suture induced extorsion. Six weeks postoperatively, 8 of 9 patients did not experience a symptomatic vertical deviation. Conclusions When performing augmented transposition procedures, intraoperative monitoring of torsion may reduce the incidence of inadvertent vertical deviations and torsion. This technique may also be useful in other cases where correction or avoidance of torsion is needed. PMID:22525168

  10. 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

  11. Multidecadal warming of Antarctic waters.

    PubMed

    Schmidtko, Sunke; Heywood, Karen J; Thompson, Andrew F; Aoki, Shigeru

    2014-12-01

    Decadal trends in the properties of seawater adjacent to Antarctica are poorly known, and the mechanisms responsible for such changes are uncertain. Antarctic ice sheet mass loss is largely driven by ice shelf basal melt, which is influenced by ocean-ice interactions and has been correlated with Antarctic Continental Shelf Bottom Water (ASBW) temperature. We document the spatial distribution of long-term large-scale trends in temperature, salinity, and core depth over the Antarctic continental shelf and slope. Warming at the seabed in the Bellingshausen and Amundsen seas is linked to increased heat content and to a shoaling of the mid-depth temperature maximum over the continental slope, allowing warmer, saltier water greater access to the shelf in recent years. Regions of ASBW warming are those exhibiting increased ice shelf melt. PMID:25477461

  12. Hydrological consequences of global warming

    SciTech Connect

    Miller, Norman L.

    2009-06-01

    The 2007 Intergovernmental Panel for Climate Change indicates there is strong evidence that the atmospheric concentration of carbon dioxide far exceeds the natural range over the last 650,000 years, and this recent warming of the climate system is unequivocal, resulting in more frequent extreme precipitation events, earlier snowmelt runoff, increased winter flood likelihoods, increased and widespread melting of snow and ice, longer and more widespread droughts, and rising sea level. The effects of recent warming has been well documented and climate model projections indicate a range of hydrological impacts with likely to very likely probabilities (67 to 99 percent) of occurring with significant to severe consequences in response to a warmer lower atmosphere with an accelerating hydrologic cycle.

  13. Solar trends and global warming

    NASA Astrophysics Data System (ADS)

    Benestad, R. E.; Schmidt, G. A.

    2009-07-01

    We use a suite of global climate model simulations for the 20th century to assess the contribution of solar forcing to the past trends in the global mean temperature. In particular, we examine how robust different published methodologies are at detecting and attributing solar-related climate change in the presence of intrinsic climate variability and multiple forcings. We demonstrate that naive application of linear analytical methods such as regression gives nonrobust results. We also demonstrate that the methodologies used by Scafetta and West (2005, 2006a, 2006b, 2007, 2008) are not robust to these same factors and that their error bars are significantly larger than reported. Our analysis shows that the most likely contribution from solar forcing a global warming is 7 ± 1% for the 20th century and is negligible for warming since 1980.

  14. MCCB warm adjustment testing concept

    NASA Astrophysics Data System (ADS)

    Erdei, Z.; Horgos, M.; Grib, A.; Preradović, D. M.; Rodic, V.

    2016-08-01

    This paper presents an experimental investigation in to operating of thermal protection device behavior from an MCCB (Molded Case Circuit Breaker). One of the main functions of the circuit breaker is to assure protection for the circuits where mounted in for possible overloads of the circuit. The tripping mechanism for the overload protection is based on a bimetal movement during a specific time frame. This movement needs to be controlled and as a solution to control this movement we choose the warm adjustment concept. This concept is meant to improve process capability control and final output. The warm adjustment device design will create a unique adjustment of the bimetal position for each individual breaker, determined when the testing current will flow thru a phase which needs to trip in a certain amount of time. This time is predetermined due to scientific calculation for all standard types of amperages and complies with the IEC 60497 standard requirements.

  15. Lagrangian description of warm plasmas

    NASA Technical Reports Server (NTRS)

    Kim, H.

    1970-01-01

    Efforts are described to extend the averaged Lagrangian method of describing small signal wave propagation and nonlinear wave interaction, developed by earlier workers for cold plasmas, to the more general conditions of warm collisionless plasmas, and to demonstrate particularly the effectiveness of the method in analyzing wave-wave interactions. The theory is developed for both the microscopic description and the hydrodynamic approximation to plasma behavior. First, a microscopic Lagrangian is formulated rigorously, and expanded in terms of perturbations about equilibrium. Two methods are then described for deriving a hydrodynamic Lagrangian. In the first of these, the Lagrangian is obtained by velocity integration of the exact microscopic Lagrangian. In the second, the expanded hydrodynamic Lagrangian is obtained directly from the expanded microscopic Lagrangian. As applications of the microscopic Lagrangian, the small-signal dispersion relations and the coupled mode equations are derived for all possible waves in a warm infinite, weakly inhomogeneous magnetoplasma, and their interactions are examined.

  16. The heated debate. [Global warming

    SciTech Connect

    Balling, R.C. Jr.

    1992-01-01

    The Heated Debate challenges head on the popular vision' of anthropogenically-caused global warming as characterized by catastrophic sea level rise, drought-desiccated farmlands, and more frequent and intense hurricanes spinning up and out from warmer tropical seas. The message of this book is that apocalyptic devastation of natural ecosystems and human socio-economic systems will not necessarily follow from a mild warming of earth's climate. According to Balling, the specter of apocalypse is clearly the dominant view held by scientists, decisionmakers and the public specter of apocalypse is clearly the dominant view held by scientists, decisionmakers and the public at large, and, in his view, it is just as clearly incorrect based on a careful examination of the historical evidence. The Heated Debate present the other side' of global warming; a kinder, gentler greenhouse debate, the stated purpose of the book is to provide the reader with some background to the greenhouse issue, present an analysis of the certainties and uncertainties for future climate change, and examine the most probably changes in climate that may occur as the greenhouse gases increase in concentration. Ultimately the author hopes the book will more completely inform decisionmakers so that they do not commit money and resources to what may turn out to be a non-problem. Indeed, global warming may have many more benefits than costs, and, in any event, the (climate) penalty for postponing action a few years is potentially small, while our knowledge base will increase tremendously allowing society to make wiser and more informed decisions.

  17. Economic Theory and Global Warming

    NASA Astrophysics Data System (ADS)

    Uzawa, Hirofumi

    2003-08-01

    Hirofumi Uzawa's theoretical framework addresses three major problems concerning global warming and other environmental hazards. First, it considers all phenomena involved with global environmental issues that exhibit externalities of one kind or another. Secondly, it covers global environmental issues involving international and intergenerational equity and justice. Lastly, it deals with global environmental issues concerning the management of the atmosphere, the oceans, water, soil, and other natural resources having to be decided by a consensus of affected countries.

  18. Analysis of data from spacecraft (stratospheric warmings)

    NASA Technical Reports Server (NTRS)

    1974-01-01

    The details of the stratospheric warming processes as to time, area, and intensity were established, and the warmings with other terrestrial and solar phenomena occurring at satellite platform altitudes, or observable from satellite platforms, were correlated. Links were sought between the perturbed upper atmosphere (mesosphere and thermosphere) and the stratosphere that might explain stratospheric warmings.

  19. Intraoperative augmented reality for laparoscopic colorectal surgery by intraoperative near-infrared fluorescence imaging and optical coherence tomography.

    PubMed

    Cahill, R A; Mortensen, N J

    2010-08-01

    Advances in imaging quality and capability have been the major driver of the laparoscopic revolution that has dramatically impacted upon operative strategies and surgical patient care in recent years. Increasingly now the technological capacity is becoming available to supraselect or extend the useful clinical range of the electromagnetic spectrum beyond visible or white light. This has markedly broadened the intraprocedural optical information available at intraluminal endoscopy and there is likely to be considerable similar benefit for laparoscopy. Rather than narrow band or ultraviolet imaging however, it is the near infrared (NIR) spectrum that seems of most potential to exploit during intra-abdominal endoscopy in particular as this energy range is capable of penetrating relatively deeply into tissues such as the mesentery and bowel wall without inducing thermal damage due to heat dissipation or indeed the intracellular effects associated with higher energy, shorter wavelength energies. By incorporating the NIR spectrum alongside more conventional laparoscopic imaging, a greater appreciation of tissue architecture, character and quality is possible in particular with respect to lymphatic and vascular channel anatomy and flow dynamics and also real-time optical histology (by NIR optical coherence tomography). Such a facility may significantly aid critical intraoperative decision making during colorectal operations by informing the surgeon regarding the most biologically relevant lymphatic basin and lymph nodes for any target area of interest (especially important if considering tailored operative extent for colorectal neoplasia), the sufficiency and quality of arterial supply (and hence inform re the perfusion of stapled intestinal ends prior to reanastomosis) and perhaps even in situ pathological assessment. This article provides a state of art overview of the fascinating potential of this emergent technological capability. PMID:20802433

  20. Warm Dense Matter: An Overview

    SciTech Connect

    Kalantar, D H; Lee, R W; Molitoris, J D

    2004-04-21

    This document provides a summary of the ''LLNL Workshop on Extreme States of Materials: Warm Dense Matter to NIF'' which was held on 20, 21, and 22 February 2002 at the Wente Conference Center in Livermore, CA. The warm dense matter regime, the transitional phase space region between cold material and hot plasma, is presently poorly understood. The drive to understand the nature of matter in this regime is sparking scientific activity worldwide. In addition to pure scientific interest, finite temperature dense matter occurs in the regimes of interest to the SSMP (Stockpile Stewardship Materials Program). So that obtaining a better understanding of WDM is important to performing effective experiments at, e.g., NIF, a primary mission of LLNL. At this workshop we examined current experimental and theoretical work performed at, and in conjunction with, LLNL to focus future activities and define our role in this rapidly emerging research area. On the experimental front LLNL plays a leading role in three of the five relevant areas and has the opportunity to become a major player in the other two. Discussion at the workshop indicated that the path forward for the experimental efforts at LLNL were two fold: First, we are doing reasonable baseline work at SPLs, HE, and High Energy Lasers with more effort encouraged. Second, we need to plan effectively for the next evolution in large scale facilities, both laser (NIF) and Light/Beam sources (LCLS/TESLA and GSI) Theoretically, LLNL has major research advantages in areas as diverse as the thermochemical approach to warm dense matter equations of state to first principles molecular dynamics simulations. However, it was clear that there is much work to be done theoretically to understand warm dense matter. Further, there is a need for a close collaboration between the generation of verifiable experimental data that can provide benchmarks of both the experimental techniques and the theoretical capabilities. The conclusion of this

  1. Use of intraoperative computed tomography in complex craniofacial trauma: an example of on-table change in management.

    PubMed

    Morrison, Clinton S; Taylor, Helena O; Collins, Scott; Oyelese, Adetokunbo; Sullivan, Stephen R

    2014-12-01

    The primary goals in repairing complex craniofacial fractures are restoration of occlusion and mastication, and anatomic reconstruction of a symmetric facial skeleton. Failure to accomplish these goals may result in the need for secondary operations. Recognition of malreduction may not be appreciated until review of a postoperative computed tomographic (CT) scan. Intraoperative CT scanning enables immediate on-table assessment of reduction and fixation, allowing alteration of the surgical plan as needed. We report using intraoperative CT scanning while repairing a panfacial injury in which malreduction was appreciated intraoperatively and corrected. Intraoperative CT can be used to improve outcomes and quality of complex facial fracture repair. PMID:25383151

  2. Excimer versus Femtosecond Laser Assisted Penetrating Keratoplasty in Keratoconus and Fuchs Dystrophy: Intraoperative Pitfalls

    PubMed Central

    El-Husseiny, Moatasem; Seitz, Berthold; Langenbucher, Achim; Akhmedova, Elena; Szentmary, Nora; Hager, Tobias; Tsintarakis, Themistoklis; Janunts, Edgar

    2015-01-01

    Purpose. To assess the intraoperative results comparing two non-mechanical laser assisted penetrating keratoplasty approaches in keratoconus and Fuchs dystrophy. Patients and Methods. 68 patients (age 18 to 87 years) with keratoconus or Fuchs dystrophy were randomly distributed to 4 groups. 35 eyes with keratoconus and 33 eyes with Fuchs dystrophy were treated with either excimer laser ([Exc] groups I and II) or femtosecond laser-assisted ([FLAK] groups III and IV) penetrating keratoplasty. Main intraoperative outcome measures included intraoperative decentration, need for additional interrupted sutures, alignment of orientation markers, and intraocular positive pressure (vis a tergo). Results. Intraoperative recipient decentration occurred in 4 eyes of groups III/IV but in none of groups I/II. Additional interrupted sutures were not necessary in groups I/II but in 5 eyes of groups III/IV. Orientation markers were all aligned in groups I/II but were partly misaligned in 8 eyes of groups III/IV. Intraocular positive pressure grade was recognized in 12 eyes of groups I/II and in 19 eyes of groups III/IV. In particular, in group III, severe vis a tergo occurred in 8 eyes. Conclusions. Intraoperative decentration, misalignment of the donor in the recipient bed, and need for additional interrupted sutures as well as high percentage of severe intraocular positive pressure were predominantly present in the femtosecond laser in keratoconus eyes. PMID:26483974

  3. Intraoperative portal vein insulin assay combined with occlusion of the pancreas for complex pancreatogenous hypoglycemia

    PubMed Central

    Yang, Zhiying; Tan, Haidong; Sun, Yongliang; Si, Shuang; Xu, Li; Liu, Xiaolei; Liu, Liguo; Zhou, Wenying; Huang, Jia

    2016-01-01

    Abstract Intraoperative localization and confirmation of complete resection of the hypersecreting tissue are the 2 main challenges in the management of pancreatogenous hypoglycemia. Here, we report our experience with intraoperative portal vein insulin assay combined with occlusion of the pancreas in the management of pancreatogenous hypoglycemia. Clinical courses of 2 patients with biochemical evidence of a pancreatogenous hypoglycemia were studied. The preoperative diagnosis was multiple endocrine neoplasia 1 (MEN-1) and nesidioblastosis, respectively. Rapid intraoperative portal vein insulin assay combined with occlusion of the pancreas was used to localize and confirm complete excision of the hypersecreting tissue. Hypoglycemia was successfully treated in both the patients. In the MEN-1 patient, 2 small tumors in the head of pancreas were not resected, as they were deemed noninsulin secreting by intraoperative portal vein insulin assay, thus avoiding a total pancreatectomy. In the patient with nesidioblastosis, using intraoperative portal vein insulin assay combined with occlusion of the pancreas, an appropriate amount of pancreatic tissue was resected thereby avoiding recurrence and diabetes. This technique may be of particular value in patients with complex conditions such as MEN-1 and nesidioblastosis, to localize and achieve complete resection of hypersecreting pancreatic tissue. PMID:27367988

  4. Intraoperative microvascular Doppler ultrasonography in cerebral aneurysm surgery

    PubMed Central

    Stendel, R.; Pietila, T.; Al, H; Schilling, A.; Brock, M.

    2000-01-01

    OBJECTIVES—Outcome of surgical treatment of cerebral aneurysms may be severely compromised by local cerebral ischaemia or infarction resulting from the inadvertent occlusion of an adjacent vessel by the aneurysm clip, or by incomplete aneurysm closure. It is therefore mandatory to optimise clip placement in situ to reduce the complication rate. The present study was performed to investigate the reliability of intraoperative microvascular Doppler ultrasonography (MDU) in cerebral aneurysm surgery, and to assess the impact of this method on the surgical procedure itself.
METHODS—Seventy five patients (19 men, 56 women, mean age 54.8 years, range 22-84 years) with 90 saccular cerebral aneurysms were evaluated. Blood flow velocities in the aneurysmal sac and in the adjacent vessels were determined by MDU before and after aneurysm clipping. The findings of MDU were analysed and compared with those of visual inspection of the surgical site and of postoperative angiography. Analysis was also made of the cases in which the clip was repositioned due to MDU findings.
RESULTS—A relevant stenosis of an adjacent vessel induced by clip positioning that had escaped detection by visual inspection was identified by Doppler ultrasonography in 17 out of 90 (18.9%) aneurysms. In addition, Doppler ultrasound demonstrated a primarily unoccluded aneurysm in 11 out of 90 (12.2%) patients. The aneurysm clip was repositioned on the basis of the MDU findings in 26 out of 90 (28.8%) cases. In middle cerebral artery (MCA) aneurysms, the MDU results were relevant to the surgical procedure in 17out of 44 (38.6%) cases. Whereas with aneurysms of the anterior cerebral artery significant findings occurred in only five of 32cases (15.6%; p<0.05). The clip was repositioned on the basis of the MDU results in 18 out of 50 (36%) aneurysms in patients with subarachnoid haemorrhage (SAH) grade I-V compared with only eight out of 40 (20%) aneurysms in patients without SAH (p<0.05).

  5. Methods of Patient Warming during Abdominal Surgery

    PubMed Central

    Shao, Li; Zheng, Hong; Jia, Feng-Ju; Wang, Hui-Qin; Liu, Li; Sun, Qi; An, Meng-Ying; Zhang, Xiu-Hua; Wen, Hao

    2012-01-01

    Background Keeping abdominal surgery patients warm is common and warming methods are needed in power outages during natural disasters. We aimed to evaluate the efficacy of low-cost, low-power warming methods for maintaining normothermia in abdominal surgery patients. Methods Patients (n = 160) scheduled for elective abdominal surgery were included in this prospective clinical study. Five warming methods were applied: heated blood transfusion/fluid infusion vs. unheated; wrapping patients vs. not wrapping; applying moist dressings, heated or not; surgical field rinse heated or not; and applying heating blankets or not. Patients’ nasopharyngeal and rectal temperatures were recorded to evaluate warming efficacy. Significant differences were found in mean temperatures of warmed patients compared to those not warmed. Results When we compared temperatures of abdominal surgery patient groups receiving three specific warming methods with temperatures of control groups not receiving these methods, significant differences were revealed in temperatures maintained during the surgeries between the warmed groups and controls. Discussion The value of maintaining normothermia in patients undergoing abdominal surgery under general anesthesia is accepted. Three effective economical and practically applicable warming methods are combined body wrapping and heating blanket; combined body wrapping, heated moist dressings, and heating blanket; combined body wrapping, heated moist dressings, and warmed surgical rinse fluid, with or without heating blanket. These methods are practically applicable when low-cost method is indeed needed. PMID:22808045

  6. A cost comparison of allogeneic and preoperatively or intraoperatively donated autologous blood.

    PubMed

    Roberts, W A; Kirkley, S A; Newby, M

    1996-07-01

    We determined the cost of allogeneic packed red blood cells and autologous whole blood donated either preoperatively or in the operating room during hemodilution. Direct and indirect cost estimates were based on patients requiring simple transfusion and included procurement and preparation of the blood including testing performed, materials and time used, waste, and materials for administration. Data were derived from prospective blood bank time studies, material invoice records, and retrospective review of anesthesia times. Viral infection and transfusion reaction costs were accepted from previously published sources. Direct cost of purchasing and indirect costs of preparation resulted in an overall cost of $107.26 for the first unit of allogeneic packed red blood cells transfused. A second unit was slightly less costly ($100.89), as no type and screen was required and the same delivery set and filter can be used. The total cost of acquisition, processing, and transfusion of 1 U of preoperatively donated autologous blood was $97.83. The total cost of a 2-U transfusion of autologous whole blood donated in the operating room during acute normovolemic hemodilution was $83.10. These data suggest that autologous predonation of whole blood is somewhat less expensive than allogeneic packed red blood cells, and that hemodilution may be a cost effective alternative to autologous predonation in selected patients. PMID:8659723

  7. 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

  8. Intraoperative C-arm CT imaging in angular stable plate osteosynthesis of distal radius fractures.

    PubMed

    Mehling, I; Rittstieg, P; Mehling, A P; Küchle, R; Müller, L P; Rommens, P M

    2013-09-01

    The purpose of this study was to analyze the practicability and benefit of intraoperative C-arm computed tomography (CT) imaging in volar plate osteosynthesis of unstable distal radius fractures. During a 1 year period, intraoperative three dimensional (3D) imaging with the ARCADIS Orbic 3D was performed in addition to standard fluoroscopy in 51 cases. The volar angular stable plate oesteosyntheses were analyzed intraoperatively and, if necessary, improved immediately. The duration of the scan and radiation exposure dose were measured. On average, performance of the scan and analysis of the CT dataset took 6.7 minutes. In 31.3% of the surgeries a misplacement of screws was detected and correction was done immediately. C-arm CT imaging can easily be integrated in the normal course of surgery. As a complement to the standard 2D-fluoroscopy, the C-arm CT is a useful tool to evaluate the quality of osteosynthesis.

  9. Intraoperative Optical Coherence Tomography Imaging and Assessment of the Macula During Cataract Surgery: A Novel Technique.

    PubMed

    Tripathy, Koushik; Chawla, Rohan; Kumawat, Babulal; Sharma, Yog Raj

    2016-09-01

    The authors describe a technique to qualitatively analyze the posterior segment during cataract surgery using intraoperative optical coherence tomography (iOCT). Macular iOCT can be done before and after intraocular lens implantation after the media is rendered clear following phacoemulsification. A handheld irrigating planoconcave contact lens is placed over the cornea with the operating microscope in retroillumination mode. After focusing the microscope and upon getting a clear view of the posterior segment, iOCT is switched on, centered at the macula, and focused. This technique enables the surgeon to intraoperatively analyze and document the macular morphology and vitreoretinal interface. Potential uses of this technique include intraoperative decision-making regarding concurrent use of anti-vascular endothelial growth factor agents or steroids in cases with dense cataracts where preoperative OCT is difficult. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:846-847.]. PMID:27631481

  10. Quantitative Wavelength Analysis and Image Classification for Intraoperative Cancer Diagnosis with Hyperspectral Imaging

    PubMed Central

    Lu, Guolan; Qin, Xulei; Wang, Dongsheng; Chen, Zhuo Georgia; Fei, Baowei

    2015-01-01

    Complete surgical removal of tumor tissue is essential for postoperative prognosis after surgery. Intraoperative tumor imaging and visualization are an important step in aiding surgeons to evaluate and resect tumor tissue in real time, thus enabling more complete resection of diseased tissue and better conservation of healthy tissue. As an emerging modality, hyperspectral imaging (HSI) holds great potential for comprehensive and objective intraoperative cancer assessment. In this paper, we explored the possibility of intraoperative tumor detection and visualization during surgery using HSI in the wavelength range of 450 nm - 900 nm in an animal experiment. We proposed a new algorithm for glare removal and cancer detection on surgical hyperspectral images, and detected the tumor margins in five mice with an average sensitivity and specificity of 94.4% and 98.3%, respectively. The hyperspectral imaging and quantification method have the potential to provide an innovative tool for image-guided surgery. PMID:26523083

  11. Quantitative wavelength analysis and image classification for intraoperative cancer diagnosis with hyperspectral imaging

    NASA Astrophysics Data System (ADS)

    Lu, Guolan; Qin, Xulei; Wang, Dongsheng; Chen, Zhuo Georgia; Fei, Baowei

    2015-03-01

    Complete surgical removal of tumor tissue is essential for postoperative prognosis after surgery. Intraoperative tumor imaging and visualization are an important step in aiding surgeons to evaluate and resect tumor tissue in real time, thus enabling more complete resection of diseased tissue and better conservation of healthy tissue. As an emerging modality, hyperspectral imaging (HSI) holds great potential for comprehensive and objective intraoperative cancer assessment. In this paper, we explored the possibility of intraoperative tumor detection and visualization during surgery using HSI in the wavelength range of 450 nm - 900 nm in an animal experiment. We proposed a new algorithm for glare removal and cancer detection on surgical hyperspectral images, and detected the tumor margins in five mice with an average sensitivity and specificity of 94.4% and 98.3%, respectively. The hyperspectral imaging and quantification method have the potential to provide an innovative tool for image-guided surgery.

  12. Cutaneous warming promotes sleep onset.

    PubMed

    Raymann, Roy J E M; Swaab, Dick F; Van Someren, Eus J W

    2005-06-01

    Sleep occurs in close relation to changes in body temperature. Both the monophasic sleep period in humans and the polyphasic sleep periods in rodents tend to be initiated when core body temperature is declining. This decline is mainly due to an increase in skin blood flow and consequently skin warming and heat loss. We have proposed that these intrinsically occurring changes in core and skin temperatures could modulate neuronal activity in sleep-regulating brain areas (Van Someren EJW, Chronobiol Int 17: 313-54, 2000). We here provide results compatible with this hypothesis. We obtained 144 sleep-onset latencies while directly manipulating core and skin temperatures within the comfortable range in eight healthy subjects under controlled conditions. The induction of a proximal skin temperature difference of only 0.78 +/- 0.03 degrees C (mean +/- SE) around a mean of 35.13 +/- 0.11 degrees C changed sleep-onset latency by 26%, i.e., by 3.09 minutes [95% confidence interval (CI), 1.91 to 4.28] around a mean of 11.85 min (CI, 9.74 to 14.41), with faster sleep onsets when the proximal skin was warmed. The reduction in sleep-onset latency occurred despite a small but significant decrease in subjective comfort during proximal skin warming. The induction of changes in core temperature (delta = 0.20 +/- 0.02 degrees C) and distal skin temperature (delta = 0.74 +/- 0.05 degrees C) were ineffective. Previous studies have demonstrated correlations between skin temperature and sleep-onset latency. Also, sleep disruption by ambient temperatures that activate thermoregulatory defense mechanisms has been shown. The present study is the first to experimentally demonstrate a causal contribution to sleep-onset latency of skin temperature manipulations within the normal nocturnal fluctuation range. Circadian and sleep-appetitive behavior-induced variations in skin temperature might act as an input signal to sleep-regulating systems. PMID:15677527

  13. High dissipative nonminimal warm inflation

    NASA Astrophysics Data System (ADS)

    Nozari, Kourosh; Shoukrani, Masoomeh

    2016-09-01

    We study a model of warm inflation in which both inflaton field and its derivatives are coupled nonminimally to curvature. We survey the spectrum of the primordial perturbations in high dissipative regime. By expanding the action up to the third order, the amplitude of the non-Gaussianity is studied both in the equilateral and orthogonal configurations. Finally, by adopting four sort of potentials, we compare our model with the Planck 2015 released observational data and obtain some constraints on the model's parameters space in the high dissipation regime.

  14. Warm/cold cloud processes

    NASA Technical Reports Server (NTRS)

    Bowdle, D. A.

    1979-01-01

    Technical assistance continued in support of the Atmospheric Cloud Physics Laboratory is discussed. A study of factors affecting warm cloud formation showed that the time of formation during an arbitrary expansion is independent of carrier gas composition for ideal gases and independent of aerosol concentration for low concentrations of very small aerosols. Equipment and procedures for gravimetric evaluation of a precision saturator were laboratory tested. A numerical feasibility study was conducted for the stable levitation of charged solution droplets by an electric field in a one-g static diffusion chamber. The concept, operating principles, applications, limits, and sensitivity of the levitation technique are discussed.

  15. 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.

  16. The impact of use of an intraoperative margin assessment device on re-excision rates.

    PubMed

    Sebastian, Molly; Akbari, Stephanie; Anglin, Beth; Lin, Erin H; Police, Alice M

    2015-01-01

    Historically there has been a high rate of surgical interventions to obtain clear margins for breast cancer patients undergoing breast conserving local therapy. An intraoperative margin assessment tool (MarginProbe) has been approved for use in the US since 2013. This study is the first compilation of data from routine use of the device, to assess the impact of device utilization on re-excision rates. We present a retrospective, observational, review from groups of consecutive patients, before and after the implementation of intraoperative use of the device during lumpectomy procedures. Lesions were localized by standard methods. The intraoperative margin assessment device was used on all circumferential margins of the main specimen, but not on any additional shavings. A positive reading by the device led to an additional shaving of the corresponding cavity location. Specimens were also, when feasible, imaged intra-operatively by X-ray, and additional shavings were taken if needed based on clinical assessment. For each surgeon, historical re-excision rates were established based on a consecutive set of patients from a time period proximal to initiation of use of the device. From March 2013 to April 2014 the device was routinely used by 4 surgeons in 3 centers. In total, 165 cases lumpectomy cases were performed. Positive margins resulted in additional re-excision procedures in 9.7% (16/165) of the cases. The corresponding historical set from 2012 and 2013 consisted of 186 Lumpectomy cases, in which additional re-excision procedures were performed in 25.8% (48/186) of the cases. The reduction in the rate of re-excision procedures was significant 62% (P < 0.0001). Use of an intraoperative margin assessment device contributes to achieving clear margins and reducing re-excision procedures. As in some cases positive margins were found on shavings, future studies of interest may include an analysis of the effect of using the device on the shavings intra-operatively

  17. Clinical Utility and Limitations of Intraoperative Monitoring of Visual Evoked Potentials

    PubMed Central

    Luo, Yeda; Regli, Luca; Bozinov, Oliver; Sarnthein, Johannes

    2015-01-01

    Objectives During surgeries that put the visual pathway at risk of injury, continuous monitoring of the visual function is desirable. However, the intraoperative monitoring of the visual evoked potential (VEP) is not yet widely used. We evaluate here the clinical utility of intraoperative VEP monitoring. Methods We analyzed retrospectively 46 consecutive surgeries in 2011-2013. High luminance stimulating devices delivered flash stimuli on the closed eyelid during intravenous anesthesia. We monitored VEP features N75 and P100 and took patients' preoperative and postoperative visual function from patient charts. Postoperative ophthalmologic workup was performed in 25 (54%) patients and preoperatively in 28 (61%) patients. Results VEP recordings were feasible in 62 of 85 eyes (73%) in 46 patients. All 23 eyes without VEP had impaired vision. During surgery, VEPs remained stable throughout surgery in 50 eyes. In 44 of these, visual function did not deteriorate and three patients (6 eyes) developed hemianopia. VEP decreased transiently in 10 eyes and visual function of all was preserved. VEPs were lost permanently in 2 eyes in two patients without new postoperative visual impairment. Conclusions Satisfactory intraoperative VEP monitoring was feasible in all patients except in those with severe visual impairment. Preservation of VEPs predicted preserved visual function. During resection of lesions in the visual cortex, VEP monitoring could not detect new major visual field defects due to injury in the posterior visual pathway. Intraoperative VEPs were sensitive enough to detect vascular damage during aneurysm clipping and mechanical manipulation of the anterior visual pathway in an early reversible stage. Intraoperative VEP monitoring influenced surgical decisions in selected patients and proved to be a useful supplement to the toolbox of intraoperative neurophysiological monitoring. PMID:25803287

  18. Visual intraoperative estimation of cup and stem position is not reliable in minimally invasive hip arthroplasty

    PubMed Central

    Woerner, Michael; Sendtner, Ernst; Springorum, Robert; Craiovan, Benjamin; Worlicek, Michael; Renkawitz, Tobias; Grifka, Joachim; Weber, Markus

    2016-01-01

    Background and purpose In hip arthroplasty, acetabular inclination and anteversion—and also femoral stem torsion—are generally assessed by eye intraoperatively. We assessed whether visual estimation of cup and stem position is reliable. Patients and methods In the course of a subgroup analysis of a prospective clinical trial, 65 patients underwent cementless hip arthroplasty using a minimally invasive anterolateral approach in lateral decubitus position. Altogether, 4 experienced surgeons assessed cup position intraoperatively according to the operative definition by Murray in the anterior pelvic plane and stem torsion in relation to the femoral condylar plane. Inclination, anteversion, and stem torsion were measured blind postoperatively on 3D-CT and compared to intraoperative results. Results The mean difference between the 3D-CT results and intraoperative estimations by eye was −4.9° (−18 to 8.7) for inclination, 9.7° (−16 to 41) for anteversion, and −7.3° (−34 to 15) for stem torsion. We found an overestimation of > 5° for cup inclination in 32 hips, an overestimation of > 5° for stem torsion in 40 hips, and an underestimation < 5° for cup anteversion in 42 hips. The level of professional experience and patient characteristics had no clinically relevant effect on the accuracy of estimation by eye. Altogether, 46 stems were located outside the native norm of 10–20° as defined by Tönnis, measured on 3D-CT. Interpretation Even an experienced surgeon’s intraoperative estimation of cup and stem position by eye is not reliable compared to 3D-CT in minimally invasive THA. The use of mechanical insertion jigs, intraoperative fluoroscopy, or imageless navigation is recommended for correct implant insertion. PMID:26848628

  19. Intra-operative awareness in children and post-traumatic stress disorder.

    PubMed

    Lopez, U; Habre, W; Van der Linden, M; Iselin-Chaves, I A

    2008-05-01

    Adults who experience intra-operative awareness can develop disturbing long-lasting after-effects, such as daytime anxiety, sleep disturbances, nightmares, flashbacks and, in the worst case, a post-traumatic stress disorder (PTSD). It is unknown whether intra-operative awareness has a similar psychological impact in children. We designed the present study in order to evaluate the incidence of psychological symptoms in children who had either confirmed or possible intra-operative awareness. Attempts were made to locate 11 children who had been identified in a previous study, approximately 1 year following their experience. A PTSD questionnaire was administered to the children and their parents in order to detect any long-term or short-term psychological symptoms (the 1-month postoperative data were evaluated retrospectively). Factors believed to be associated with PTSD, such as intra-operative perceptions, the children's temperament and cognitive strategies, and the parents' coping strategies, were also analysed. Seven children were successfully located and interviewed and no short or long-term psychological symptoms were identified. None of them offered negative appraisals of the traumatic event and none had displayed dysfunctional behaviour or cognitive strategies. Thus, none of them had developed a PTSD syndrome. In contrast with what has been reported in adults, these children claimed not to have experienced major pain, terror or helplessness during their surgery. Despite the small sample size, the results of the present study suggest that children suffer less psychological sequelae than adults following intra-operative awareness. This may be due to the fact that the children reported less frightening intra-operative sensations as compared with the adults, and had less understanding of the anaesthesia procedure, and this may have influenced their appraisal of their awareness and protected them from the full impact of this potentially traumatic experience. PMID

  20. 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

  1. A preliminary study of the clinical application of optic pathway diffusion tensor tractography in suprasellar tumor surgery: preoperative, intraoperative, and postoperative assessment.

    PubMed

    Hajiabadi, Mohamadreza; Samii, Madjid; Fahlbusch, Rudolf

    2016-09-01

    OBJECT Visual impairments are the most common objective manifestations of suprasellar lesions. Diffusion tensor imaging (DTI) is a noninvasive MRI modality that depicts the subcortical white matter tracts in vivo. In this study the authors tested the value of visual pathway tractography in comparison with visual field and visual acuity analyses. METHODS This prospective study consisted of 25 patients with progressive visual impairment due to suprasellar mass lesions and 6 control patients with normal vision without such lesions. Visual acuity, visual field, and the optic fundus were examined preoperatively and repeated 1 week and 3 months after surgery. Visual pathway DTI tractography was performed preoperatively, intraoperatively immediately after tumor resection, and 1 week and 3 months after surgery. RESULTS In the control group, pre- and postoperative visual status were normal and visual pathway tractography revealed fibers crossing the optic chiasm without any alteration. In patients with suprasellar lesions, vision improved in 24 of 25. The mean distance between optic tracts in tractography decreased after tumor resection and detectable fibers crossing the optic chiasm increased from 12% preoperatively to 72% postoperatively 3 months after tumor resection, and undetectable fibers crossing the optic chiasm decreased from 88% preoperatively to 27% postoperatively 3 months after tumor resection. Visual improvement after tumor removal 1 week and 3 months after surgery was significantly correlated with the distance between optic tracts in intraoperative tractography (p < 0.01). CONCLUSIONS Visual pathway DTI tractography appears to be a promising adjunct to the standard clinical and paraclinical visual examinations in patients with suprasellar mass lesions. The intraoperative findings, in particular the distance between optic tract fibers, can predict visual outcome after tumor resection. Furthermore, postoperative application of this technique may be useful in

  2. Donor disc attachment assessment with intraoperative spectral optical coherence tomography during descemet stripping automated endothelial keratoplasty

    PubMed Central

    Wylegala, Edward; Nowinska, Anna K; Wroblewska-Czajka, Ewa; Janiszewska, Dominika

    2013-01-01

    Optical coherence tomography has already been proven to be useful for pre- and post-surgical anterior eye segment assessment, especially in lamellar keratoplasty procedures. There is no evidence for intraoperative usefulness of optical coherence tomography (OCT). We present a case report of the intraoperative donor disc attachment assessment with spectral-domain optical coherence tomography in case of Descemet stripping automated endothelial keratoplasty (DSAEK) surgery combined with corneal incisions. The effectiveness of the performed corneal stab incisions was visualized directly by OCT scan analysis. OCT assisted DSAEK allows the assessment of the accuracy of the Descemet stripping and donor disc attachment. PMID:24104711

  3. Modern intraoperative imaging modalities for the vascular neurosurgeon treating intracerebral hemorrhage.

    PubMed

    Goren, Oded; Monteith, Stephen J; Hadani, Moshe; Bakon, Mati; Harnof, Sagi

    2013-05-01

    This paper reviews the current intraoperative imaging tools that are available to assist neurosurgeons in the treatment of intracerebral hemorrhage (ICH). This review shares the authors' experience with each modality and discusses the advantages, potential limitations, and disadvantages of each. Surgery for ICH is directed at blood clot removal, reduction of intracranial pressure, and minimization of secondary damage associated with hematoma breakdown products. For effective occlusion and safe obliteration of vascular anomalies associated with ICH, vascular neurosurgeons today require a thorough understanding of the various intraoperative imaging modalities available for obtaining real-time information. Use of one or more of these modalities may improve the surgeon's confidence during the procedure, the patient's safety during surgery, and surgical outcome. The modern techniques discussed include 1) indocyanine green-based video angiography, which provides real-time information based on high-quality images showing the residual filling of vascular pathological entities and the patency of blood vessels of any size in the surgical field; and 2) intraoperative angiography, which remains the gold standard intraoperative diagnostic test in the surgical management of cerebral aneurysms and arteriovenous malformations. Hybrid procedures, providing multimodality image-guided surgeries and combining endovascular with microsurgical strategies within the same surgical session, have become feasible and safe. Microdoppler is a safe, noninvasive, and reliable technique for evaluation of hemodynamics of vessels in the surgical field, with the advantage of ease of use. Intraoperative MRI provides an effective navigation tool for cavernoma surgery, in addition to assessing the extent of resection during the procedure. Intraoperative CT scanning has the advantage of very high sensitivity to acute bleeding, thereby assisting in the confirmation of the extent of hematoma evacuation and

  4. Cardiopulmonary Bypass and Extracorporeal Life Support for Emergent Intraoperative Thoracic Situations.

    PubMed

    Machuca, Tiago N; Cypel, Marcelo; Keshavjee, Shaf

    2015-08-01

    Intraoperative thoracic surgical catastrophes may require extracorporeal circulation modes to support the patient while the appropriate repair is made. Teamwork is key and, given the evidence supporting better performance with the use of simulation and surgical-crisis checklists, their use should be encouraged. Anticipation is another important factor because the results of intrathoracic malignancy resection are clearly superior in the setting of planned cardiopulmonary support. In addition, familiarity with the different modes of support that are currently available can direct the decision-making process toward the best option to facilitate resolution of the intraoperative catastrophe with the least related morbidity. PMID:26210928

  5. Infratentorial benign cystic meningioma mimicking a hemangioblastoma radiologically and a pilocytic astrocytoma intraoperatively: a case report

    PubMed Central

    2013-01-01

    Introduction Cystic meningiomas are rare variants of meningiomas; they can pose a radiological diagnostic dilemma. Case presentation We present a rare case of a 30-year-old Chinese woman with a histopathological diagnosis of infratentorial cystic meningioma (World Health Organization Grade 1) in which the features in imaging modalities were suggestive of a hemangioblastoma. Intraoperatively, however, the gross macroscopic features were more in keeping with a pilocytic astrocytoma. Conclusion In benign cystic meningiomas, particularly the infratentorial variety, radiological findings utilizing the various imaging modalities and intraoperative impressions may not be reflective of or in keeping with the final histopathological diagnosis. PMID:23537099

  6. Intraoperative imaging and fluorescence image guidance in oncologic surgery using a wearable fluorescence goggle system

    NASA Astrophysics Data System (ADS)

    Mondal, Suman B.; Gao, Shengkui; Zhu, Nan; Liu, Yang; Sudlow, Gail P.; Akers, Walter J.; Liang, Rongguang; Gruev, Viktor; Achilefu, Samuel

    2014-03-01

    We have developed a wearable, fluorescence goggle based system for intraoperative imaging of tumors and image guidance in oncologic surgery. Our system can detect fluorescence from cancer selective near infra-red (NIR) contrast agent, facilitating intraoperative visualization of surgical margins and tumors otherwise not apparent to the surgeon. The fluorescence information is displayed directly to the head mounted display (HMD) of the surgeon in real time, allowing unhindered surgical procedure under image guidance. This system has the potential of improving surgical outcomes in oncologic surgery and reduce the chances of cancer recurrence.

  7. SOFIA Observations of S106: Dynamics of the Warm Gas

    NASA Technical Reports Server (NTRS)

    Simon, R.; Schneider, N.; Stutzki, J.; Gusten, R.; Graf, U. U.; Hartogh, P.; Guan, X.; Staguhn, J. G.; Benford, D. J.

    2012-01-01

    Context The H II region/PDR/molecular cloud complex S106 is excited by a single O-star. The full extent of the warm and dense gas close to the star has not been mapped in spectrally resolved high-J CO or [C II] lines, so the kinematics of the warm. partially ionized gas, are unknown. Whether the prominent dark lane bisecting the hourglass-shaped nebula is due solely to the shadow cast by a small disk around the exciting star or also to extinction in high column foreground gas was an open question until now. Aims. To disentangle the morphology and kinematics of warm neutral and ionized gas close to the star, study their relation to the bulk of the molecular gas. and to investigate the nature of the dark lane. Methods. We use the heterodyne receiver GREAT on board SOFIA to observe velocity resolved spectral lines of [C II] and CO 11 yields 10 in comparison with so far unpublished submm continuum data at 350 micron (8HARC-Il) and complementary molecular line data. Results. The high angular and spectral resolution observations show a very complex morphology and kinematics of the inner S106 region, with many different components at different excitation conditions contributing to the observed emission. The [C II] lines are found to be bright and very broad. tracing high velocity gas close to the interface of molecular cloud and H II region. CO 11 yields 10 emission is more confined.. both spatially and in velocity, to the immediate surroundings of S 106 IR showing the presence of warm, high density (clumpy) gas. Our high angular resolution submm continuum observations rule out the scenario where the dark lane separating the two lobes is due solely to the shadow cast by a small disk close to the star. The lane is clearly seen also as warm, high column density gas at the boundary of the molecular cloud and H II region.

  8. Forecasting phenology under global warming.

    PubMed

    Ibáñez, Inés; Primack, Richard B; Miller-Rushing, Abraham J; Ellwood, Elizabeth; Higuchi, Hiroyoshi; Lee, Sang Don; Kobori, Hiromi; Silander, John A

    2010-10-12

    As a consequence of warming temperatures around the world, spring and autumn phenologies have been shifting, with corresponding changes in the length of the growing season. Our understanding of the spatial and interspecific variation of these changes, however, is limited. Not all species are responding similarly, and there is significant spatial variation in responses even within species. This spatial and interspecific variation complicates efforts to predict phenological responses to ongoing climate change, but must be incorporated in order to build reliable forecasts. Here, we use a long-term dataset (1953-2005) of plant phenological events in spring (flowering and leaf out) and autumn (leaf colouring and leaf fall) throughout Japan and South Korea to build forecasts that account for these sources of variability. Specifically, we used hierarchical models to incorporate the spatial variability in phenological responses to temperature to then forecast species' overall and site-specific responses to global warming. We found that for most species, spring phenology is advancing and autumn phenology is getting later, with the timing of events changing more quickly in autumn compared with the spring. Temporal trends and phenological responses to temperature in East Asia contrasted with results from comparable studies in Europe, where spring events are changing more rapidly than are autumn events. Our results emphasize the need to study multiple species at many sites to understand and forecast regional changes in phenology. PMID:20819816

  9. Population growth and global warming.

    PubMed

    Short, R V

    2009-01-01

    When I was born in 1930, the human population of the world was a mere 2 billion. Today, it has already reached 6.8 billion, and is projected to reach 9.1 billion by 2050. That is unsustainable. It is slowly beginning to dawn on us that Global Warming is the result of increasing human CO2 emissions, and the more people there are in the world, the worse it will become. Ultimately, it is the sky that will prove to be the limit to our numbers. The developed countries of the world are the most affluent, and also the most effluent, so we must lead by example and contain our own population growth and per capita emissions. We also have a big debt to repay to former colonial territories in Africa, Asia and South America, who desperately need our help to contain their excessive rates of population growth. Belgian and Dutch obstetricians and gynaecologists can play a critical role in this endeavour. After all, we already have a pill that will stop global warming - the oral contraceptive pill. PMID:25478068

  10. Population growth and global warming.

    PubMed

    Short, R V

    2009-01-01

    When I was born in 1930, the human population of the world was a mere 2 billion. Today, it has already reached 6.8 billion, and is projected to reach 9.1 billion by 2050. That is unsustainable. It is slowly beginning to dawn on us that Global Warming is the result of increasing human CO2 emissions, and the more people there are in the world, the worse it will become. Ultimately, it is the sky that will prove to be the limit to our numbers. The developed countries of the world are the most affluent, and also the most effluent, so we must lead by example and contain our own population growth and per capita emissions. We also have a big debt to repay to former colonial territories in Africa, Asia and South America, who desperately need our help to contain their excessive rates of population growth. Belgian and Dutch obstetricians and gynaecologists can play a critical role in this endeavour. After all, we already have a pill that will stop global warming - the oral contraceptive pill.

  11. Atlantic Warm Pool Trigger for the Younger Dryas Climate Event

    NASA Astrophysics Data System (ADS)

    Abdul, N. A.; Mortlock, R. A.; Wright, J. D.; Fairbanks, R. G.; Teneva, L. T.

    2011-12-01

    There is growing evidence that variability in the size and heat content of the tropical Atlantic Warm Pool impacts circum-North Atlantic climate via the Atlantic Multi-decadal Oscillation mode (Wang et al., 2008). The Atlantic Warm Pool spans the Gulf of Mexico, Caribbean Sea and the western tropical North Atlantic. Barbados is located near the center of the tropical Atlantic Warm Pool and coupled ocean models suggest that Barbados remains near the center of the tropical Atlantic Warm Pool under varying wind stress simulations. Measurements of the oxygen isotope paleothermometer in Acropora palmata coral species recovered from cores offshore Barbados, show a 3oC monotonic decrease in sea surface temperature from 13106 ± 83 to 12744 ± 61 years before present (errors given as 2 sigma). This interval corresponds to a sea level rise from 71.4 meters to 67.1 meters below present levels at Barbados. The 3oC temperature decrease is captured in eight A. palmata specimens that are in stratigraphic sequence, 230Th/234U dated, and analyzed for oxygen isotopes. All measurements are replicated. We are confident that this is the warm pool equivalent of the Younger Dryas climate event. The initiation of this temperature drop in the Atlantic Warm Pool predates the Younger Dryas start in Greenland ice cores, reported to start at 12896 ± 138 years (relative to AD 2000) (Rasmussen et al., 2006), while few other Younger Dryas climate records are dated with similar accuracy to make the comparison. Rasmussen, S.O., Andersen, K.K., Svensson, A.M., Steffensen, J.P., Vinther, B.M., Clausen, H.B., Siggaard-Andersen, M.L., Johnsen, S.J., Larsen, L.B., Dahl-Jensen, D., Bigler, M., Röthlisberger, R., Fischer, H., Goto-Azuma, K., Hansson, M.E., and Ruth, U., 2006, A new Greenland ice core chronology for the last glacial termination: J. Geophys. Res., v. 111, p. D06102. Wang, C., Lee, S.-K., and Enfield, D.B., 2008, Atlantic Warm Pool acting as a link between Atlantic Multidecadal

  12. Rapid endovascular warming for profound hypothermia.

    PubMed

    Laniewicz, Megan; Lyn-Kew, Kenneth; Silbergleit, Robert

    2008-02-01

    Profound hypothermia is associated with high mortality and morbidity. Optimal outcomes have been reported with invasive extracorporeal warming techniques not readily available in most hospitals. Endovascular warming devices may provide a less invasive alternative. A 68-year-old woman developed profound hypothermia after environmental exposure. On arrival, she was comatose, severely bradycardic, without palpable pulses, and with a core body temperature of 23.0 degrees C (72 degrees F). Attempts to warm her with traditional methods during 2 hours were ineffective. An endovascular temperature control system was placed and effectively warmed the patient at about 3 degrees C (4.5 degrees F) per hour, with return of hemodynamic stability. When hypothermia is profound, surface warming works poorly and invasive strategies, including cardiopulmonary bypass, are recommended. Rapid warming from profound hypothermia can be accomplished with endovascular systems, and these may be an effective alternative to more invasive extracorporeal methods. PMID:17681640

  13. Passive Warming using a Heat-Band versus a Resistive Heating Blanket for the Prevention of Inadvertent Perioperative Hypothermia during Laparotomy for Gynaecological Surgery

    PubMed Central

    Wan Fadzlina, Wan Muhd Shukeri; Wan Mohd Nazaruddin, Wan Hassan; Rhendra Hardy, Mohamad Zaini

    2016-01-01

    Background Inadvertent perioperative hypothermia (IPH) is a common problem, despite advancements in a variety of warming systems. The use of a resistive heating blanket (RHB) is a common but costly approach to patient warming. We have introduced the use of a heat-band in our centre as a cost-effective alternative to the RHB for patient warming. The efficacy of the heat-band in preventing IPH during laparotomy for gynaecological surgeries was compared with that of the RHB. Methods Thirty-two patients undergoing surgeries under combined general-epidural anaesthesia, with an expected duration of surgery of 2–4 h, were randomised to receive either the heat-band or RHB. The core body temperatures of the two groups were compared at several perioperative times, in addition to the incidence of post-anaesthesia shivering, time to extubation and intraoperative blood loss. Results The core body temperatures were comparable between the two groups in the pre-operative period, immediately after the induction of anaesthesia and skin incision, 1 h after the incision, at the time of complete skin closing, at extubation, upon arrival to the recovery room and 1 h post-operatively. There were no significant between-group differences in the incidence of post-anaesthesia shivering, time to extubation and intra-operative blood loss. Conclusion The heat-band is as effective as the RHB in preventing IPH and its complications in gynaecological laparotomies. PMID:27547112

  14. Global warming; What needs to be done

    SciTech Connect

    Not Available

    1991-04-01

    This paper names global warming as a high-level risk. However, global warming's risk status is a point of debate in some circles, reflecting one of the complexities of using risk-based criteria to establish priorities for action. The position that global warming is a long-term environmental trend that must be halted. In this paper, argument son both sides of the global warming issue are presented to illustrate the difficulties associated with establishing the existence and magnitude of environmental and health risks, an issue that must be faced if the SAB recommendations for EPA policy change are implemented.

  15. Stratospheric sudden warming and lunar tide

    NASA Astrophysics Data System (ADS)

    Yamazaki, Yosuke; Kosch, Michael

    2016-07-01

    A stratospheric sudden warming is a large-scale disturbance in the middle atmosphere. Recent studies have shown that the effect of stratospheric sudden warnings extends well into the upper atmosphere. A stratospheric sudden warming is often accompanied by an amplification of lunar tides in the ionosphere/theremosphere. However, there are occasionally winters when a stratospheric sudden warming occurs without an enhancement of the lunar tide in the upper atmosphere, and other winters when large lunar tides are observed without a strong stratospheric sudden warming. We examine the winters when the correlation breaks down and discuss possible causes.

  16. Modern Physics and Warm Friendship

    NASA Astrophysics Data System (ADS)

    Yang, Chen Ning

    2013-05-01

    During the academic year 1941-42 I was a senior in the Physics Department at the National Southwest Associated University in Kunming. The Department was quite small, with about 10 faculty members, 10 instructors, a few graduate students and not more than 20 students in each undergraduate class. When the academic year started in the fall of 1941, a new face appeared, auditing many of the senior and graduate courses and participating in all discussions. That was Huang Kun. He had already received his bachelor's degree in physics from Yenching University in Beiping, and had come to Kunming to join the Southwest Associated University as an instructor. Soon we got to know each other well, and that was the beginning of half of a century of warm friendship...

  17. How to stop global warming

    SciTech Connect

    Goldenberg, J. . Dept. de Fisica)

    1990-11-01

    This paper reports on how to stop global warming. At the Toronto Conference on Climate Change in 1988, the world's industrialized nations agreed on a goal of cutting greenhouse gas emissions 20 percent by the year 2005. This would not stabilize atmospheric levels of greenhouse gases but would at least slow their accumulation. Although difficult to achieve, the Toronto goal is certainly reachable. Newer, more efficient technologies can lower energy consumption without effecting economic output. CFC- substitutes can provide refrigeration. In fact, an international carbon tax of just $1 per barrel of oil, or $6 per ton of coal, would generate more than enough revenue to pay for the necessary fuel-saving measures. This tax could result from an international agreement similar to the 1987 Montreal Protocol, which obliges its signatories to cut down on production of CFCs.

  18. Meteorology: hurricanes and global warming.

    PubMed

    Landsea, Christopher W

    2005-12-22

    Anthropogenic climate change has the potential for slightly increasing the intensity of tropical cyclones through warming of sea surface temperatures. Emanuel has shown a striking and surprising association between sea surface temperatures and destructiveness by tropical cyclones in the Atlantic and western North Pacific basins. However, I question his analysis on the following grounds: it does not properly represent the observations described; the use of his Atlantic bias-removal scheme may not be warranted; and further investigation of a substantially longer time series for tropical cyclones affecting the continental United States does not show a tendency for increasing destructiveness. These factors indicate that instead of "unprecedented" tropical cyclone activity having occurred in recent years, hurricane intensity was equal or even greater during the last active period in the mid-twentieth century.

  19. End Calorimeter Warm Tube Heater

    SciTech Connect

    Primdahl, K.; /Fermilab

    1991-08-06

    The Tevatron accelerator beam tube must pass through the End Calorimeter cryostats of the D-Zero Collider Detector. Furthermore, the End Calorimeter cryostats must be allowed to roll back forty inches without interruption of the vacuum system; hence, the Tev tube must slide through the End Calorimeter cryostat as it is rolled back. The Tev pass through the End Calorimeter can actually be thought of as a cluster of concentric tubes: Tev tube, warm (vacuum vessel) tube, IS layers of superinsulation, cold tube (argon vessel), and Inner Hadronic center support tube. M. Foley generated an ANSYS model to study the heat load. to the cryostat. during collider physics studies; that is, without operation of the heater. A sketch of the model is included in the appendix. The vacuum space and superinsulation was modeled as a thermal solid, with conductivity derived from tests performed at Fermilab. An additional estimate was done. by this author, using data supplied by NR-2. a superinsulation manufacturer. The ANSYS result and hand calculation are in close agreement. The ANSYS model was modified. by this author. to incorporate the effect of the heater. Whereas the earlier model studied steady state operation only. the revised model considers the heater-off steady state mode as the initial condition. then performs a transient analysis with a final load step for time tending towards infinity. Results show the thermal gradient as a function of time and applied voltage. It should be noted that M. Foley's model was generated for one half the warm tube. implying the tube to be symmetric. In reality. the downstream connection (relative to the collision point) attachment to the vacuum shell is via several convolutions of a 0.020-inch wall bellows; hence. a nearly adiabatic boundary condition. Accordingly. the results reported in the table reflect extrapolation of the curves to the downstream end of the tube. Using results from the ANSYS analysis, that is, tube temperature and

  20. Combined therapy: surgery and intraoperative HDR brachytherapy for locally advanced and recurrent rectal cancer. Practical experience of Brachytherapy Department in Warsaw

    PubMed Central

    Radziszewski, Jakub; Lyczek, Jaroslaw; Kawczynska, Maria; Kulik, Anna

    2009-01-01

    Purpose Patients with locally advanced and recurrent rectal cancer have a dismal prognosis. The aim of proposed combined therapy – surgery and intraoperative brachytherapy, is to improve results of already applied methods and to define optimal group of patients for this treatment. We introduce practical experience of Brachytherapy Department in Cancer Centre – Institute in Warsaw. Material and methods Patients with primary T4NxM0 rectal cancer and isolated local pelvic recurrence were qualified for therapy. Between January 2005 and September 2008, 13 patients were included: 4 with primary cancer and 9 with recurrence, median age of 56. After surgical resection intraoperative radiotherapy was delivered with boost of high dose rate brachytherapy of 20Gy dose to the tumor bed. Results Primary point of the study is to evaluate impact of applied therapy on local control (LC), overall survival (OS) and disease free survival (DFS). Median follow-up is 16 months. Four of the patients died and 3 survivors are disease-free. There was no case of perioperative mortality. Conclusions A multimodality approach, using surgical resection with intra operative brachytherapy improves local control as well as patients survival in comparison with historical treatment group. Combined therapy is related to high morbidity, but low mortality. The preliminary observations seem to correspond with other authors data.

  1. Analysis of endocardial acceleration during intraoperative optimization of cardiac resynchronization therapy

    PubMed Central

    Hernandez, Alfredo I.; Ziglio, Filippo; Amblard, Amel; Senhadji, Lotfi; Leclercq, Christophe

    2013-01-01

    Cardiac resynchronization therapy (CRT) is the therapy of choice for selected patients suffering from drug-refractory congestive heart failure and presenting an interventricular desynchronization. CRT is delivered by an implantable biventricular pacemaker, which stimulates the right atrium and both ventricles at specific timings. The optimization and personalization of this therapy requires to quantify both the electrical and the mechanical cardiac functions during the intraoperative and postoperative phases. The objective of this paper is to evaluate the feasibility of the calculation of features extracted from endocardial acceleration (EA) signals and the potential utility of these features for the intraoperative optimization of CRT. Endocardial intraoperative data from one patient are analyzed for 33 different pacing configurations, including changes in the atrio-ventricular and inter-ventricular delays and different ventricular stimulation sites. The main EA features are extracted for each pacing configuration and analyzed so as to estimate the intra-configuration and inter-configuration variability. Results show the feasibility of the proposed approach and suggest the potential utility of EA for intraoperative monitoring of the cardiac function and defining optimal, adaptive pacing configurations. PMID:24111356

  2. 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.

  3. Numerical characterization of intraoperative and chronic electrodes in deep brain stimulation

    PubMed Central

    Paffi, Alessandra; Camera, Francesca; Apollonio, Francesca; d’Inzeo, Guglielmo; Liberti, Micaela

    2015-01-01

    An intraoperative electrode (microelectrode) is used in the deep brain stimulation (DBS) technique to pinpoint the brain target and to choose the best parameters for the electrical stimulus. However, when the intraoperative electrode is replaced with the chronic one (macroelectrode), the observed effects do not always coincide with predictions. To investigate the causes of such discrepancies, a 3D model of the basal ganglia has been considered and realistic models of both intraoperative and chronic electrodes have been developed and numerically solved. Results of simulations of the electric potential (V) and the activating function (AF) along neuronal fibers show that the different geometries and sizes of the two electrodes do not change the distributions and polarities of these functions, but rather the amplitudes. This effect is similar to the one produced by the presence of different tissue layers (edema or glial tissue) in the peri-electrode space. Conversely, an inaccurate positioning of the chronic electrode with respect to the intraoperative one (electric centers not coincident) may induce a completely different electric stimulation in some groups of fibers. PMID:25745397

  4. Preoperative and Intraoperative Evaluation of the Eustachian Tube in Chronic Ear Surgery.

    PubMed

    Tarabichi, Muaaz; Kapadia, Mustafa

    2016-10-01

    This article discusses the authors' approach to the assessment of the eustachian tube using opening pressure measurement, endoscopic assessment of the protympanic segment of the eustachian tube, and Valsalva computed tomography. A possible algorithm for the evaluation of eustachian tube obstructive disorders is detailed both preoperatively and intraoperatively. PMID:27468635

  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

    2015-01-01

    The specific design of the mobile dedicated intraoperative radiotherapy (IORT) accelerators and different electron beam collimation system can change the dosimetric characteristics of electron beam with respect to the conventional accelerators. The aim of this study is to measure and compare the dosimetric characteristics of electron beam produced by intraoperative and conventional radiotherapy accelerators. To this end, percentage depth dose along clinical axis (PDD), transverse dose profile (TDP), and output factor of LIAC IORT and Varian 2100C/D conventional radiotherapy accelerators were measured and compared. TDPs were recorded at depth of maximum dose. The results of this work showed that depths of maximum dose, R90, R50, and RP for LIAC beam are lower than those of Varian beam. Furthermore, for all energies, surface doses related to the LIAC beam are substantially higher than those of Varian beam. The symmetry and flatness of LIAC beam profiles are more desirable compared to the Varian ones. Contrary to Varian accelerator, output factor of LIAC beam substantially increases with a decrease in the size of the applicator. Dosimetric characteristics of beveled IORT applicators along clinical axis were different from those of the flat ones. From these results, it can be concluded that dosimetric characteristics of intraoperative electron beam are substantially different from those of conventional clinical electron beam. The dosimetric characteristics of the LIAC electron beam make it a useful tool for intraoperative radiotherapy purposes.

  6. [Intraoperative monitoring of motor cranial nerves in operations of the neck and cranial base].

    PubMed

    Maurer, J; Pelster, H; Mann, W

    1994-11-01

    Intraoperative monitoring of cranial nerves is performed to minimize postoperative cranial nerve dysfunction. We performed electrophysiological monitoring of motor cranial nerves with a NIM 2 unit from Xomed Treace and a patient multiplexer developed in our clinic. This multiplexer allows simultaneous monitoring of 4 cranial nerves and is additionally equipped with a bipolar stimulation mode. This intraoperative monitoring was employed during 102 skull base operations. Of these 102 operations, 44 were acoustic neuroma removals by translabyrinthine approach and 36 by a middle fossa approach. Various operations including removal of tumours of the jugular foramen and the infratemporal fossa were performed in the remaining 22 patients. The facial nerve, being the most frequently monitored nerve, was evaluated both pre- and intraoperatively. Electrophysiologic data were evaluated with respect to their predictive value for postoperative facial nerve function. The relative per cent decrease in amplitude of the EMG after resection compared to that observed before resection seems to be of some predictive value for postoperative facial nerve function. A 50-60% decrease or more is associated with an increase in the House classification. Intraoperative monitoring is a useful tool in skull base surgery allowing for safer and faster identification of motor nerves in pathologic anatomic conditions. It allows the surgeon a degree of comfort by providing immediate information regarding the status of the nerve. It may also improve post-operative nerve function and shorten operating time. Additionally, neuromonitoring provides some information about expected postoperative facial nerve function.

  7. Intraoperative measurement of graft blood flow--a necessity in liver transplantation.

    PubMed

    Rasmussen, A; Hjortrup, A; Kirkegaard, P

    1997-01-01

    Portal venous and hepatic arterial flow was measured intraoperatively in the 70 most recent patients undergoing liver transplantation in our institution. Impaired graft flow due to vascular abnormalities was detected in six patients. One patient suffered from arterial steal due to stenosis of the recipient celiac trunk with blood shunting from the hepatic to the splenic artery. Ligation of the recipient hepatic artery restored the arterial graft flow. In two patients we found reduced portal venous flow due to large portosystemic collaterals. The collaterals accountable for the impaired portal flow were identified and ligated, which restored portal venous graft flow. Excessive sensitivity of the portal venous flow to the position of the graft was found in a 6-month-old boy. Portal venous flow varied considerably, depending upon the position of the graft, and intraoperative flow measurement allowed the best position of the graft to be identified. Two patients developed arterial thrombosis in the early postoperative course. Immediate laparatomy with thrombectomy resulted in good, palpable pulsation in the graft artery in both patients. Intraoperative flow measurement demonstrated satisfactory arterial flow in one patient, whereas there was no net flow in the other patient's graft artery. Pulsation in this patient was caused by blood oscillating in and out of the liver. In conclusion, we find that causes of primary graft dysfunction due to technically flawed reperfusion of the graft can be identified and alleviated by intraoperative measurement of the flow in the graft vessels.

  8. 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…

  9. A review of brain retraction and recommendations for minimizing intraoperative brain injury.

    PubMed

    Andrews, R J; Bringas, J R

    1993-12-01

    Brain retraction is required for adequate exposure during many intracranial procedures. The incidence of contusion or infarction from overzealous brain retraction is probably 10% in cranial base procedures and 5% in intracranial aneurysm procedures. The literature on brain retraction injury is reviewed, with particular attention to the use of intermittent retraction. Intraoperative monitoring techniques--brain electrical activity, cerebral blood flow, and brain retraction pressure--are evaluated. Various intraoperative interventions--anesthetic agents, positioning, cerebrospinal fluid drainage, operative approaches involving bone resection or osteotomy, hyperventilation, induced hypotension, induced hypertension, mannitol, and nimodipine--are assessed with regard to their effects on brain retraction. Because brain retraction injury, like other forms of focal cerebral ischemia, is multifactorial in its origins, a multifaceted approach probably will be most advantageous in minimizing retraction injury. Recommendations for operative management of cases involving significant brain retraction are made. These recommendations optimize the following goals: anesthesia and metabolic depression, improvement in cerebral blood flow and calcium channel blockade, intraoperative monitoring, and operative exposure and retraction efficacy. Through a combination of judicious retraction, appropriate anesthetic and pharmacological management, and aggressive intraoperative monitoring, brain retraction should become a much less common source of morbidity in the future.

  10. Excision of nasopharyngeal angiofibroma facilitated by intra-operative 3D-image guidance.

    PubMed

    Murray, A; Falconer, M; McGarry, G W

    2000-04-01

    The latest 3D-image guidance systems to assist surgeons have greatly improved over earlier models. We describe the use of an optical infra-red system to assist in the removal of a juvenile nasopharyngeal angiofibroma. The specific advantages of this system in pre-operative assessment, intra-operative evaluation and excision of the angiofibroma are discussed.

  11. 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

  12. Intraoperative MRI: the challenges of providing a safe environment for patients and personnel.

    PubMed

    Porteous, Joan

    2014-06-01

    Real-time intraoperative magnetic resonance imaging (iMRI) provides a tremendous benefit to patients undergoing brain tumour surgery. This paper will discuss the Winnipeg Health Sciences Centre's experience implementing a new iMRI program in a new neurosurgery operating room suite. It will review MRI technology and discuss related safety considerations for patients and personnel.

  13. Impact of Intraoperative Acetaminophen Administration on Postoperative Opioid Consumption in Patients Undergoing Hip or Knee Replacement

    PubMed Central

    Vaughan, Cathy; McGee, Ann

    2014-01-01

    Abstract Background: Opioid utilization for acute pain has been associated with numerous adverse events, potentially resulting in longer inpatient stays and increased costs. Objective: To examine the effect of intravenous (IV) acetaminophen administered intraoperatively on postoperative opioid consumption in adult subjects who underwent hip or knee replacement. Methods: This retrospective cohort study evaluated postoperative opioid consumption in 176 randomly selected adult subjects who underwent hip or knee replacement at Duke University Hospital (DUH). Eighty-eight subjects received a single, intraoperative, 1 g dose of IV acetaminophen. The other subjects did not receive any IV acetaminophen. This study evaluated mean opioid consumption (in oral morphine equivalents) during the 24-hour postoperative period in the 2 groups. Other endpoints included length of stay in the postanesthesia care unit (PACU), incidence of oversedation, need for acute opioid reversal, and adjunctive analgesic utilization. Results: Subjects who were given a single dose of intraoperative acetaminophen received an average of 149.3 mg of oral morphine equivalents during the 24 hours following surgery compared to 147.2 mg in participants who were not exposed to IV acetaminophen (P = .904). The difference in average length of PACU stay between the IV acetaminophen group (163 minutes) and those subjects not exposed to IV acetaminophen (169 minutes) was not statistically significant (P = .588). No subjects in the study experienced oversedation or required acute opioid reversal. Conclusion: There was not a statistically significant difference in postoperative opioid consumption between patients receiving and not receiving IV acetaminophen intraoperatively. PMID:25673891

  14. Liquid Cooling/Warming Garment

    NASA Technical Reports Server (NTRS)

    Koscheyev, Victor S.; Leon, Gloria R.; Dancisak, Michael J.

    2010-01-01

    The NASA liquid cooling/ventilating garment (LCVG) currently in use was developed over 40 years ago. With the commencement of a greater number of extra-vehicular activity (EVA) procedures with the construction of the International Space Station, problems of astronaut comfort, as well as the reduction of the consumption of energy, became more salient. A shortened liquid cooling/warming garment (SLCWG) has been developed based on physiological principles comparing the efficacy of heat transfer of different body zones; the capability of blood to deliver heat; individual muscle and fat body composition as a basis for individual thermal profiles to customize the zonal sections of the garment; and the development of shunts to minimize or redirect the cooling/warming loop for different environmental conditions, physical activity levels, and emergency situations. The SLCWG has been designed and completed, based on extensive testing in rest, exercise, and antiorthostatic conditions. It is more energy efficient than the LCVG currently used by NASA. The total length of tubing in the SLCWG is approximately 35 percent less and the weight decreased by 20 percent compared to the LCVG. The novel features of the innovation are: 1. The efficiency of the SLCWG to maintain thermal status under extreme changes in body surface temperatures while using significantly less tubing than the LCVG. 2. The construction of the garment based on physiological principles of heat transfer. 3. The identification of the body areas that are most efficient in heat transfer. 4. The inclusion of a hood as part of the garment. 5. The lesser consumption of energy.

  15. Synergistic Interactions with a High Intraoperative Expander Fill Volume Increase the Risk for Mastectomy Flap Necrosis

    PubMed Central

    Khavanin, Nima; Jordan, Sumanas; Lovecchio, Francis; Fine, Neil A.

    2013-01-01

    Purpose Prosthetic-based breast reconstruction is performed with increasing frequency in the United States. Major mastectomy skin flap necrosis is a significant complication with outcomes ranging from poor aesthetic appearance to reconstructive failure. The present study aimed to explore the interactions between intraoperative fill and other risk factors on the incidence of flap necrosis in patients undergoing mastectomy with immediate expander/implant-based reconstruction. Methods A retrospective review of 966 consecutive patients (1,409 breasts) who underwent skin or nipple sparing mastectomy with immediate tissue expander reconstruction at a single institution was conducted. Age, body mass index, hypertension, smoking status, premastectomy and postmastectomy radiation, acellular dermal matrix use, and application of the tumescent mastectomy technique were analyzed as potential predictors of flap necrosis both independently and as synergistic variables with high intraoperative fill. The following three measures of interaction were calculated: relative excess risk due to interaction, attributable proportion of risk due to interaction, and synergy index (SI). Results Intraoperative tissue expander fill volume was high (≥66.7% of the maximum volume) in 40.9% (576 of 1,409 breasts) of cases. The unadjusted flap necrosis rate was greater in the high intraoperative fill cohort than in the low fill cohort (10.4% vs. 7.1%, p=0.027). Multivariate logistic regression did not identify high intraoperative fill volume as an independent risk factor for flap necrosis (odds ratio 1.442, 95% confidence interval 0.973-2.137, p=0.068). However, four risk factors were identified that interacted significantly with intraoperative fill volume, namely tumescence, age, hypertension, and obesity. The SI, or the departure from additive risks, was largest for tumescence (SI, 25.3), followed by hypertension (SI, 2.39), obesity (SI, 2.28), and age older than 50 years (SI, 1.17). Conclusion

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

    PubMed Central

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

    2014-01-01

    One of the major challenges impeding advancement in image-guided surgical (IGS) systems is the soft-tissue deformation during surgical procedures. These deformations reduce the utility of the patient’s preoperative images and may produce inaccuracies in the application of preoperative surgical plans. Solutions to compensate for the tissue deformations include the acquisition of intraoperative tomographic images of the whole organ for direct displacement measurement and techniques that combines intraoperative organ surface measurements with computational biomechanical models to predict subsurface displacements. The later solution has the advantage of being less expensive and amenable to surgical workflow. Several modalities such as textured laser scanners, conoscopic holography, and stereo-pair cameras have been proposed for the intraoperative 3D estimation of organ surfaces to drive patient-specific biomechanical models for the intraoperative update of preoperative images. Though each modality has its respective advantages and disadvantages, stereo-pair camera approaches used within a standard operating microscope is the focus of this article. A new method that permits the automatic and near real-time estimation of 3D surfaces (at 1Hz) under varying magnifications of the operating microscope is proposed. This method has been evaluated on a CAD phantom object and on full-length neurosurgery video sequences (~1 hour) acquired intraoperatively by the proposed stereovision system. To the best of our knowledge, this type of validation study on full-length brain tumor surgery videos has not been done before. The method for estimating the unknown magnification factor of the operating microscope achieves accuracy within 0.02 of the theoretical value on a CAD phantom and within 0.06 on 4 clinical videos of the entire brain tumor surgery. When compared to a laser range scanner, the proposed method for reconstructing 3D surfaces intraoperatively achieves root mean square

  17. Design and performance of combined infrared canopy and belowground warming in the B4WarmED (Boreal Forest Warming at an Ecotone in Danger) experiment.

    PubMed

    Rich, Roy L; Stefanski, Artur; Montgomery, Rebecca A; Hobbie, Sarah E; Kimball, Bruce A; Reich, Peter B

    2015-06-01

    Conducting manipulative climate change experiments in complex vegetation is challenging, given considerable temporal and spatial heterogeneity. One specific challenge involves warming of both plants and soils to depth. We describe the design and performance of an open-air warming experiment called Boreal Forest Warming at an Ecotone in Danger (B4WarmED) that addresses the potential for projected climate warming to alter tree function, species composition, and ecosystem processes at the boreal-temperate ecotone. The experiment includes two forested sites in northern Minnesota, USA, with plots in both open (recently clear-cut) and closed canopy habitats, where seedlings of 11 tree species were planted into native ground vegetation. Treatments include three target levels of plant canopy and soil warming (ambient, +1.7°C, +3.4°C). Warming was achieved by independent feedback control of voltage input to aboveground infrared heaters and belowground buried resistance heating cables in each of 72-7.0 m(2) plots. The treatments emulated patterns of observed diurnal, seasonal, and annual temperatures but with superimposed warming. For the 2009 to 2011 field seasons, we achieved temperature elevations near our targets with growing season overall mean differences (∆Tbelow ) of +1.84°C and +3.66°C at 10 cm soil depth and (∆T(above) ) of +1.82°C and +3.45°C for the plant canopies. We also achieved measured soil warming to at least 1 m depth. Aboveground treatment stability and control were better during nighttime than daytime and in closed vs. open canopy sites in part due to calmer conditions. Heating efficacy in open canopy areas was reduced with increasing canopy complexity and size. Results of this study suggest the warming approach is scalable: it should work well in small-statured vegetation such as grasslands, desert, agricultural crops, and tree saplings (<5 m tall). PMID:25640748

  18. Design and performance of combined infrared canopy and belowground warming in the B4WarmED (Boreal Forest Warming at an Ecotone in Danger) experiment.

    PubMed

    Rich, Roy L; Stefanski, Artur; Montgomery, Rebecca A; Hobbie, Sarah E; Kimball, Bruce A; Reich, Peter B

    2015-06-01

    Conducting manipulative climate change experiments in complex vegetation is challenging, given considerable temporal and spatial heterogeneity. One specific challenge involves warming of both plants and soils to depth. We describe the design and performance of an open-air warming experiment called Boreal Forest Warming at an Ecotone in Danger (B4WarmED) that addresses the potential for projected climate warming to alter tree function, species composition, and ecosystem processes at the boreal-temperate ecotone. The experiment includes two forested sites in northern Minnesota, USA, with plots in both open (recently clear-cut) and closed canopy habitats, where seedlings of 11 tree species were planted into native ground vegetation. Treatments include three target levels of plant canopy and soil warming (ambient, +1.7°C, +3.4°C). Warming was achieved by independent feedback control of voltage input to aboveground infrared heaters and belowground buried resistance heating cables in each of 72-7.0 m(2) plots. The treatments emulated patterns of observed diurnal, seasonal, and annual temperatures but with superimposed warming. For the 2009 to 2011 field seasons, we achieved temperature elevations near our targets with growing season overall mean differences (∆Tbelow ) of +1.84°C and +3.66°C at 10 cm soil depth and (∆T(above) ) of +1.82°C and +3.45°C for the plant canopies. We also achieved measured soil warming to at least 1 m depth. Aboveground treatment stability and control were better during nighttime than daytime and in closed vs. open canopy sites in part due to calmer conditions. Heating efficacy in open canopy areas was reduced with increasing canopy complexity and size. Results of this study suggest the warming approach is scalable: it should work well in small-statured vegetation such as grasslands, desert, agricultural crops, and tree saplings (<5 m tall).

  19. Warming: mechanism and latitude dependence

    NASA Astrophysics Data System (ADS)

    Barkin, Yury

    2010-05-01

    Introduction. In the work it is shown, that in present warming of climate of the Earth and in style of its display a fundamental role the mechanism of the forced swing and relative oscillations of eccentric core of the Earth and its mantle plays. Relative displacements of the centers of mass of the core and the mantle are dictated by the features of orbital motions of bodies of solar system and nonineriality of the Earth reference frame (or ot the mantle) at the motion of the Earth with respect to a baricenter of solar system and at rotation of the planet. As a result in relative translational displacements of the core and the mantle the frequencies characteristic for orbital motion of all bodies of solar system, and also their combination are shown. Methods of a space geodesy, gravimetry, geophysics, etc. unequivocally and clearly confirm phenomenon of drift of the center of mass of the Earth in define northern direction. This drift is characterized by the significant velocity in about 5 mm/yr. The unique opportunity of its explanation consists in the natural assumption of existence of the unidirectional relative displacement (drift) the center of mass of the core and the center of mass of the mantle of the Earth. And this displacement (at superfluous mass of the core in 16.7 % from the mass of full the Earth) is characterized still more significant velocity in 2.6 cm/yr and occurs on our geodynamic studies in a direction to Taimyr peninsula. The dynamic explanation to century drift for today does not exist. It is possible to note, however, that data of observations of last years, indirectly testifying that similar drifts of the centers of mass in present epoch occur on other bodies of Solar system have been obtain: the Sun, Mars, the Titan, Enceladus, the Neptune, etc. We connect with mentioned phenomena the observed secular variations of natural processes on this celestial bodies. I.e. it is possible to assume, that observable eccentric positions of the centers

  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. Efficient Warm-ups: Creating a Warm-up That Works.

    ERIC Educational Resources Information Center

    Lauffenburger, Sandra Kay

    1992-01-01

    Proper warm-up is important for any activity, but designing an effective warm-up can be time consuming. An alternative approach is to take a cue from Laban Movement Analysis (LMA) and consider movement design from the perspective of space and planes of motion. Efficient warm-up exercises using LMA are described. (SM)

  3. Warm Pressurant Gas Effects on the Liquid Hydrogen Bubble Point

    NASA Technical Reports Server (NTRS)

    Hartwig, Jason W.; McQuillen, John B.; Chato, David J.

    2013-01-01

    This paper presents experimental results for the liquid hydrogen bubble point tests using warm pressurant gases conducted at the Cryogenic Components Cell 7 facility at the NASA Glenn Research Center in Cleveland, Ohio. The purpose of the test series was to determine the effect of elevating the temperature of the pressurant gas on the performance of a liquid acquisition device. Three fine mesh screen samples (325 x 2300, 450 x 2750, 510 x 3600) were tested in liquid hydrogen using cold and warm noncondensible (gaseous helium) and condensable (gaseous hydrogen) pressurization schemes. Gases were conditioned from 0 to 90 K above the liquid temperature. Results clearly indicate a degradation in bubble point pressure using warm gas, with a greater reduction in performance using condensable over noncondensible pressurization. Degradation in the bubble point pressure is inversely proportional to screen porosity, as the coarsest mesh demonstrated the highest degradation. Results here have implication on both pressurization and LAD system design for all future cryogenic propulsion systems. A detailed review of historical heated gas tests is also presented for comparison to current results.

  4. Alpine proglacial suspended sediment dynamics in warm and cool ablation seasons: Implications for global warming

    NASA Astrophysics Data System (ADS)

    Stott, Tim; Mount, Nick

    2007-01-01

    SummaryData on suspended sediment dynamics and loads obtained from the Torrent du Glacier Noir, Ecrins Massif, SE France, during the unusually warm 2003 and cooler 2004 ablation seasons are used to indicate the likely future impacts of climate warming on suspended sediment transport processes in temperate Alpine proglacial zones. Suspended sediment concentration (SSC) and discharge ( Q) were continuously monitored for 16-day periods during July 2003 and July 2004. SSC was monitored by automated pump sampling during diurnal events in each season and supplemented by a 10 min turbidity record. Q was monitored at a range of flows and a rating curve used to convert a 10 min water level record into Q. Air temperature (AT) was also logged at 10 min intervals throughout the study. Comparison of the 2003 and 2004 monitoring periods showed that daily mean AT measured at the site was 1.2 °C higher in 2003, mean Q was 2.3 times higher, and the suspended sediment load (SSL) was between 3.1 and 4.1 times greater in July 2003 than for the same period in the 2004 ablation season. There is an increase in SSC during the 2004 observation period which is less apparent in 2003, most likely because higher ATs and consequently higher Q earlier in the 2003 melt season had removed available sediment before the study took place in July. The rating curve method for estimating SSL produced a total load for the 16-day study period in 2003 which, when corrected upwards to account for statistical bias, was 10 314 ± 743 t or 95% of the load estimated from the turbidity record for the same period. In 2004 the corrected SSC- Q rating curve estimate was 2504 ± 126 t while the estimate from the turbidity record was 743 ± 112 t though a more sensitive turbidity sensor produced a higher estimate of 3474 ± 302 t. While the different SSL estimation methods in 2004 are not in perfect agreement, the contrast between the two seasons is nevertheless very clear, and is largely attributed to a mean

  5. Nonlinear electron oscillations in a warm plasma

    SciTech Connect

    Sarkar, Anwesa; Maity, Chandan; Chakrabarti, Nikhil

    2013-12-15

    A class of nonstationary solutions for the nonlinear electron oscillations of a warm plasma are presented using a Lagrangian fluid description. The solution illustrates the nonlinear steepening of an initial Gaussian electron density disturbance and also shows collapse behavior in time. The obtained solution may indicate a class of nonlinear transient structures in an unmagnetized warm plasma.

  6. Warming of Water in a Glass

    ERIC Educational Resources Information Center

    Paulins, Paulis; Krauze, Armands; Ozolinsh, Maris; Muiznieks, Andris

    2016-01-01

    The article focuses on the process of water warming from 0 °C in a glass. An experiment is performed that analyzes the temperature in the top and bottom layers of water during warming. The experimental equipment is very simple and can be easily set up using devices available in schools. The temperature curves obtained from the experiment help us…

  7. Warm-up: A Psychophysiological Phenomenon.

    ERIC Educational Resources Information Center

    Lopez, Richard; Dausman, Cindy

    1981-01-01

    The effectiveness of warm-up as an aid to athletic performance is related to an interaction of both psychological and physiological factors. Benefits of warm-up include an increase in blood and muscle temperatures and an increased muscular endurance. (JN)

  8. Exploring the Sociopolitical Dimensions of Global Warming

    ERIC Educational Resources Information Center

    Sadler, Troy D.; Klosterman, Michelle L.

    2009-01-01

    The authors present an activity to help high school students conceptualize the sociopolitical complexity of global warming through an exploration of varied perspectives on the issue. They argue that socioscientific issues such as global warming present important contexts for learning science and that the social and political dimensions of these…

  9. Global Warming: Lessons from Ozone Depletion

    ERIC Educational Resources Information Center

    Hobson, Art

    2010-01-01

    My teaching and textbook have always covered many physics-related social issues, including stratospheric ozone depletion and global warming. The ozone saga is an inspiring good-news story that's instructive for solving the similar but bigger problem of global warming. Thus, as soon as students in my physics literacy course at the University of…

  10. Global Warming: Understanding and Teaching the Forecast.

    ERIC Educational Resources Information Center

    Andrews, Bill

    1994-01-01

    A resource for the teaching of the history and causes of climate change. Discusses evidence of climate change from the Viking era, early ice ages, the most recent ice age, natural causes of climate change, human-made causes of climate change, projections of global warming, and unequal warming. (LZ)

  11. Turkish Students' Ideas about Global Warming

    ERIC Educational Resources Information Center

    Kilinc, Ahmet; Stanisstreet, Martin; Boyes, Edward

    2008-01-01

    A questionnaire was used to explore the prevalence of ideas about global warming in Year 10 (age 15-16 years) school students in Turkey. The frequencies of individual scientific ideas and misconceptions about the causes, consequences and "cures" of global warming were identified. In addition, several general findings emerged from this study.…

  12. Rapid warming of Large Marine Ecosystems

    NASA Astrophysics Data System (ADS)

    Belkin, Igor M.

    2009-04-01

    The need to understand local effects of global climate change is most urgent in the Large Marine Ecosystems (LMEs) since marine ecosystem-based management requires information on the LME scale. Reported here is a study of sea surface temperature (SST) change in the World Ocean LMEs in 1957-2006 that revealed strong regional variations in the rate of SST change. The rapid warming in 1982-2006 was confined to the Subarctic Gyre, European Seas, and East Asian Seas. These LMEs warmed at rates 2-4 times the global mean rate. The most rapid warming was observed in the land-locked or semi-enclosed European and East Asian Seas (Baltic Sea, North Sea, Black Sea, Japan Sea/East Sea, and East China Sea) and also over the Newfoundland-Labrador Shelf. The Indian Ocean LMEs’ warming was slow, while two major upwelling areas - California and Humboldt Currents - experienced a slight cooling. The Subarctic Gyre warming was likely caused by natural variability related to the North Atlantic Oscillation. The extremely rapid surface warming in the enclosed and semi-enclosed European and East Asian Seas surrounded by major industrial/population agglomerations may have resulted from the observed terrestrial warming directly affecting the adjacent coastal seas. Regions of freshwater influence in the European and East Asian Seas seem to play a special role in modulating and exacerbating global warming effects on the regional scale.

  13. Global Warming: How Much and Why?

    ERIC Educational Resources Information Center

    Lanouette, William

    1990-01-01

    Summarizes the history of the study of global warming and includes a discussion of the role of gases, like carbon dioxide, methane, and chlorofluorocarbon (CFC). Discusses modern research on the global warming, including computer modelling and the super-greenhouse effect. (YP)

  14. Global Warming: Understanding and Teaching the Forecast.

    ERIC Educational Resources Information Center

    Andrews, Bill

    1995-01-01

    A resource for teaching about the consequences of global warming. Discusses feedback from the temperature increase, changes in the global precipitation pattern, effects on agriculture, weather extremes, effects on forests, effects on biodiversity, effects on sea levels, and actions which will help the global community cope with global warming. (LZ)

  15. Catching a Cold When It's Warm

    MedlinePlus

    ... our exit disclaimer . Subscribe Catching a Cold When It’s Warm What’s the Deal with Summertime Sniffles? Most ... be more unfair than catching a cold when it’s warm? How can cold symptoms arise when it’s ...

  16. In vivo intra-operative breast tumor margin detection using a portable OCT system with a handheld surgical imaging probe

    NASA Astrophysics Data System (ADS)

    Erickson-Bhatt, Sarah J.; Nolan, Ryan; Shemonski, Nathan D.; Adie, Steven G.; Putney, Jeffrey; Darga, Donald; McCormick, Daniel T.; Cittadine, Andrew; Marjanovic, Marina; Chaney, Eric J.; Monroy, Guillermo L.; South, Fredrick; Carney, P. Scott; Cradock, Kimberly A.; Liu, Z. George; Ray, Partha S.; Boppart, Stephen A.

    2014-02-01

    Breast-conserving surgery is a frequent option for women with stage I and II breast cancer, and with radiation treatment, can be as effective as a mastectomy. However, adequate margin detection remains a challenge, and too often additional surgeries are required. Optical coherence tomography (OCT) provides a potential method for real-time, high-resolution imaging of breast tissue during surgery. Intra-operative OCT imaging of excised breast tissues has been previously demonstrated by several groups. In this study, a novel handheld surgical probe-based OCT system is introduced, which was used by the surgeon to image in vivo, within the tumor cavity, and immediately following tumor removal in order to detect the presence of any remaining cancer. Following resection, study investigators imaged the excised tissue with the same probe for comparison. We present OCT images obtained from over 15 patients during lumpectomy and mastectomy surgeries. Images were compared to post-operative histopathology for diagnosis. OCT images with micron scale resolution show areas of heterogeneity and disorganized features indicative of malignancy, compared to more uniform regions of normal tissue. Video-rate acquisition shows the inside of the tumor cavity as the surgeon sweeps the probe along the walls of the surgical cavity. This demonstrates the potential of OCT for real-time assessment of surgical tumor margins and for reducing the unacceptably high re-operation rate for breast cancer patients.

  17. Direct evidence from intraoperative electrocortical stimulation indicates shared and distinct speech production center between Chinese and English languages.

    PubMed

    Wu, Jinsong; Lu, Junfeng; Zhang, Han; Zhang, Jie; Yao, Chengjun; Zhuang, Dongxiao; Qiu, Tianming; Guo, Qihao; Hu, Xiaobing; Mao, Ying; Zhou, Liangfu

    2015-12-01

    Chinese processing has been suggested involving distinct brain areas from English. However, current functional localization studies on Chinese speech processing use mostly "indirect" techniques such as functional magnetic resonance imaging and electroencephalography, lacking direct evidence by means of electrocortical recording. In this study, awake craniotomies in 66 Chinese-speaking glioma patients provide a unique opportunity to directly map eloquent language areas. Intraoperative electrocortical stimulation was conducted and the positive sites for speech arrest, anomia, and alexia were identified separately. With help of stereotaxic neuronavigation system and computational modeling, all positive sites elicited by stimulation were integrated and a series of two- and three-dimension Chinese language probability maps were built. We performed statistical comparisons between the Chinese maps and previously derived English maps. While most Chinese speech arrest areas located at typical language production sites (i.e., 50% positive sites in ventral precentral gyrus, 28% in pars opercularis and pars triangularis), which also serve English production, an additional brain area, the left middle frontal gyrus (Brodmann's areas 6/9), was found to be unique in Chinese production (P < 0.05). Moreover, Chinese speakers' inferior ventral precentral gyrus (Brodmann's area 6) was used more than that in English speakers. Our finding suggests that Chinese involves more perisylvian region (extending to left middle frontal gyrus) than English. This is the first time that direct evidence supports cross-cultural neurolinguistics differences in human beings. The Chinese language atlas will also helpful in brain surgery planning for Chinese-speakers.

  18. Direct evidence from intraoperative electrocortical stimulation indicates shared and distinct speech production center between Chinese and English languages.

    PubMed

    Wu, Jinsong; Lu, Junfeng; Zhang, Han; Zhang, Jie; Yao, Chengjun; Zhuang, Dongxiao; Qiu, Tianming; Guo, Qihao; Hu, Xiaobing; Mao, Ying; Zhou, Liangfu

    2015-12-01

    Chinese processing has been suggested involving distinct brain areas from English. However, current functional localization studies on Chinese speech processing use mostly "indirect" techniques such as functional magnetic resonance imaging and electroencephalography, lacking direct evidence by means of electrocortical recording. In this study, awake craniotomies in 66 Chinese-speaking glioma patients provide a unique opportunity to directly map eloquent language areas. Intraoperative electrocortical stimulation was conducted and the positive sites for speech arrest, anomia, and alexia were identified separately. With help of stereotaxic neuronavigation system and computational modeling, all positive sites elicited by stimulation were integrated and a series of two- and three-dimension Chinese language probability maps were built. We performed statistical comparisons between the Chinese maps and previously derived English maps. While most Chinese speech arrest areas located at typical language production sites (i.e., 50% positive sites in ventral precentral gyrus, 28% in pars opercularis and pars triangularis), which also serve English production, an additional brain area, the left middle frontal gyrus (Brodmann's areas 6/9), was found to be unique in Chinese production (P < 0.05). Moreover, Chinese speakers' inferior ventral precentral gyrus (Brodmann's area 6) was used more than that in English speakers. Our finding suggests that Chinese involves more perisylvian region (extending to left middle frontal gyrus) than English. This is the first time that direct evidence supports cross-cultural neurolinguistics differences in human beings. The Chinese language atlas will also helpful in brain surgery planning for Chinese-speakers. PMID:26351094

  19. Warm Disks from Giant Impacts

    NASA Astrophysics Data System (ADS)

    Kohler, Susanna

    2015-10-01

    In the process of searching for exoplanetary systems, weve discovered tens of debris disks close around distant stars that are especially bright in infrared wavelengths. New research suggests that we might be looking at the late stages of terrestrial planet formation in these systems.Forming Terrestrial PlanetsAccording to the widely-accepted formation model for our solar-system, protoplanets the size of Mars formed within a protoplanetary disk around our Sun. Eventually, the depletion of the gas in the disk led the orbits of these protoplanets to become chaotically unstable. Finally, in the giant impact stage, many of the protoplanets collided with each other ultimately leading to the formation of the terrestrial planets and their moons as we know them today.If giant impact stages occur in exoplanetary systems, too leading to the formation of terrestrial exoplanets how would we detect this process? According to a study led by Hidenori Genda of the Tokyo Institute of Technology, we might be already be witnessing this stage in observations of warm debris disks around other stars. To test this, Genda and collaborators model giant impact stages and determine what we would expect to see from a system undergoing this violent evolution.Modeling CollisionsSnapshots of a giant impact in one of the authors simulations. The collision causes roughly 0.05 Earth masses of protoplanetary material to be ejected from the system. Click for a closer look! [Genda et al. 2015]The collaborators run a series of simulations evolving protoplanetary bodies in a solar system. The simulations begin 10 Myr into the lifetime of the solar system, i.e., after the gas from the protoplanetary disk has had time to be cleared and the protoplanetary orbits begin to destabilize. The simulations end when the protoplanets are done smashing into each other and have again settled into stable orbits, typically after ~100 Myr.The authors find that, over an average giant impact stage, the total amount of

  20. Global Warming: Lessons from Ozone Depletion

    NASA Astrophysics Data System (ADS)

    Hobson, Art

    2010-11-01

    My teaching and textbook have always covered many physics-related social issues, including stratospheric ozone depletion and global warming. The ozone saga is an inspiring good-news story that's instructive for solving the similar but bigger problem of global warming. Thus, as soon as students in my physics literacy course at the University of Arkansas have developed a conceptual understanding of energy and of electromagnetism, including the electromagnetic spectrum, I devote a lecture (and a textbook section) to ozone depletion and another lecture (and section) to global warming. Humankind came together in 1986 and quickly solved, to the extent that humans can solve it, ozone depletion. We could do the same with global warming, but we haven't and as yet there's no sign that we will. The parallel between the ozone and global warming cases, and the difference in outcomes, are striking and instructive.