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Sample records for perioperative frozen section

  1. [Rapid frozen sections in neuropathology].

    PubMed

    Haybaeck, J; von Campe, G; Hainfellner, J A

    2012-09-01

    Neuropathological evaluation of frozen sections requires a) special expertise in neuropathological specimen assessment and neurooncology as well as b) a trustful and open communication culture with the neurosurgeons. In addition to frozen sections, cytological examinations of smear and touch preparations as supporting methods are available to reach a correct diagnosis: these additional methods should therefore be performed whenever possible. Besides evaluation of biopsy specimens, appraisal of resection specimens and resection margin controls are of high clinical relevance. In the case of diffusely infiltrating central nervous system (CNS) neoplasms, in particular gliomas, resection margin control is often not feasible in contrast to other types of solid tumor.

  2. Use of frozen section in genitourinary pathology.

    PubMed

    Shen, Steven S; Truong, Luan D; Ro, Jae Y; Ayala, Alberto G

    2012-08-01

    Frozen section diagnosis provides critical information for immediate surgical management decision making. Over the last several years, there have been some significant advances in treatment of genitourinary cancer, particularly with regard to surgical techniques. These changes in turn impact the type and frequency of intraoperative frozen section requests. In this review, we describe the main indications and diagnostic challenges of frozen section diagnosis during surgeries of each genitourinary organ system including prostate, kidney, bladder, testis, and penis. The pitfalls and approaches to different diagnostic situations are discussed. It is also stressed that pathologists must not only be familiar with the histological diagnosis, but also understand the limitations of frozen section diagnosis and communicate with urologists during the intraoperative treatment decision making process.

  3. [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.

  4. [PERIOPERATIVE ANALGESIA INFLUENCE ON MOTHER REHABILITATION PERIOD AFTER CESAREAN SECTION].

    PubMed

    Sedykh, S V

    2015-01-01

    Early breast-feeding is a standard of perinatal care currently. After cesarean section it can be possible in case of early mother activation (verticalization). Assessment of perioperative analgesia influence on activation timing was the aim of our research. We included 120 parturient women. It was proved, that local analgesia using in postoperative period promotes early mother verticaliration, and optimal breast-feeding starting.

  5. [Use of polyvinyl alcohol for preparing frozen histological sections].

    PubMed

    Serga, V A; Bykov, L A; Kasatonov, V G

    1982-01-01

    The authors developed a new method for preparation of frozen histological sections. It consists in the use of glycerin-plastified polymer, polyvinyl alcohol, and distilled water for impregnation of tissue pieces and subsequent freezing of them in the same medium. This produces histological sections of high quality. The frozen sections are sufficiently thin (3--5 micrometers). The method excludes cell structure destruction by ice crystals and overfreezing of blocks; the sections do not crumble. Losses of free cell elements, extraction of substances and other artifacts are minimized. The frozen histological sections are firmly glued to the glass without using protein with glycerin. The method saves time and reagents for the preparation of the sections and allows their wide use in morphological and histochemical studies.

  6. Xanthogranuloma of the sellar region diagnosed by frozen section

    PubMed Central

    Ji, Kun; Zhang, Liyan; Wang, Liwei

    2016-01-01

    Abstract Xanthogranuloma (XG) of the sellar region is uncommon and is difficult to diagnose based on intraoperative frozen sections. This study is a case presentation and review of the literature, highlighting the need to explore underlying diseases in order to guarantee an accurate patient diagnosis. Herein, we presented the case of a 43-year-old woman who was afflicted with xanthogranuloma of the sellar region; the patient had a history of headache and lengthened menstrual cycles over the 6 months prior to presentation. Endocrinology tests revealed that the patient’s levels of prolactin were high and the MRI of the patient showed a clearly defined sellar mass. As a result, the patient was considered to have prolactinoma prior to undergoing surgery. The tumor was completely removed using a transsphenoidal approach, and intraoperative frozen section revealed histology similar to xanthogranuloma. When the tumor was removed by surgical operation, the patient’s visual field defects and headache were relieved. Although intraoperative frozen section should provide some guidance with regard to the diagnosis, a pathological study is conducted to confirm the actual diagnosis. PMID:28352831

  7. [Perioperative metronidazole-prophylaxis for cesarian section (author's transl].

    PubMed

    Gerstner, G; Kofler, E; Huber, J

    1980-12-01

    A prospective, randomized clinical trial was conducted in 103 patients undergoing cesarian section to assess the efficacy of prophylactic, intravenously administered Metronidazole on the infectious morbidity. A group of 53 patients with perioperative Metronidazol-prophylaxis was compared to a similar controll-group without prophylaxis. Bacteriologic swabs were taken from the cervix pre- and postoperatively, using anaerobic transport media. Prophylactic Metronidazole reduced postoperative fever of more than 38 degrees C on two subsequent days from 60% in the controll-group to 30,2% in the Metronidazole-group (p less than 0,01) wound infections were reduced from 18% without to 5,7% with prophylaxis (p less than 0,05) and Endometritis from 30% without to 13,2% with prophylaxis (p less than 0,05). An additional antibiotic therapy was necessary in 44% of the cases in the controllgroup, compared to 24,5% of the cases in the Metronidazolegroup (p less than 0,05). The mean duration of hospitalisation was reduced from 12,1 +/- 3,2 days in the controll-group to 11,2 +/- 2,1 in the Metronidazole-group (p less than 0,01). Anaerobic bacteria were isolated from the servical swabs in 60% preoperatively, with a still increasing incidence to 72% postoperatively, compared to 7% in the Metronidazole-group. Our results suggest, that prophylactic, intravenously administered Metronidazol reduces the infectious morbidity following cesarian section due to the reduction of the anaerobic flora at the female genital-tract.

  8. Pulsed field gel electrophoresis on frozen tumour tissue sections.

    PubMed Central

    Boultwood, J.; Kaklamanis, L.; Gatter, K. C.; Wainscoat, J. S.

    1992-01-01

    The application of pulsed field gel electrophoresis (PFGE) to the molecular genetic analysis of solid tumours has been restricted by the requirement for whole single cells as a DNA source. A simple technique which allows for the direct analysis of histologically characterised solid tumour material by pulsed field gel electrophoresis was developed. Single frozen tissue sections obtained from colonic carcinoma specimens were embedded without further manipulation in molten, low melting temperature agarose. The tumour DNA contained within the agarose plug was subjected to restriction enzyme digestion and PFGE. Sufficient high molecular weight DNA is yielded by this method to obtain a hybridisation signal with a single copy probe. Histological examination of adjacent tissue sections may also be carried out, permitting correlation between molecular analysis and tumour histology. Images PMID:1401187

  9. Limitation of intraoperative frozen section during thyroid surgery.

    PubMed

    Estebe, Sandrine; Montenat, Cecile; Tremoureux, Adrien; Rousseau, Chloé; Bouilloud, François; Jegoux, Franck

    2017-03-01

    Retrospective analysis on 312 patients, operated for thyroid nodules between 2014 and 2015, was conducted to evaluate the impact of frozen section analysis on the strategy of thyroid nodule surgery. One hundred and ninety-three patients were included. They all underwent preoperative US, fine needle aspiration cytology (FNAC), per operative frozen section (FS) and post operative definitive pathological analysis. Se, Sp, VPP and VPN of FNAC and FS were calculated and compared (McNemar's test). Multivariate analysis was performed to identify independent factor of good results. Se of FS and FNAC were, respectively, 86.1 and 81% with significant superiority of FS (p = .0352). Sp of FS and FNAC were, respectively, 100 and 72% with significant superiority of FS (p = .0156). A strategy based only on FNAC would have led to a 3.6% rate of unnecessary total thyroidectomy vs. 0% using FS. Overall rate of second procedure after lobectomy would have been significantly greater 28.9% without (28.9%) than with (10.3%) FS (p = .018). Overall rate of undone one-stage central neck dissection concurrent to total thyroidectomy for MNG would not have been significantly different without (9.4%) and with (2.1%) FS (.058). FNAC alone is unable to determine the extent of thyroid nodule surgery whatever the Bethesda subtype may be. FS significantly decreases the risk of two-stage procedure. For one-stage total thyroidectomy for MNG, the gain with FS is scarce.

  10. Reliability of the frozen section in sharp knife cone biopsy of the cervix.

    PubMed

    Woodford, H D; Poston, W; Elkins, T E

    1986-10-01

    Eight patient records were reviewed following cold knife conization in which frozen section diagnosis was utilized to aid the surgeon in formulating appropriate therapy after conization. Two patients were diagnosed as having microinvasive squamous cell carcinoma on final pathology when frozen sections were read as showing no invasion. Furthermore, in the 51 instances in which a degree of cervical dysplasia was determined from frozen sections, 14 discrepancies were noted on final pathology (27%). Such discrepancies may lead to unnecessary hysterectomies performed for cervical dysplasia that is easily treated with outpatient office procedures, especially when cold knife conization and frozen section diagnosis are performed without prior colposcopy and biopsy.

  11. Immunofluorescence staining with frozen mouse or chick embryonic tissue sections.

    PubMed

    Wang, Hui; Matise, Michael P

    2013-01-01

    Immunofluorescence (IF), a form of immunohistochemistry (IHC) with specific applications, is commonly used for both basic research and clinical studies, including diagnostics, and involves visualizing the cellular distribution of target molecules (e.g., proteins, DNA, and small molecules) using a microscope capable of exciting and detecting fluorochrome compounds that emit light at specific, largely nonoverlapping wavelengths. The procedure for carrying out IF varies according to the tissue type and methods for processing and preparing tissue (e.g., fixative used to preserve tissue morphology and antigenicity). The protocol presented here provides a general guideline for multichannel IF staining using frozen embryonic mouse or chicken tissue sectioned on a cryostat. In general, the procedure involves the following: (1) fixing freshly dissected tissues in a 4 % paraformaldehyde solution buffered in the physiological pH range, (2) cryopreservation of tissue in a 30 % sucrose solution, (3) embedding and sectioning tissue in Optimal Cutting Temperature (OCT) matrix compound, (4) direct or indirect detection of the target antigen/s using fluorochrome-conjugated antibodies.

  12. Contraction-free, fume-fixed longitudinal sections of fresh frozen muscle

    NASA Technical Reports Server (NTRS)

    Riley, Danny A.; Slocum, Glenn R.

    1988-01-01

    Contraction damage occurring when longitudinal frozen sections of fresh unfixed muscles are thawed on microscope slides has limited histological examination of this tissue mainly to cross sections. Longitudinally oriented sections are advantageous for investigating properties that vary along the length of the muscle fibers. A fume fixation technique has been developed for preventing contraction of thick longitudinal frozen sections. The technique is compatible with histochemical staining of enzymes.

  13. Ultrasound-guided core needle biopsy of the breast: does frozen section give an accurate diagnosis?

    PubMed

    Mueller-Holzner, Elisabeth; Frede, Thomas; Daniaux, Martin; Ban, Michael; Taucher, Susanne; Schneitter, Alois; Zeimet, Alain G; Marth, Christian

    2007-12-01

    Reducing the period of uncertainty between the discovery of a breast tumor and histological diagnosis alleviates the psychological impact of breast cancer to an important degree. We aimed to verify whether histological results obtained with frozen sections of core needle biopsies (CNBs) offer an accurate and reliable tool for minimising this period. In 2619 cases we compared histological diagnosis on frozen sections with those on paraffin sections of CNB and finally with the results of open biopsies. Of the cases 49% were proved malignant and 51% benign. In 99.3% of the malignant lesions preceding CNB was correctly classified as B5 (n = 1185, 92.9%) or at least B4 (n = 82, 6.4%) in frozen and in paraffin sections. There were seven false-negative cases in frozen (false-negative rate = 0.5%) and five false-negative cases (false-negative rate = 0.4%) in paraffin sections of CNB. On frozen sections complete sensitivity was 99.5% and the positive predictive value of B5 was 99.9%. There was one false-positive case in frozen sections and one in paraffin sections. False-positive rate = 0.08%, negative predictive value for B2 = 99.4% for frozen and 99.6% for paraffin sections; full specificity was 85.9 for frozen and 85.8 for paraffin sections of CNBs. Immediate investigation of CNB in frozen sections is an accurate diagnostic method and an important step in reducing psychological strain on patients with breast tumors and may be offered by specialised Breast Assessment Units.

  14. Ice crystal damage in frozen thin sections: freezing effects and their restoration.

    PubMed

    Frederik, P M; Busing, W M

    1981-02-01

    Thin sections of unfixed kidney, fast frozen without cryoprotectants, were fixed in osmium tetroxide vapour directly after freeze drying or after 30 min in a moist atmosphere. Dry sections fixed in vapour showed ice crystal damage characteristic for the freezing procedure. This was demonstrated with freeze fracture replicas from the same preparation. Ice crystal holes were obscured in serial sections which were freeze dried and allowed to rehydrate in a moist atmosphere. The same ultrastructural appearance was observed in frozen sections brought to room temperature immediately after cutting. Frozen thin sections from unfixed tissue, if freeze dried, are very sensitive to atmospheric conditions and need some form of stabilization (e.g. osmium vapour fixation, sealing with an evaporated carbon film) before electron microscope images can be interpreted as representative for the frozen state. Restoration of ice crystal damage can occur by melting frozen sections or by rehydration of freeze dried frozen sections. Restoration phenomena will impair studies aimed at the localization of diffusible substances by autoradiography or X-ray microanalysis.

  15. Does Preoperative Diagnosis of Endometrial Hyperplasia Necessitate Intraoperative Frozen Section Consultation?

    PubMed Central

    Boyraz, Gokhan; Başaran, Derman; Salman, Mehmet C.; Özgül, Nejat; Yüce, Kunter

    2016-01-01

    Background In women with endometrial hyperplasia, there is a risk for co-existent endometrial cancer when patients are subjected to immediate surgical treatment. Aims The aim of this study was to investigate the frequency of endometrial cancer and the accuracy of frozen section analysis at the time of hysterectomy among patients with endometrial hyperplasia, to reveal whether or not a preoperative diagnosis of endometrial hyperplasia necessitates frozen section consultation. Study Design Retrospective cross-sectional study. Methods A department database review was performed to identify patients who were subjected to hysterectomy with a preoperative diagnosis of endometrial hyperplasia, during the period from 2007 to 2014. Results The study group included 189 cases. The final pathological examination revealed endometrial cancer in 16 women (8.4%). The risk of cancer in patients with endometrial hyperplasia was 1 of 125 (0.8%) in simple hyperplasia without atypia, 1 of 21 (4.8%) in complex hyperplasia without atypia and 14 of 43 (32.5%) in atypical hyperplasia. Of women with cancer, 2 of 16 (12.5%) had high-risk features. Frozen section analysis was requested in 46 cases. Frozen sections helped to identify six out of 11 cases of endometrial cancer (54.5%). The sensitivity, specificity and positive and negative predictive values of frozen section analysis for the detection of endometrial cancer among women with endometrial hyperplasia were 54.4%, 97.2%, 85.7% and 87.5%, respectively. Conclusion Although a significant proportion of patients with atypical endometrial hyperplasia are diagnosed with endometrial cancer following hysterectomy, most of these cases have low-risk features and do not require surgical staging. Additionally, intraoperative frozen section analysis if not helpful for diagnosing concurrent endometrial cancer in patients with endometrial hyperplasia. Therefore, it seems that patients with endometrial hyperplasia can be operated upon in settings with

  16. Robot-assisted partial cystectomy with intraoperative frozen section examination: Evolution and evaluation of a novel technique

    PubMed Central

    Klett, Dane E.; Abdollah, Firas; Sammon, Jesse D.; Pucheril, Dan; Menon, Mani; Jeong, Wooju; Peabody, James O.

    2016-01-01

    Purpose To describe a novel modification to robot-assisted partial cystectomy (RAPC) that allows for intraoperative surgical margin assessment by bimanual-examination and frozen-section analysis. Materials and Methods A total of 7 patients underwent RAPC at a single tertiary-care institution between 2008 and 2013. The technique evolved over the study-period and permitted real-time intraoperative surgical margin evaluation in the last 5 patients via bimanual-examination and frozen-section analysis, utilizing the GelPOINT platform (a hand-assist device). The GelPOINT platform was placed through a 4- to 5-cm vertical supraumbilical incision and allowed for rapid retrieval of the bladder specimen without compromising the pneumoperitoneum or prolonging the operative time. Perioperative, oncological and functional outcomes were evaluated; all patients had a minimum 12-month follow-up. At the time of last follow-up, a cross-sectional survey of patients was performed to evaluate regret/satisfaction utilizing validated questionnaires. Results The mean age was 72.5 years; 71.4% of the patients were men (n=5). All patients underwent RAPC for a malignant indication. The mean operative and console times were 291 and 217 minutes, respectively. No patient had a positive surgical margin. Mean length-of-stay was 1.7 days. At a median follow-up of 38.9 months, 1 patient experienced a local recurrence 6 months postsurgery. The only mortality was secondary to Lewy-body disease, in the same patient, 1 year postoperatively. Patient assessment of regret and satisfaction indicated 0% regret and 0% dissatisfaction. Conclusions The 'modified' technique of RAPC is technically feasible, safe, and reproducible; further, RAPC leads to favorable oncological, functional and quality-of-life outcomes in patients eligible for partial cystectomy. PMID:27195322

  17. Coccidioides, cryptococcus, or blastomyces? A diagnostic dilemma encountered during frozen section evaluation.

    PubMed

    McClain, Colt M; Van Horn, Gerald T; Chappell, James D; Stratton, Charles W

    2012-01-01

    Intraoperative consultation via frozen section is an important part of modern day surgical pathology. Recognizing fungi in tissues on frozen and permanent sections is not always a simple task, and correctly identifying the agent can be a significant challenge, even for experienced microscopists. We present a case of a 17-year-old boy with chronic osteomyelitis involving the right proximal ulna. During an irrigation and debridement operation, a frozen section was sent to surgical pathology for evaluation. A limited patient history coupled with sparse organisms present in the frozen section led to the diagnosis of fungal osteomyelitis, favor Coccidioides . Follow-up permanent sections with special staining and successful fungal culture clarified the causal agent to be Blastomyces dermatitidis . The role of frozen sections is not to perfectly speciate the fungal pathogen but to describe the morphology and infectious process and provide a differential diagnosis of the candidate fungi. The importance of intraoperative culture in infectious cases cannot be understated, and it is the responsibility of pathologists to inform surgeons that tissue is needed for culture. A brief overview of Blastomyces , including histopathologic features and key microscopic differences from Coccidioides and Cryptococcus , is discussed.

  18. The accuracy of frozen section by tumor weight for ovarian epithelial neoplasms.

    PubMed

    Puls, L; Heidtman, E; Hunter, J E; Crane, M; Stafford, J

    1997-10-01

    This study evaluated the effect ovarian weight has on the accuracy of frozen sections in serous and mucinous ovarian tumors. The study group included 294 patients who had an initial frozen section (189 serous and 105 mucinous tumors) at surgery. The pathology reports were separated into subgroups (benign, borderline, or malignant). Tumors were broken down into three weight categories: < or = 450 g, > 450 to < or = 1360 g, and > 1360 g. In each weight category, accuracy, sensitivity, specificity, and positive and negative predicative values were calculated on frozen sections. The mean weight of the ovarian tumors was 1042 g. As the weight increased in serous tumors, the sensitivity fell from 96.2 to 93.8 to 75%, respectively, in each weight category. The same trend was noted with mucinous tumors as sensitivity fell from 91.7 to 87.5 to 66.7%, respectively. With an increase in the size of ovarian tumors, a decrease in the sensitivity of frozen section was observed. With tumors greater than 1360 g, sensitivity was only 69%. Twenty-three percent of ovarian tumors revealing borderline diagnosis at frozen section were malignant on the final pathology report, with the greatest misclassification in > 1360-g mucinous tumors (50%). For patients with large ovarian tumors, consideration should be given to performing staging at the time of the initial laparotomy.

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

    PubMed

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

    2014-06-01

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

  20. DETECTION OF DNA BY TRITIATED ACTINOMYCIN D ON ULTRATHIN FROZEN SECTIONS

    PubMed Central

    Bernier, Roch; Iglesias, Roberto; Simard, René

    1972-01-01

    Ultrathin frozen sections of fresh liver tissue were floated on actinomycin D-3H. Quantitative high resolution radioautography was performed to determine the value of the method for detection of DNA by electron microscopy. A complete series of control experiments involving various treatments of frozen sections with enzymes (pronase, DNase) and 0.1 N HCl were also carried out to determine the specificity of the labeling. The results indicate the value of the method for detection of DNA directly on ultrathin frozen sections. Short treatments with pronase followed by DNase reduce the labeling to zero, whereas removal of chromosomal proteins with HCl increases the amount of radioactivity in the nucleus considerably. The results are discussed in view of the future applications opened by ultracryotomy, since radioautographic detection of various macromolecules and cellular components by labeled compound with specific affinities will now be possible. PMID:4554990

  1. Preparation and Observation of Fresh-frozen Sections of the Green Fluorescent Protein Transgenic Mouse Head

    PubMed Central

    Tada, Masahito; Shinohara, Yoshinori; Kato, Ichiro; Hiraga, Koichi; Aizawa, Tomoyasu; Demura, Makoto; Mori, Yoshihiro; Shinoda, Hiroyuki; Mizuguchi, Mineyuki; Kawano, Keiichi

    2006-01-01

    Hard tissue decalcification can cause variation in the constituent protein characteristics. This paper describes a method of preparating of frozen mouse head sections so as to clearly observe the nature of the constituent proteins. Frozen sections of various green fluorescent protein (GFP) transgenic mouse heads were prepared using the film method developed by Kawamoto and Shimizu. This method made specimen dissection without decalcification possible, wherein GFP was clearly observed in an undamaged state. Conversely, using the same method with decalcification made GFP observation in the transgenic mouse head difficult. This new method is suitable for observing GFP marked cells, enabling us to follow the transplanted GFP marked cells within frozen head sections. PMID:17375207

  2. Acute fungal sinusitis: natural history and the role of frozen section.

    PubMed

    Taxy, Jerome B; El-Zayaty, Shady; Langerman, Alexander

    2009-07-01

    Acute fungal sinusitis is a life-threatening infection affecting immunocompromised patients. Historically, the most commonly recovered fungi are Aspergillus and Mucor. The extent of potentially disfiguring debridement surgery is grossly determined by the appearance of bleeding at the margins, signifying viable tissue and the absence of fungus. Requests for frozen section may concern the initial diagnosis and the intraoperative verification of margin status. In 12 patients with acute fungal sinusitis, frozen section was used in 8. Routine H&E stains demonstrated fungal hyphae in necrotic debris in 5 cases, often associated with vascular and perineural invasion. All patients underwent extensive sinus debridement, including orbital exenteration in 2 cases. All 12 patients died, 9 of fungal sepsis. Autopsy in 3 patients showed pulmonary involvement (2 cases), intracranial spread (1 case), and no residual fungus (1 case). Inexperience with organism recognition is surmountable. Frozen section has a role in the management of this devastating disease.

  3. Accuracy of intra-operative frozen section analysis of ovarian tumours.

    PubMed

    Gorisek, B; Stare, M Rebolj; Krajnc, I

    2009-01-01

    During operative treatment for ovarian tumours assistance is frequently required to make decisions regarding malignancy status and the extent of the ensuing procedure. Intra-operative frozen section analysis may be useful, provided there is adequate acquaintance with the correlation between using frozen sections and permanent histopathological sections for diagnosis at the institution where the operation is being undertaken. This retrospective study aimed to determine this correlation. Findings from 131 intra-operative frozen sections were compared with the subsequent diagnosis from permanent histopathological sections for women with benign, borderline and malignant ovarian tumours at the Maribor Teaching Hospital (now the University Clinical Centre Maribor) between 1 January 1993 and 31 December 2001. Frozen-section findings corresponded to histopathological findings in 84.7% of cases, with 15.3% false-negative and no false-positive results. For benign, borderline and malignant ovarian tumours, sensitivity was 100.0%, 76.1% and 89.0%, respectively, and specificity was 90.6%, 90.6% and 100.0%, respectively. The majority of errors occurred in diagnosing mucinous borderline tumours. Precise pre-operative diagnosis is extremely important in the treatment of ovarian tumours.

  4. The Importance of Frozen Section-Controlled Excision in Recurrent Basal Cell Carcinoma of the Eyelids

    PubMed Central

    Şahan, Berna; Çiftçi, Ferda; Özkan, Ferda; Öztürk, Vildan

    2016-01-01

    Objectives: To show the importance of frozen section-controlled excision to avoid the re-recurrence of recurrent basal cell carcinoma (BCC) of the eyelids. Materials and Methods: Thirty-five cases who underwent eyelid tumor excision in different centers and were admitted to our clinic with recurrent eyelid tumors. Recurrent tumors were resected by excision 1-2 mm from the tumor’s visible margin and sent to pathology for frozen section examination. Eyelid reconstructions with flap and graft were performed after confirming that the surgical margins were negative. Results: Twenty-one (60%) of our patients were male and 14 (40%) were female. Median age of our group was 63.4±14.2 years. Excision and sending the excised material for frozen section control was performed once for 11 patients, twice for 12 patients, 3 times for 8 patients and 4 times for 4 patients to confirm that the surgical margins were clean. All pathology samples were reported as BCC. All patients had eyelid reconstruction with flap and graft. Recurrence was detected in 2 patients (5.7%) during 1 to 8 years (mean 4.3 years) of follow-up and those patients were reoperated; no recurrence was detected in the remaining 33 patients (94.3%). Conclusion: Frozen section control can provide low re-recurrence rate in patients with recurrent BCC of the eyelids. PMID:28050325

  5. Rapid Reticulin Fiber Staining Method is Helpful for the Diagnosis of Pituitary Adenoma in Frozen Section.

    PubMed

    Noh, Songmi; Kim, Sun Ho; Cho, Nam Hoon; Kim, Se Hoon

    2015-05-01

    Approximately 90% of neoplasms found in the sellar region are adenoma of the pituitary gland. The use of frozen sections for the diagnosis of pituitary adenomas has an accuracy of 90% and is useful in evaluating complete tumor removal. However, it is sometimes difficult to diagnose pituitary adenomas using frozen sections because of the small sample size and marked artifact, and the contiguity of the pituitary adenoma with normal pituitary gland tissue. In this study, we evaluated the use of our modified reticulin stain to make correct decision in frozen section with reduced stain time and investigated the objective diagnostic criteria of pituitary adenoma with reticulin stain. We used Gomori's silver impregnation methods to stain reticulin fibers in frozen pituitary gland sections of 36 samples from 24 patients. We modified the conventional staining method by reducing the overall staining time. We diagnosed pituitary lesion according to our interpretation criteria and compared the results to those of the conventional method and findings of hematoxylin and eosin-stained slides. Reticulin fiber staining of normal adenohypophysis outlines the supporting stroma around the blood vessels and shows regular of the gland meshwork interconnecting the capillaries. In contrast, reticulin fiber staining of the adenomatous tissue shows loss of meshwork or frequent fragmentation. Our modified reticulin stain is more rapid than the established method and shows similar levels of accuracy. Independent evaluation by two pathologists showed discrepancies in diagnosis in four out of 36 cases with modified reticulin stain. Our rapid modified reticulin staining method for frozen sections may be useful as a diagnostic tool for pituitary adenomas and can complement routine hematoxylin and eosin staining.

  6. Micro-PIXE analyses of frozen-hydrated semi-thick biological sections

    NASA Astrophysics Data System (ADS)

    Wang, Y. D.; Mesjasz-Przybylowicz, J.; Tylko, G.; Barnabas, A. D.; Przybylowicz, W. J.

    2013-07-01

    Cryo-micro-PIXE system and methodology of microanalysis of frozen-hydrated semi-thick biological sections is described. A commercially available cryotransfer system used in electron microscopy has been adapted for this purpose. The analyzed material was frozen by metal-mirror method and sections of 20-50 micron thickness were prepared. Micro-PIXE and simultaneous proton backscattering was performed using 3 MeV proton beam. Monitoring of water vapour composition during the proton bombardment showed good stability of the analyzed material. The results of repetitive analyses of standards prepared from gelatin-glycerol solution with added known concentrations of K, Ni, Cu, Zn were in good agreement with expected, calculated values. Mass losses and changes of elemental composition were monitored. Elemental maps obtained for frozen-hydrated semi-thick section of Ni hyperaccumulator Senecio coronatus showed excellent preservation of leaf morphology and the distribution of elements. Quantitative elemental mapping of frozen-hydrated specimens compared with subsequent analysis of the same areas after freeze-drying revealed similar distribution pattern in both cases. It is clear, however, that freeze-drying induces some distortion of cell morphology and specimen shrinkage.

  7. Outpatient frozen sections by telepathology in a Veterans Administration medical center.

    PubMed

    Dawson, P J; Johnson, J G; Edgemon, L J; Brand, C R; Hall, E; Van Buskirk, G F

    2000-07-01

    A relatively simple telepathology system is described for evaluating the margins of excision of cutaneous basal and squamous carcinomas. The system uses a microscope with a built-in television camera, but no eyepieces. The image is projected onto an adjacent monitor and transmitted by T1 line at 768 Kbs to a remote, large screen monitor. The microscope is operated by the surgeon under the telephone direction of the pathologist at the remote site. In a series of 66 cases involving more than 400 individual tissue blocks, we have had only 2 cases with false-negative interpretations and 2 in which the block was not fully displayed on the frozen section. In 15 cases, 1 or more surgical margins were positive, and the surgeon proceeded to excise additional tissue. Our success is attributed to dedicated involvement by the surgeon, very high-quality frozen sections, and the experience of the pathologist.

  8. Frozen section evaluation of margins in radical prostatectomy specimens: a contemporary study and literature review.

    PubMed

    Nunez, Amberly L; Giannico, Giovanna A; Mukhtar, Faisal; Dailey, Virginia; El-Galley, Rizk; Hameed, Omar

    2016-10-01

    The utility of routine frozen section (FS) analysis for margin evaluation during radical prostatectomy (RP) remains controversial. A retrospective search was conducted to identify RPs evaluated by FS over a 5-year period. The potential of FS to discriminate between benign and malignant tissue and to predict final margins was evaluated. During the study period, 71 (12.3%) of 575 cases underwent FS evaluation of margins, generating 192 individual FSs. There were 8 FSs diagnosed as atypical/indeterminate because of significant freezing, crushing, and/or thermal artifacts; 11 as positive for carcinoma; and 173 as benign. Two FSs classified as benign were diagnosed as positive for carcinoma on subsequent permanent section. Frozen sections' sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for diagnosis of prostatic adenocarcinoma were 85%, 100%, 100%, 99%, and 99%, respectively. Overall RP final margin predictive accuracy was 81%. Positive FS was significantly associated with perineural invasion on biopsy and extraprostatic extension and higher stage disease on RP, but not with the overall final margin status. The high FS accuracy supports its use to guide the extent of surgery. However, FS cannot be used to predict the overall final margin status. Recognition of the histological artifacts inherent to the FS procedure is important to ensure appropriate utilization.

  9. Frequently asked questions concerning the use of whole-slide imaging telepathology for neuropathology frozen sections.

    PubMed

    Evans, Andrew J; Kiehl, Tim-Rasmus; Croul, Sidney

    2010-08-01

    TP involves the provision of pathology services over a distance using the Internet to link pathologists at the "viewing site" with diagnostic material in a "remote site." Robotic microscopes were a mainstay of TP; however, this is now changing with the development of whole-slide imaging (WSI) systems which enable rapid production of digital slides that can be reviewed over a complete range of magnifications with a viewing experience closely replicating that of light microscopy. As such, WSI will undoubtedly become a viable option for pathology departments considering TP for remote frozen section (FS) coverage, and in the future for rapid consultation on difficult cases. For reasons to be discussed below, it may be particularly attractive to use WSI TP for neuropathology frozen sections (NPFS). We have been using WSI TP for primary NPFS diagnoses since 2006. This brief review provides answers to questions that we have frequently been asked about our program. The answers reflect our experience, and it is important to note that our recommendations may not be applicable in all institutions. The reader is directed to the recent literature for more detailed information on WSI as well as a complete description of our TP program.

  10. Utility of Fresh Frozen Section Analysis in Foot and Ankle Surgery: A Pilot Study.

    PubMed

    Monaco, Spencer J; Manway, Jeffery M; Burns, Patrick R

    2016-01-01

    The use of intraoperative fresh frozen section (FFS) analysis to determine the presence of infection has been well reported in orthopedic studies. Specifically, the number of polymorphonuclear leukocytes per high-power field has been used to diagnose total joint arthroplasty-related infection. Less commonly, reconstructive surgeons have extended the use of FFS analysis for intraoperative evaluation when suspicion of deep infection with or without hardware is high. The purpose of the present study was to retrospectively review the data from 11 patients undergoing foot and ankle reconstruction in the setting of possible deep infection and determine the usefulness of FFS analysis. A retrospective review of the medical records of patients who had undergone reconstructive foot and ankle revision surgery with intraoperative FFS analysis and tissue/swab cultures available was performed. A positive FFS was defined as >5 polymorphonuclear leukocytes per high-power field. A positive frozen section was associated with a positive tissue culture 4 of 7 times (57%). The sensitivity and specificity of FFS analysis for infection was 80% and 50%, respectively. The positive and negative predictive value of the FFS result was 57.1% and 75%, respectively. In conclusion, FFS analysis and intraoperative cultures correlated only 57% of the time in the present series. This test had moderate sensitivity for detecting infection at 80%, but the specificity was poor (50%). More research is needed to further evaluate the role of FFS analysis in foot and ankle surgery.

  11. Evaluation of panoramic digital images using Panoptiq for frozen section diagnosis

    PubMed Central

    Pradhan, Dinesh; Monaco, Sara E.; Parwani, Anil V.; Ahmed, Ishtiaque; Duboy, Jon; Pantanowitz, Liron

    2016-01-01

    Introduction: Whole slide imaging (WSI) permits intraoperative consultations (frozen sections) to be performed remotely. However, WSI files are large and can be problematic if there are tissue artifacts (e.g., tissue folds) or when slides are scanned without multiplanes (Z-stacks) to permit focusing. The Panoptiq dynamic imaging system allows users to create their own digital files that combine low power panoramic digital images with regions of interest that can be imaged using high power Z-stacks. The aim of this study was to determine the utility of the Panoptiq dynamic imaging system for frozen section telepathology. Materials and Methods: Twenty archival randomly selected genitourinary surgical pathology frozen sectional cases were evaluated using conventional light microscopy (glass slides), panoramic images, and whole slide images. To create panoramic images glass slides were digitized using a Prosilica GT camera (model GT1920C, Allied Vision Technologies) attached to an Olympus B × 45 microscope and Dell Precision Tower 810 computer (Dell). Panoptiq 3 version 3.1.2 software was used for image acquisition and Panoptiq View version 3.1.2 to view images (ViewsIQ, Richmond, BC, Canada). Image acquisition using Panoptiq software involved a pathology resident, who manually created digital maps (×4 objective) and then selected representative regions of interest to generate Z-stacks at higher magnification (×40 objective). Whole slide images were generated using an Aperio XT Scanscope (Leica) and viewed using ImageScope Software (Aperio ePathology, Leica). Three pathologists were asked to render diagnoses and rate image quality (1–10) and their diagnostic confidence (1–10) for each modality. Results: The diagnostic concordance with glass slides was 98.3% for panoramic images and 100% for WSI. Panoptiq images were comparable to the glass slide viewing experience in terms of image quality and diagnostic confidence. Complaints regarding WSI included poor focus

  12. Frozen-section diagnosis by wireless telepathology and ultra portable computer: use in pathology resident/faculty consultation.

    PubMed

    Frierson, Henry F; Galgano, Mary T

    2007-09-01

    Residents in anatomic pathology are allowed increased diagnostic responsibility including the initial interpretation of intraoperative frozen-section consultations during their years of training. This frozen-section responsibility requires staff faculty backup for diagnostic confirmation and consultation. In this study, we tested a telepathology system using an ultra portable computer with a 4.5-in diagonal screen (scrolled image size of 2.5 x 1.75 in, width x height) and both wireless Local Area Network (LAN) final connection from a DSL and wireless Wide Area Network (WAN) telecommunications. The diagnostic agreement for a chief resident/faculty staff duo using telepathology for 100 consecutive frozen-section cases (50 with wireless LAN final connection and 50 with wireless WAN) with limited clinical information was compared with the original frozen-section diagnosis rendered by other staff pathologists. There was diagnostic agreement for 95 of the 100 cases. For the 5 that were discordant, 2 were deemed to be errors in the original frozen-section diagnosis; 1 was not clinically important; and 2 were believed to have potential clinical implications. For the 2 having potential clinical importance, the absence of knowledge of the gross findings in each case and the preoperative biopsy results for one specimen contributed to the misinterpretation of the frozen sections. The median time between transmission of image(s) from the chief resident to the faculty consultant until diagnosis by the latter was 1 minute 42 seconds for wireless WAN and 51 seconds for the wireless LAN final connection to the display device. We conclude that a telepathology system using an ultra portable computer and wireless telecommunications is useful for frozen-section consultation between an experienced resident and a faculty member in pathology.

  13. Forecast on the application of Japanese universal service fund to remote diagnosis for frozen section.

    PubMed

    Nakajima, Isao

    2010-12-01

    Due to the socioeconomic reason in Japan, some cancer patient is sometimes operated at a rural hospital where only several surgeons perform and no pathologist checks its malignancy. Therefore, the system of the remote diagnosis for frozen section has been standing up in this country for 7 years. In Japan, the USF has started from February 2007 to support only telecommunications operator's hardware (NTT's equipment such as digital switch board) in high cost areas, not for the reimbursement of the tariff of the public users, such as telepathology. To solve such social cormorant equality, when the USF and PAs were supported in the present quick frozen intraoperative telepathology diagnosis, the quality of the cancer treatment in rural area will be improved. Based on the past data of the Japanese telepathology with beta distribution function, it can be estimated that user terminals becomes five times more than present users with support of USF and PAs. Moreover, using VPN on the B'FLETS, the effect of other teleconsultations will spread to the nationwide.

  14. 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.

  15. Implementation of a Software Application for Presurgical Case History Review of Frozen Section Pathology Cases

    PubMed Central

    Norgan, Andrew P.; Okeson, Mathew L.; Juskewitch, Justin E.; Shah, Kabeer K.; Sukov, William R.

    2017-01-01

    Background: The frozen section pathology practice at Mayo Clinic in Rochester performs ~20,000 intraoperative consultations a year (~70–80/weekday). To prepare for intraoperative consultations, surgical pathology fellows and residents review the case history, previous pathology, and relevant imaging the day before surgery. Before the work described herein, review of pending surgical pathology cases was a paper-based process requiring handwritten transcription from the electronic health record, a laborious and potentially error prone process. Methods: To facilitate more efficient case review, a modular extension of an existing surgical listing software application (Surgical and Procedure Scheduling [SPS]) was developed. The module (SPS-pathology-specific module [PM]) added pathology-specific functionality including recording case notes, prefetching of radiology, pathology, and operative reports from the medical record, flagging infectious cases, and real-time tracking of cases in the operating room. After implementation, users were surveyed about its impact on the surgical pathology practice. Results: There were 16 survey respondents (five staff pathologists and eleven residents or fellows). All trainees (11/11) responded that the application improved an aspect of surgical list review including abstraction from medical records (10/11), identification of possibly infectious cases (7/11), and speed of list preparation (10/11). The average reported time savings in list preparation was 1.4 h/day. Respondents indicated the application improved the speed (11/16), clarity (13/16), and accuracy (10/16) of morning report. During the workday, respondents reported the application improved real-time case review (14/16) and situational awareness of ongoing cases (13/16). Conclusions: A majority of respondents found the SPS-PM improved all preparatory and logistical aspects of the Mayo Clinic frozen section surgical pathology practice. In addition, use of the SPS-PM saved an

  16. A histochemical study of the posterior silk glands of Bombyx mori during metamorphosis from larvae to pupae using frozen sections.

    PubMed

    Kawamoto, K; Kawamoto, T; Shiba, H; Hosono, K

    2014-02-01

    The fine structures of the whole bodies and the posterior silk glands of Bombyx mori during metamorphosis from larvae to pupae in the cocoon were preserved virtually without damage when frozen sections were prepared using an adhesive plastic film. We used frozen sections for histochemical and enzyme histochemistry to characterize the metamorphosis of the posterior silk glands. Frozen sections were stained with DAPI to observe nuclear changes, examined using the TUNEL method to detect DNA fragments, and investigated using in situ hybridization to detect B. mori caspase expression. Both DNA fragments and expression of B. mori caspase increased with progressing metamorphosis. The degeneration of the posterior silk gland during metamorphosis appears to be an apoptotic event.

  17. A novel method for high-pressure freezing of adherent cells for frozen hydrated sectioning and CEMOVIS.

    PubMed

    Mesman, R J

    2013-09-01

    With the development of Cryo Electron Microscopy Of Vitreous Sections (CEMOVIS), imaging cells in a close to native state has become a reality. However with the commonly used carriers for high-pressure freezing and cryo-sectioning, adherent grown cells either need to be detached from their substrate. Here a new method is presented for high-pressure freezing adherent growing cells for frozen-hydrated sectioning and CEMOVIS. Cells are cultured on golden grids, containing a carbon coated Formvar film, and frozen on a membrane carrier which provides the grids with the structural support needed to withstand the strain of trimming and cryo-sectioning. This method was successfully tested for the two different types of high-pressure freezers, those using a pressure chamber (HPM010, EMHPF, Wohlwend Compact 01/02, HPM100) and those directly pressurizing the sample (EMPact series).

  18. A microautoradiographic method for fresh-frozen sections to reveal the distribution of radionuclides at the cellular level in plants.

    PubMed

    Hirose, Atsushi; Kobayashi, Natsuko I; Tanoi, Keitaro; Nakanishi, Tomoko M

    2014-06-01

    Microautoradiography (MAR) is a conventional imaging method based on the daguerreotype. The technique is used to visualize the distribution of radionuclide-labeled compounds within a tissue section. However, application of the classical MAR method to plant tissue sections is associated with several difficulties. In this study, we report an MAR method applicable to fresh-frozen plant sections. Our method had two features: (i) the sample was kept frozen from plant tissue collection to radioisotope detection, making it possible to fix solutes without solvent exchange; and (ii) 1.2 µm thick polyphenylene sulfide film was inserted between the fresh-frozen plant section and the photosensitive nuclear emulsion to separate the section from the emulsion before autoradiography was conducted, which significantly improved the quality of the section until microscopic detection, the quality of the MAR image and the success rate. Then, the passage of cadmium (Cd) through vegetative rice stem tissue after 24 h of (109)Cd absorption was described for the first time using the MAR method. MAR clearly revealed the distribution of (109)Cd at the tissue level with high resolution. The (109)Cd concentration in phloem cells was found to be particularly high, whereas the xylem cells contained only small amounts of (109)Cd. The MAR method was also applicable for detecting (109)Cd and [(33)P]phosphate in roots. The MAR method developed here is expected to provide distribution images for a variety of compounds and ions in plant tissue.

  19. Validation of whole slide imaging for frozen section diagnosis in surgical pathology

    PubMed Central

    Bauer, Thomas W.; Slaw, Renee J.; McKenney, Jesse K.; Patil, Deepa T.

    2015-01-01

    Background: Whole slide imaging (WSI) using high-resolution scanners is gaining acceptance as a platform for consultation as well as for frozen section (FS) evaluation in surgical pathology. We report results of an intra-observer concordance study comparing evaluation of WSI of scanned FS microscope slides with the original interpretation of the same microscope slides after an average lag time of approximately 1-year. Methods: A total of 70 FS cases (148 microscope slides) originally interpreted by 2 pathologists were scanned at ×20 using Aperio CS2 scanner (Leica Biosystems, San Diego, CA, USA). Reports were redacted such that the study pathologists reviewed images using eSlide Manager Healthcare Network application (Leica Biosystems) accompanied by the same clinical information available at the time of original FS evaluation. Discrepancies between the original FS diagnosis and WSI diagnosis were categorized as major (impacted patient care) or minor (no impact on patient care). Results: Lymph nodes, margins for head and neck cancer resections, and arthroplasty specimens to exclude infection, were the most common FS specimens. The average wash-out interval was 380 days (range: 303–466 days). There was one major discrepancy (1.4% of 70 cases) where the original FS was interpreted as severe squamous dysplasia, and the WSI FS diagnosis was mild dysplasia. There were two minor discrepancies; one where the original FS was called focal moderate squamous dysplasia and WSI FS diagnosis was negative for dysplasia. The second case was an endometrial adenocarcinoma that was originally interpreted as Federation of Gynecology and Obstetrics (FIGO) Grade I, while the WSI FS diagnosis was FIGO Grade II. Conclusions: These findings validate and support the use of WSI to provide interpretation of FS in our network of affiliated hospitals and ambulatory surgery centers. PMID:26430537

  20. Does videomediastinoscopy with frozen sections improve mediastinal staging during video-assisted thoracic surgery pulmonary resections?

    PubMed Central

    Gonfiotti, Alessandro; Viggiano, Domenico; Borgianni, Sara; Borrelli, Roberto; Tancredi, Giorgia; Jaus, Massimo O.; Politi, Leonardo; Comin, Camilla E.; Voltolini, Luca

    2016-01-01

    Background To assess if video-mediastinoscopy (VM) with frozen sections (FS) combined with a video-assisted thoracic surgery major pulmonary resection (VMPRS) is able to improve VATS mediastinal intraoperative staging. Methods From June 2012 to March 2015 a total of 146 patients underwent VMPRS lymphadenectomy. NCCN guidelines were followed for pre-operative staging, including VM with FS in 27 patients (19%). Procedural time, dissected nodal stations, complications related to VM and VATS lymphadenectomy and definitive histology, were evaluated. Results Operative time for VATS resection with VM (group 1) and VATS pulmonary resection alone (group 2) was 198±64 vs. 167±43 min (P=0.003). Mean/median numbers of dissected nodal stations were 4.93±1.1/5 (range, 4–8) in group 1 and 3.25±0.5/5 (range, 3–8) in group 2 (P<0.001). Group 1 vs. group 2 right-sided lymphadenectomy (n=86) was performed at station 2R/4R in 18 (90%) and 46 (69.7%); at station 3a/3p in 14 (51.8%) and 22 (31%); at station 7 in 18 (90%) and 44 (66.7%); at station 8/9 in 11 (55%) and 24 (36.4%) respectively. On the left side (n=60) group 1 vs. group 2 lymphadenectomy resulted at station 4 in 6 (85.7%) and 38 (71.7%); at station 5/6 in 6 (85.7%) and 26 (49%); at station 7 in 6 (85.7%) and 33 (62.3%), and at station 8/9 in 1 (14.3%) and 18 (34%). There were no early deaths and recurrent laryngeal nerve palsy occurred in 1 (0.8%) in group 2. Pathological upstaging (pN1; pN2) was found in 5 patients (17%) in group 1, and 13 (11%) in group 2 (P=0.23). About FS (n=29), formal paraffin histology resulted in 0% of both, false negative and false positive results. Conclusions Based on our experience, the combination “VM with FS followed by VMPRS in sequence”, seems to be effective and offers an alternative approach to improve intraoperative mediastinal staging. PMID:28149542

  1. Two-photon excitation cross section in light and intermediate atoms in frozen-core LS-coupling approximation

    NASA Technical Reports Server (NTRS)

    Omidvar, K.

    1980-01-01

    Using the method of explicit summation over the intermediate states two-photon absorption cross sections in light and intermediate atoms based on the simplistic frozen-core approximation and LS coupling have been formulated. Formulas for the cross section in terms of integrals over radial wave functions are given. Two selection rules, one exact and one approximate, valid within the stated approximations are derived. The formulas are applied to two-photon absorptions in nitrogen, oxygen, and chlorine. In evaluating the radial integrals, for low-lying levels, the Hartree-Fock wave functions, and for high-lying levels, hydrogenic wave functions obtained by the quantum-defect method have been used. A relationship between the cross section and the oscillator strengths is derived.

  2. Localization of telomerase hTERT protein in frozen sections of basal cell carcinomas (BCC) and tumor margin tissues.

    PubMed

    Fabricius, Eva-Maria; Kruse-Boitschenko, Ute; Khoury, Reem; Wildner, Gustav-Paul; Raguse, Jan-Dirk; Klein, Martin; Hoffmeister, Bodo

    2009-12-01

    In previous studies we demonstrated telomerase activity in frozen tissues from BCC and their tumor-free margins by the PCR ELISA. In this study we examined in the same frozen sections immunohistochemical presence of hTERT in the nucleus. After fixation in acetone and methanol followed by steaming we used for visualization the antigen-antibody reactions by APAAP. This was the best method of preparation of the frozen sections in our preliminary hTERT-study with squamous cell carcinomas. This study was supplemented with antibodies against Ki-67, nucleolin, common leucocyte antigen CD45 and mutated p53. The immunoreactive scores were determined and included the comparison with telomerase activity. The investigation of hTERT expression was performed in the tissues of 41 patients with BCC and control tissues of 14 patients without tumor. Eleven commercial antibodies were used for a nuclear staining of hTERT expression. With the anti-hTERT antibodies we looked for both satisfactory distribution and intensity of immunohistochemical labeling in the carcinomas and in the squamous epithelia of the tumor centers, of the tumor-free margins and of the control tissues. The hTERT expression in the BCC was distributed heterogeneously. The score values established by the anti-hTERT antibodies used were variably or significantly increased. In the stroma they tended to be negative, so we disregarded stroma hTERT. Proof of hTERT did not differ uniformly from telomerase activity. We compared the high with the lower median hTERT values in the Kaplan-Meier curve. Patients with lower hTERT scores in the center or tumor margin as shown by some of the antibodies suffered relapse earlier. Finally, we compared the hTERT expression in BCC tissues with the hTERT scores in HNSCC tissues from our previous study. Only one anti-hTERT antibody (our Ab 7) yielded significantly higher scores in BCC than in HNSCC.

  3. Findings from frozen sections of spinal subependymomas: Is it possible to differentiate this diagnosis from other common spinal tumors?

    PubMed

    Choi, Seung Kyu; Lee, Sang Hoon; Kim, Byeongwoo; Minn, Yang Ki; Kim, Keung-Nyun; Kim, Se Hoon

    2016-01-01

    Subependymomas are slow-growing, benign neoplasms that are rarely found in the spinal cord. Because of the differences in the treatment plans, it might be very helpful for neurosurgeons to intraoperatively establish a diagnosis of spinal subependymoma, differentiated from other spinal intramedullary tumors. In this study, we analyzed frozen sections of spinal subependymomas to identify potential histological clues of spinal subependymomas to differentiate them from tumors that mimic spinal subependymoma. We reviewed the frozen sections and the corresponding permanent slides for 7 cases of spinal subependymoma. The spinal subependymomas showed several characteristic patterns, including, most importantly, an eccentric or both central and eccentric location in the axial plane. Histologically, they showed a (1) well-demarcated and multinodular mass with (2) low or moderate cellularity, (3) a microlobular pattern, and (4) small clusters of neoplastic cells. These features appear to be very specific to spinal subependymomas and could help differentiate them from ependymomas or astrocytomas. Although we might not be able to provide an exact diagnosis of all spinal subependymomas using these histological features, we hope that they help neuropathologists and neurosurgeons to adequately diagnose and treat spinal subependymomas.

  4. The Efficacy of Intraoperative Frozen Section Analysis During Breast-Conserving Surgery for Patients with Ductal Carcinoma In Situ

    PubMed Central

    Kim, Mi Jin; Kim, Cheol Seung; Park, Young Sam; Choi, Eun Hye; Han, Kyu Dam

    2016-01-01

    INTRODUCTION Recently, the incidence of ductal carcinoma in situ (DCIS), a noninvasive breast malignancy, has increased. This has resulted in an increase in the incidence of breast-conserving surgery (BCS). Numerous studies have suggested that intraoperative frozen section analysis (IFSA) could reduce the rate of additional excisions required to obtain adequate resection margins. However, DCIS is a known risk factor for positive margin status during BCS. Furthermore, some authors have concluded that IFSA may not be reliable for the detection of DCIS. AIM The aim of this study was to evaluate the safety and efficacy of IFSA in patients with DCIS. METHODS The operative and pathological reports of patients with DCIS, who underwent BCS at our institute between 2006 and 2015, were retrospectively reviewed. The results of IFSA and the pathological findings of final reanalyzed frozen tissue specimens were analyzed. RESULTS In total, 25 patients were included in our analysis. None of the patients required additional operations. The correct diagnosis rate for IFSA was 89.6%, with a sensitivity and specificity of 60.0% and 95.8%, respectively. CONCLUSION IFSA could be beneficial for determining safety resection margins in patients with DCIS. PMID:27980416

  5. Nipple-sparing Mastectomy and Sub-areolar Biopsy: To Freeze or not to Freeze? Evaluating the Role of Sub-areolar Intraoperative Frozen Section.

    PubMed

    Alperovich, Michael; Choi, Mihye; Karp, Nolan S; Singh, Baljit; Ayo, Diego; Frey, Jordan D; Roses, Daniel F; Schnabel, Freya R; Axelrod, Deborah M; Shapiro, Richard L; Guth, Amber A

    2016-01-01

    Use of nipple-sparing mastectomy (NSM) for risk-reduction and therapeutic breast cancer resection is growing. The role for intraoperative frozen section of the nipple-areolar complex remains controversial. Records of patients undergoing NSM at our institution from 2006 to 2013 were reviewed. Records from 501 nipple-sparing mastectomies were reviewed (216 therapeutic, 285 prophylactic). Of the 480 breasts with sub-areolar biopsies, 307 had intraoperative frozen sections and 173 were evaluated with permanent paraffin section only. Among the 307 intraoperative frozen sections, 12 biopsies were positive on permanent paraffin section (3.9% or 12/307). Of the 12 positive permanent biopsies, five were false negative and the remaining seven concordant intraoperatively. Sensitivity and specificity of sub-areolar frozen section were 0.58 and 1, respectively. Positive sub-areolar biopsies consisted primarily of ductal carcinoma in situ (62% or 13/21). The nipples or nipple-areolar complex were resected in a separate procedure following mastectomy (10/21), intraoperatively following frozen section results (7/21) or during second-stage breast reconstruction (3/21; 1 additional scheduled). Only 30% (6/20) of resected specimens had abnormal residual pathology. Intraoperative frozen section is highly specific and moderately sensitive for the detection of positive sub-areolar biopsies in NSM. Its use can help guide intraoperative reconstructive planning. The presence of positive sub-areolar biopsies in both contralateral and high-risk prophylactic mastectomy specimens emphasizes the need to perform sub-areolar biopsies in all nipple-sparing mastectomies.

  6. Proliferation/apoptosis determination by tissue cytometry in gastrointestinal fresh frozen sections using triple labeling and automated scanning fluorescence microscopy

    NASA Astrophysics Data System (ADS)

    Bocsi, Jozsef; Sipos, Ferenc; Ficsor, Levente; Varga, Viktor S.; Tulassay, Zsolt; Tarnok, Attila; Molnár, Béla

    2006-02-01

    Proliferation/apoptosis balance is an important information in gastrointestinal ulcerative and malignant diseases. Immunohistochemical staining and visual counting is routine procedure. Recently we reported a new scanning fluorescence technique for automated motorized microscopes (SFM). Development of triple fluorescent labeling method for proliferating/apoptotic/resting cells and application of SFM for the automated analysis and counting on gastric biopsy specimen. Routine antral biopsy specimens by gastroscopy were fresh frozen and 5 micron sections were prepared. Proliferation was detected using a PCNA antibody, anti-mouse-biotin and streptavidin-Texas-Red labeling system. Apoptotic cells was labeled using the TUNEL reaction with FITC bound nucleotids. DAPI nuclear counter staining was applied. Labeled sections were scanned and digitized in the three fluorescent channels. SFM was modified to detect epithelial surface, glands in the biopsy specimen. Automated nuclei detection, PCNA and TUNEL detection was performed, ratio was calculated. In parallel standard biopsies were labeled with PCNA and AEC. TUNEL reaction was performed. Up to 1000 epithelial cells were manually counted. The mean PCNA labeling in healthy samples were 45,3+/-12,4%, that significantly increased to 56.4+/-8.7% in H. Pylori positive cases. Positive TUNEL reaction was found in 2,9+/-1,1% in H. pylori negative cases, while in the H. Pylori positive cases the apoptotic ratio was significantly increased (14.1+/-3.2%, p<0.05). Significant correlation in apoptosis/proliferation ratio between the SFM and routine methods could be observed (p<0,05). SFM procedure proved to be more time efficient both in labeling, both in detection procedures. Triple fluorescent labeling and automated fluorescence microscopy is an applicable tool for the proliferation, apoptosis determination in fresh frozen samples.

  7. Intraoperative frozen sections of the regional lymph nodes contribute to surgical decision-making in non-small cell lung cancer patients

    PubMed Central

    Li, Wei; Yang, Xue-Ning; Liao, Ri-Qiang; Nie, Qiang; Dong, Song; Zhai, Hao-Ran

    2016-01-01

    Background Individualization of pulmonary parenchymal resection and lymphadenectomy in lung cancer patients will likely become more important as surgical innovation. This study explored the utility of intraoperative pathological frozen sections of regional lymph nodes in non-small cell lung cancer (NSCLC) patients. Methods Patients with NSCLC underwent intraoperative sampling of N1 station lymph nodes depending on the location of the tumor, any other suspicious lymph nodes were also biopsied. The contribution of frozen-section analysis to surgical decision-making was evaluated. Results Of 74 lung cancer patients who underwent intraoperative frozen section analysis of lymph nodes, the positive rate was 18/74 (24.3%). The extents of agreement between preoperative N staging (cN) and intraoperative N staging (sN), cN staging and postoperative N staging (pN), and sN staging and pN staging were 62.2% (46/74), 63.5% (47/74), and 71.6% (53/74), respectively. When frozen section was combined with evaluation of pulmonary function and intrathoracic adhesions, surgical strategies were modified during operations in 18 cases (5 sN-positive, 13 sN-negative). Of these patients, five underwent extensive pulmonary parenchymal resection, and four had conservative lung parenchymal resection. In nine patients, the extent of lymph node dissection (LND) was changed. Conclusions Intraoperative frozen section of regional lymph nodes led to 24.3% operative strategies modification in lung cancer. Frozen section analysis may make an important contribution to surgical decision-making in terms of pulmonary parenchymal resection and LND. PMID:27621849

  8. A procedure for tissue freezing and processing applicable to both intra-operative frozen section diagnosis and tissue banking in surgical pathology.

    PubMed

    Steu, Susanne; Baucamp, Maya; von Dach, Gabriela; Bawohl, Marion; Dettwiler, Susanne; Storz, Martina; Moch, Holger; Schraml, Peter

    2008-03-01

    Different methods for snap freezing surgical human tissue specimens exist. At pathology institutes with higher work loads, solid carbon dioxide, freezing sprays, and cryostat freezing are commonly used as coolants for diagnosing frozen tissue sections, whereas for tissue banking, liquid nitrogen or isopentane cooled with liquid nitrogen is preferred. Freezing tissues for diagnostic and research purposes are therefore often time consuming, laborious, even hazardous, and not user friendly. In tissue banks, frozen tissue samples are stored in cryovials, capsules, cryomolds, or cryocassettes. Tissues are additionally embedded using freezing media or wrapped in plastic bags or aluminum foils to prevent desiccation. The latter method aggravates enormously further tissue handling and processing. Here, we describe an isopentane-based workflow which concurrently facilitates tissue freezing and processing for both routine intra-operative frozen section and tissue banking and satisfies the qualitative demands of pathologists, cancer researchers, laboratory technicians, and tissue bankers.

  9. Rapid and simple fixation-staining technique of fresh frozen cryostat sections for SIMS microscopy.

    PubMed

    Li, H; Okabe, M; Yoshida, T; Takaya, K

    2001-12-01

    Before observing freeze-dried cryosections by ion microscopy, it is necessary to perform localization of the analysis site by light microscopy. The present study reports a rapid fixation-staining method for preparing freeze-dried or air-dried cryosections, wherein cryosections are observed after immersion in Carnoy-Lebrun fixative for 30 s and staining in undiluted Giemsa solution for 30 s. Cryostat sections of goldfish intestine and kidney tissue on the silicon wafer substratum were subsequently examined by SIMS. Positive cesium ion images showed a general histology of the intestinal villi with goblet cells. Their granules contained large amounts of sodium, magnesium, potassium and calcium on ion images. By contrast, iron, copper and CsFe ion images showed diffuse distribution throughout the sections.

  10. A new laboratory device with mathematically based positioning of a frozen tissue block facilitating precise sectioning of large specimens.

    PubMed

    Bieniek, A; Matusiak, Ł; Woźniak, Z; Lichtenstein, M; Szymkowski, J; Kozioł, M; Salwa, A; Szepietowski, J C

    2016-06-01

    Mohs micrographic surgery (MMS) is a treatment method aiming at thorough, personalized eradication of skin cancers by mean of staged excision of tissues surrounding the tumor with complete (100%) histopathological examination of their margins. In many MMS laboratories, the excised tissue is divided, shaped, frozen in a cryostat with a heat extractor and positioned manually (with the block on the object disc) in an articulated cryostat chuck during cutting. However, these activities may be difficult, time-consuming and associated with the risk of imprecise tissue sectioning. Development of a laboratory device allowing for processing of large tissue specimens, with the function of mechanical, mathematically steered positioning of the tissue block surface directly to the microtome knife cutting place, eliminating the need for manual adjustment. The prototype device was designed and manufactured. Its functioning was tested on 513 histological slides produced during 212 operations of skin cancers using MMS. The depth of the first complete sections and the diameter of sections were measured. Complete sections were obtained at an average depth of 81.60 m (min. 20 m, max. 180 m, SD = 29.15), whereas the average diameter of sections was 18.11 mm (min. 4 mm, max. 42 mm, SD = 9.10). The histological processing of large specimens with mathematically based positioning of the tissue surface in relation to the cryotome knife cutting plane is precise, fast and easy. The device can be useful in those MMS centers which continue to employ manual setting of the cryostat chuck or share the cryostat with other users, which prevents fixing the chuck position (including large hospital settings). It may also be helpful in centers using a cryostat with a fixed chuck, for the correction of minimal inaccuracies of its preset position.

  11. Fine structures and ion images on fresh frozen dried ultrathin sections by transmission electron and scanning ion microscopy

    NASA Astrophysics Data System (ADS)

    Takaya, K.; Okabe, M.; Sawataishi, M.; Takashima, H.; Yoshida, T.

    2003-01-01

    Ion microscopy (IM) of air-dried or freeze-dried cryostat and semi-thin cryosections has provided ion images of elements and organic substances in wide areas of the tissue. For reproducible ion images by a shorter time of exposure to the primary ion beam, fresh frozen dried ultrathin sections were prepared by freezing the tissue in propane chilled with liquid nitrogen, cryocut at 60 nm, mounted on grids and silicon wafer pieces, and freeze-dried. Rat Cowper gland and sciatic nerve, bone marrow of the rat administered of lithium carbonate, tree frog and African toad spleen and buffy coat of atopic dermatitis patients were examined. Fine structures and ion images of the corresponding areas in the same or neighboring sections were observed by transmission electron microscopy (TEM) followed by sector type and time-of-flight type IM. Cells in the buffy coat contained larger amounts of potassium and magnesium while plasma had larger amounts of sodium and calcium. However, in the tissues, lithium, sodium, magnesium, calcium and potassium were distributed in the cell and calcium showed a granular appearance. A granular cell of the tree frog spleen contained sodium and potassium over the cell and magnesium and calcium were confined to granules.

  12. 21 CFR 158.170 - Frozen peas.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 2 2014-04-01 2014-04-01 false Frozen peas. 158.170 Section 158.170 Food and... CONSUMPTION FROZEN VEGETABLES Requirements for Specific Standardized Frozen Vegetables § 158.170 Frozen peas. (a) Identity—(1) Product definition. Frozen peas is the food in “package” form as that term...

  13. 21 CFR 160.110 - Frozen eggs.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 2 2014-04-01 2014-04-01 false Frozen eggs. 160.110 Section 160.110 Food and... CONSUMPTION EGGS AND EGG PRODUCTS Requirements for Specific Standardized Eggs and Egg Products § 160.110 Frozen eggs. (a) Frozen eggs, frozen whole eggs, frozen mixed eggs is the food prepared by...

  14. 21 CFR 160.110 - Frozen eggs.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 2 2012-04-01 2012-04-01 false Frozen eggs. 160.110 Section 160.110 Food and... CONSUMPTION EGGS AND EGG PRODUCTS Requirements for Specific Standardized Eggs and Egg Products § 160.110 Frozen eggs. (a) Frozen eggs, frozen whole eggs, frozen mixed eggs is the food prepared by...

  15. 21 CFR 160.110 - Frozen eggs.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 2 2013-04-01 2013-04-01 false Frozen eggs. 160.110 Section 160.110 Food and... CONSUMPTION EGGS AND EGG PRODUCTS Requirements for Specific Standardized Eggs and Egg Products § 160.110 Frozen eggs. (a) Frozen eggs, frozen whole eggs, frozen mixed eggs is the food prepared by...

  16. 21 CFR 160.110 - Frozen eggs.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 2 2011-04-01 2011-04-01 false Frozen eggs. 160.110 Section 160.110 Food and... CONSUMPTION EGGS AND EGG PRODUCTS Requirements for Specific Standardized Eggs and Egg Products § 160.110 Frozen eggs. (a) Frozen eggs, frozen whole eggs, frozen mixed eggs is the food prepared by...

  17. 21 CFR 160.110 - Frozen eggs.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Frozen eggs. 160.110 Section 160.110 Food and... CONSUMPTION EGGS AND EGG PRODUCTS Requirements for Specific Standardized Eggs and Egg Products § 160.110 Frozen eggs. (a) Frozen eggs, frozen whole eggs, frozen mixed eggs is the food prepared by...

  18. [CONTROVERSIES REGARDING THE ACCURACY AND LIMITATIONS OF FROZEN SECTION IN THYROID PATHOLOGY: AN EVIDENCE-BASED ASSESSMENT].

    PubMed

    Stanciu-Pop, C; Pop, F C; Thiry, A; Scagnol, I; Maweja, S; Hamoir, E; Beckers, A; Meurisse, M; Grosu, F; Delvenne, Ph

    2015-12-01

    Palpable thyroid nodules are present clinically in 4-7% of the population and their prevalence increases to 50%-67% when using high-resolution neck ultrasonography. By contrast, thyroid carcinoma (TC) represents only 5-20% of these nodules, which underlines the need for an appropriate approach to avoid unnecessary surgery. Frozen section (PS) has been used for more than 40 years in thyroid surgery to establish the diagnosis of malignancy. However, a controversy persists regarding the accuracy of FS and its place in thyroid pathology has changed with the emergence of fine-needle aspiration (FNA). A PubMed Medline and SpringerLink search was made covering the period from January 2000 to June 2012 to assess the accuracy of ES, its limitations and indications for the diagnosis of thyroid nodules. Twenty publications encompassing 8.567 subjects were included in our study. The average value of TC among thyroid nodules in analyzed studies was 15.5 %. ES ability to detect cancer expressed by its sensitivity (Ss) was 67.5 %. More than two thirds of the authors considered PS useful exclusively in the presence of doubtful ENA and for guiding the surgical extension in cases confirmed as malignant by FNA; however, only 33% accepted FS as a routine examination for the management of thyroid nodules. The influence of FS on surgical reintervention rate in nodular thyroid pathology was considered to be negligible by most studies, whereas 31 % of the authors thought that FS has a favorable benefit by decreasing the number of surgical re-interventions. In conclusion, the role of FS in thyroid pathology evolved from a mandatory component for thyroid surgery to an optional examination after a pre-operative FNA cytology. The accuracy of FS seems to provide no sufficient additional benefit and most experts support its use only in the presence of equivocal or suspicious cytological features, for guiding the surgical extension in cases confirmed as malignant by FNA and for the

  19. Frozen Frozen CO2

    NASA Technical Reports Server (NTRS)

    2005-01-01

    2 October 2005 This Mars Global Surveyor (MGS) Mars Orbiter Camera (MOC) image shows a view of frozen carbon dioxide in the south polar residual cap of Mars. Much of the south polar residual cap exhibits terrain that resembles stacks of sliced Swiss cheese, but this portion of the cap lacks the typical, circular depressions that characterize much of the region. Carbon dioxide on Mars freezes at a temperature of around 148 Kelvins, which is -125oC or about -193oF.

    Location near: 87.2oS, 28.4oW Image width: width: 3 km (1.9 mi) Illumination from: upper left Season: Southern Spring

  20. 21 CFR 101.95 - “Fresh,” “freshly frozen,” “fresh frozen,” “frozen fresh.”

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 2 2010-04-01 2010-04-01 false âFresh,â âfreshly frozen,â âfresh frozen,â âfrozen... frozen,” “fresh frozen,” “frozen fresh.” The terms defined in this section may be used on the label or in... state and has not been frozen or subjected to any form of thermal processing or any other form...

  1. Analysis of perioperative pain management in vascular surgery indicates that practice does not adhere with guidelines: a retrospective cross-sectional study

    PubMed Central

    Boric, Krste; Boric, Matija; Boric, Teo; Puljak, Livia

    2017-01-01

    Background Inadequate treatment of pain related to surgery may be associated with complications and prolonged recovery time and increased morbidity and mortality rates. We investigated perioperative pain management in vascular surgery and compared it with the relevant guidelines for the treatment of perioperative pain. Methods We conducted a retrospective study on 501 patients who underwent vascular surgery at the University Hospital Split, Croatia. We collected the following data from patients’ charts: age, gender, premedication, preoperative patient’s physical status, type of surgery, duration of surgery and anesthesia, type of anesthesia, postoperative analgesia, and need for intensive care. We examined departmental procedures to assess adherence to guidelines for perioperative pain management. Results None of the 501 patients’ charts recorded information about perioperative pain intensity, 28% of patients did not receive any medication the night before their elective surgical procedures, and 17% of patients did not receive premedication immediately before the procedure. Most patients (66%) did not receive any pain medication in the operating room after surgery. Following surgery, 36% of patients were monitored in the intensive care units, while the rest were released to the ward. Some patients (17%) did not receive any analgesia after surgery. Procedures at the department did not adhere to the current recommendations for perioperative pain management. Conclusion The study indicates that management of surgery-related pain in complex vascular procedures at this hospital did not follow guidelines for the management of acute perioperative pain. Our finding that most patients did not receive appropriate analgesia after vascular surgery leads to the conclusion that the institution would benefit from developing guidelines for the management of acute perioperative pain, which should be applied in all cases. PMID:28176903

  2. Frozen shoulder.

    PubMed Central

    Anton, H. A.

    1993-01-01

    The frozen shoulder is a common cause of shoulder pain and disability. Most patients slowly improve over 12 to 24 months. Some have prolonged loss of movement, pain, and associated disability. Treatments include physiotherapy, corticosteroid injections, and manipulation. Clinical trials of these treatments have produced conflicting results. PMID:8374364

  3. 7 CFR 58.327 - Frozen cream.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 3 2010-01-01 2010-01-01 false Frozen cream. 58.327 Section 58.327 Agriculture... Material § 58.327 Frozen cream. To produce frozen cream eligible for official certification, the quality of the cream used shall meet the requirements of cream acceptable for the manufacture of U.S. Grade AA...

  4. 5 CFR 1650.3 - Frozen accounts.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Frozen accounts. 1650.3 Section 1650.3... SAVINGS PLAN General § 1650.3 Frozen accounts. (a) All withdrawals from the TSP are subject to the rules... participant may not withdraw any portion of his or her account balance if the account is frozen due to...

  5. Musculoskeletal perioperative problems. The role of physical and rehabilitation medicine physicians. The European perspective based on the best evidence. A paper by the UEMS-PRM Section Professional Practice Committee.

    PubMed

    Varela, E; Oral, A; Ilieva, E; Küçükdeveci, A A; Valero, R; Berteanu, M; Christodoulou, N

    2013-10-01

    One of the objectives of the Professional Practice Committee (PPC) of the Physical and Rehabilitation Medicine (PRM) Section of the Union of European Medical Specialists (UEMS) is the development of the field of competence of PRM physicians in Europe. To achieve this objective, UEMS PRM Section PPC has adopted a systematic action plan of preparing a series of papers describing the role of PRM physicians in a number of disabling health conditions, based on the evidence of effectiveness of the physical and rehabilitation medicine interventions. According to the UEMS-PRM section, the role of PRM physician in musculoskeletal perioperative settings has to be situated inside general pain management. Musculoskeletal surgery (MSS) represents a frequent medical situation among patients suffering from musculoskeletal disorders (MSDs), in which PRM physicians need to be involved. A wide number of MSDs have to be operated in order to diminish disability and relieve symptoms, thus improving the patient´s functioning and social participation: Joint replacements, spine decompressions, vertebroplasties, internal fixation of unstable fractures, arthroscopies for tendon and joint repairs, and others. This paper describes the role of the PRM physician during the perioperative period. A well-coordinated rehabilitation programme followed by a good home rehabilitation programme results in pain reduction, faster recovery with better patient participation and increased cost effectiveness. PRM physicians have to identify patients at risk of continuing activity limitation and participation restriction who will benefit from an early rehabilitation process and formulate a PRM programme of care taking into account each patient's environmental factors.

  6. Using immunoglobulin Y as an alternative antibody for the detection of hepatitis A virus in frozen liver sections.

    PubMed

    Bentes, Gentil Arthur; Lanzarini, Natália Maria; Lima, Lyana Rodrigues Pinto; Manso, Pedro Paulo de Abreu; da Silva, Alexandre Dos Santos; Mouta Junior, Sergio da Silva E; Guimarães, Juliana Rodrigues; de Moraes, Marcia Terezinha Baroni; Pelajo-Machado, Marcelo; Pinto, Marcelo Alves

    2015-06-01

    An increasing amount of research has been conducted on immunoglobulin Y (IgY) because the use of IgY offers several advantages with respect to diagnostic testing, including its easy accessibility, low cost and translatability to large-scale production, in addition to the fact that it can be ethically produced. In a previous work, immunoglobulin was produced and purified from egg yolks (IgY) reactive to hepatitis A virus (HAV) antigens. In the present work, this anti-HAV-specific IgY was used in an indirect immunofluorescence assay to detect viral antigens in liver biopsies that were obtained from experimentally infected cynomolgus monkeys. Fields that were positive for HAV antigen were detected in liver sections using confocal microscopy. In conclusion, egg yolks from immunised hens may be a reliable source for antibody production, which can be employed for immunological studies.

  7. Immunofluorescent Staining for the Detection of the Hepatitis B Core Antigen in Frozen Liver Sections of Human Liver Chimeric Mice.

    PubMed

    Allweiss, Lena; Lütgehetmann, Marc; Dandri, Maura

    2017-01-01

    The hepatitis B virus (HBV) is the causative agent for chronic hepatitis B infection, which affects an estimate of 240 million people worldwide and puts them at risk of developing terminal liver disease. The life cycle of the virus and its interactions with the host immune system are still incompletely understood, and currently available treatment options rarely achieve a cure. Therefore, basic research and new drug development are needed. One parameter for measuring the intrahepatic activity of the virus is monitoring the production of the HBV core antigen (HBcAg), which not only serves as the main structural protein of its nucleocapsid but is also recruited to the covalently closed circular DNA (cccDNA), the nuclear HBV genome responsible for infection persistence. Here, we report a sensitive immunofluorescence staining method to detect HBcAg in cryopreserved liver sections. The method combines conventional immunofluorescence staining procedures with the Tyramide Signal Amplification (TSA) system.

  8. Correlation of Intraoperative Frozen Section Report and Histopathological Diagnosis of 
Central Nervous System Tumors – A Six-Year Retrospective Study

    PubMed Central

    Al-Ajmi, Radiya; Al-Kindi, Hunaina; George, Mina; Thomas, Kurien

    2016-01-01

    Objectives To evaluate the degree of agreement between the intraoperative frozen section (FS) reporting of central nervous system (CNS) tumors and final histopathological diagnosis based on permanent paraffin section. Methods All CNS tumor cases with a diagnosis at FS and subsequent permanent section (n = 261) taken from 2007 to 2012 were retrospectively reviewed. Twenty percent of FS were double-checked by a senior pathologist as part of the study and the intraobserver agreement between the pathologist and the agreement between final report, and initial FS report was estimated by the intraclass correlation coefficient (ICC). Results A total of 261 cases were reviewed. The most common diagnosis was glioblastoma (grade IV) and meningioma (grade I–II) forming 45.6% of cases. Fifty-three cases were subjected to intraobserver agreement of histological diagnosis. There was nearly perfect intraobserver agreement on histopathology (ICC = 0.9). Out of 261 cases, 224 cases showed a strong agreement between the FS diagnosis and final histological diagnosis (ICC = 0.747). A discrepancy between the FS and final diagnosis were found in eight cases. The disagreement did not relate to any specific tumor type. However, in three cases, the discrepancy was in the grading of the glioma. In 29 cases, a definite opinion could not be given on FS as the samples examined were nonrepresentative. Conclusions Histopathological slides classified by World Health Organization criteria of CNS tumors had excellent intraobserver agreement. Our results show a moderate to high degree of agreement in the intraoperative diagnosis of CNS lesions using FS. However, there are limitations, and some lesions are a diagnostic challenge. There is a need to improve our diagnostic skills and knowledge of possible errors and establish better communication with neurosurgeons. PMID:27974956

  9. A modified protocol for the detection of three different mRNAs with a new-generation in situ hybridization chain reaction on frozen sections.

    PubMed

    Sui, Qian-Qian; Zhu, Jiao; Li, Xiangnan; Knight, Gillian E; He, Cheng; Burnstock, Geoffrey; Yuan, Hongbin; Xiang, Zhenghua

    2016-12-01

    A new multiple fluorescence in situ hybridization method based on hybridization chain reaction was recently reported, enabling simultaneous mapping of multiple target mRNAs within intact zebrafish and mouse embryos. With this approach, DNA probes complementary to target mRNAs trigger chain reactions in which metastable fluorophore-labeled DNA hairpins self-assemble into fluorescent amplification polymers. The formation of the specific polymers enhances greatly the sensitivity of multiple fluorescence in situ hybridization. In this study we describe the optimal parameters (hybridization chain reaction time and temperature, hairpin and salt concentration) for multiple fluorescence in situ hybridization via amplification of hybridization chain reaction for frozen tissue sections. The combined use of fluorescence in situ hybridization and immunofluorescence, together with other control experiments (sense probe, neutralization and competition, RNase treatment, and anti-sense probe without initiator) confirmed the high specificity of the fluorescence in situ hybridization used in this study. Two sets of three different mRNAs for oxytocin, vasopressin and somatostatin or oxytocin, vasopressin and thyrotropin releasing hormone were successfully visualized via this new method. We believe that this modified protocol for multiple fluorescence in situ hybridization via hybridization chain reaction would allow researchers to visualize multiple target nucleic acids in the future.

  10. Ultrastructural non-radioactive in situ hybridization of GH mRNA in rat pituitary gland: pre-embedding vs ultra-thin frozen sections vs post-embedding.

    PubMed

    Le Guellec, D; Trembleau, A; Pechoux, C; Gossard, F; Morel, G

    1992-07-01

    In situ hybridization at the ultrastructural level can be carried out using three different methods: on vibratome sections before embedding in epoxy resin, on ultra-thin frozen sections, or on ultra-thin sections of tissues embedded in hydrophilic resin such as Lowicryl. With the purpose of comparing the sensitivity, resolution, and ultrastructural preservation of these three methods, we examined the expression of the growth hormone (GH) gene in anterior pituitary cells by in situ hybridization at the ultrastructural level, using a synthetic oligonucleotide complementary to the codons of the mRNA from Gln 45 to Ser 54 labeled at the 3' end of biotin-21dUTP. All these methods gave similar results: mRNA was located on the lamellar endoplasmic reticulum of somatotrophs. The pre-embedding method gave the best ultrastructural preservation, with low resolution with the enzymatic detection system and an intermediate sensitivity. A probe concentration of 10 pmol/ml was sufficient to obtain a signal. With this method gold particles could not be used without pre-treatment. The frozen section method gave the best sensitivity (a signal was observed with 4 pmol/ml of probe) but the lowest ultrastructural preservation. On ultra-thin Lowicryl sections, resolution was as high as with the frozen-section method, ultrastructural conservation was intermediate, and sensitivity was low. These results indicate that the last method seems to be a good compromise between sensitivity and ultrastructural preservation.

  11. A 10-Year Trend Analysis of Sentinel Lymph Node Frozen Section and Completion Axillary Dissection for Breast Cancer: Are These Procedures Becoming Obsolete?

    PubMed Central

    Weber, Walter P.; Barry, Mitchel; Stempel, Michelle M.; Junqueira, Manuela J.; Eaton, Anne A.; Patil, Sujata M.; Morrow, Monica; Cody, Hiram S.

    2013-01-01

    Background Recent results from the ACOSOG Z0011 trial question the use of intraoperative frozen section (FS) during sentinel lymph node (SLN) biopsy and the role of axillary dissection (ALND) for SLN-positive breast cancer patients. Here we present a 10-year trend analysis of SLN-FS and ALND in our practice. Methods We reviewed our prospective SLN database over 10 years (1997–2006, 7509 SLN procedures) for time trends and variation between surgeons in the use of SLN-FS and ALND in patients with cN0 invasive breast cancer. Results Use of SLN-FS decreased from 100% to 62% (P < 0.0001) and varied widely by surgeon (66% to 95%). There were no statistically significant trends in the performance of ALND for patients with SLN metastases detected by FS (n = 1370, 99–99%) or routine hematoxylin and eosin (H&E) (n = 333; 69–77%), but only for those detected by serial section H&E with or without immunohistochemistry (n = 438; 73–48%; P = 0.0054) or immunohistochemistry only (n = 294; 48–28%; P < 0.0001). These trends coincided with an increase in the proportion of completion versus immediate ALND (30–40%; P = 0.0710). Conclusions Over 10 years, we have observed a diminishing rate of SLN-FS and, for patients with low-volume SLN metastases, fewer ALND, trends that suggest a more nuanced approach to axillary management. If the Z0011 selection criteria had been applied to our cohort, 66% of SLN-FS (4159 of 6327) and 48% of ALND (939 of 1953) would have been avoided, sparing 13% of all patients the morbidity of ALND. PMID:21647763

  12. Identification of regions of normal grey matter and white matter from pathologic glioblastoma and necrosis in frozen sections using Raman imaging.

    PubMed

    Kast, Rachel; Auner, Gregory; Yurgelevic, Sally; Broadbent, Brandy; Raghunathan, Aditya; Poisson, Laila M; Mikkelsen, Tom; Rosenblum, Mark L; Kalkanis, Steven N

    2015-11-01

    In neurosurgical applications, a tool capable of distinguishing grey matter, white matter, and areas of tumor and/or necrosis in near-real time could greatly aid in tumor resection decision making. Raman spectroscopy is a non-destructive spectroscopic technique which provides molecular information about the tissue under examination based on the vibrational properties of the constituent molecules. With careful measurement and data processing, a spatial step and repeat acquisition of Raman spectra can be used to create Raman images. Forty frozen brain tissue sections were imaged in their entirety using a 300-µm-square measurement grid, and two or more regions of interest within each tissue were also imaged using a 25 µm-square step size. Molecular correlates for histologic features of interest were identified within the Raman spectra, and novel imaging algorithms were developed to compare molecular features across multiple tissues. In previous work, the relative concentration of individual biomolecules was imaged. Here, the relative concentrations of 1004, 1300:1344, and 1660 cm(-1), which correspond primarily to protein and lipid content, were simultaneously imaged across all tissues. This provided simple interpretation of boundaries between grey matter, white matter, and diseased tissue, and corresponded with findings from adjacent hematoxylin and eosin-stained sections. This novel, yet simple, multi-channel imaging technique allows clinically-relevant resolution with straightforward molecular interpretation of Raman images not possible by imaging any single peak. This method can be applied to either surgical or laboratory tools for rapid, non-destructive imaging of grey and white matter.

  13. 21 CFR 160.190 - Frozen egg yolks.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Frozen egg yolks. 160.190 Section 160.190 Food and... CONSUMPTION EGGS AND EGG PRODUCTS Requirements for Specific Standardized Eggs and Egg Products § 160.190 Frozen egg yolks. (a) Frozen egg yolks, frozen yolks is the food prepared by freezing egg yolks...

  14. 21 CFR 160.190 - Frozen egg yolks.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 2 2011-04-01 2011-04-01 false Frozen egg yolks. 160.190 Section 160.190 Food and... CONSUMPTION EGGS AND EGG PRODUCTS Requirements for Specific Standardized Eggs and Egg Products § 160.190 Frozen egg yolks. (a) Frozen egg yolks, frozen yolks is the food prepared by freezing egg yolks...

  15. 21 CFR 160.150 - Frozen egg whites.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Frozen egg whites. 160.150 Section 160.150 Food... HUMAN CONSUMPTION EGGS AND EGG PRODUCTS Requirements for Specific Standardized Eggs and Egg Products § 160.150 Frozen egg whites. (a) Frozen egg whites, frozen egg albumen is the food prepared by...

  16. 21 CFR 160.150 - Frozen egg whites.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 2 2012-04-01 2012-04-01 false Frozen egg whites. 160.150 Section 160.150 Food... HUMAN CONSUMPTION EGGS AND EGG PRODUCTS Requirements for Specific Standardized Eggs and Egg Products § 160.150 Frozen egg whites. (a) Frozen egg whites, frozen egg albumen is the food prepared by...

  17. 21 CFR 160.150 - Frozen egg whites.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 2 2014-04-01 2014-04-01 false Frozen egg whites. 160.150 Section 160.150 Food... HUMAN CONSUMPTION EGGS AND EGG PRODUCTS Requirements for Specific Standardized Eggs and Egg Products § 160.150 Frozen egg whites. (a) Frozen egg whites, frozen egg albumen is the food prepared by...

  18. 21 CFR 160.190 - Frozen egg yolks.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 2 2013-04-01 2013-04-01 false Frozen egg yolks. 160.190 Section 160.190 Food and... CONSUMPTION EGGS AND EGG PRODUCTS Requirements for Specific Standardized Eggs and Egg Products § 160.190 Frozen egg yolks. (a) Frozen egg yolks, frozen yolks is the food prepared by freezing egg yolks...

  19. 21 CFR 160.190 - Frozen egg yolks.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 2 2012-04-01 2012-04-01 false Frozen egg yolks. 160.190 Section 160.190 Food and... CONSUMPTION EGGS AND EGG PRODUCTS Requirements for Specific Standardized Eggs and Egg Products § 160.190 Frozen egg yolks. (a) Frozen egg yolks, frozen yolks is the food prepared by freezing egg yolks...

  20. 21 CFR 160.150 - Frozen egg whites.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 2 2013-04-01 2013-04-01 false Frozen egg whites. 160.150 Section 160.150 Food... HUMAN CONSUMPTION EGGS AND EGG PRODUCTS Requirements for Specific Standardized Eggs and Egg Products § 160.150 Frozen egg whites. (a) Frozen egg whites, frozen egg albumen is the food prepared by...

  1. 21 CFR 160.150 - Frozen egg whites.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 2 2011-04-01 2011-04-01 false Frozen egg whites. 160.150 Section 160.150 Food... HUMAN CONSUMPTION EGGS AND EGG PRODUCTS Requirements for Specific Standardized Eggs and Egg Products § 160.150 Frozen egg whites. (a) Frozen egg whites, frozen egg albumen is the food prepared by...

  2. 21 CFR 160.190 - Frozen egg yolks.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 2 2014-04-01 2014-04-01 false Frozen egg yolks. 160.190 Section 160.190 Food and... CONSUMPTION EGGS AND EGG PRODUCTS Requirements for Specific Standardized Eggs and Egg Products § 160.190 Frozen egg yolks. (a) Frozen egg yolks, frozen yolks is the food prepared by freezing egg yolks...

  3. 21 CFR 152.126 - Frozen cherry pie.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Frozen cherry pie. 152.126 Section 152.126 Food... HUMAN CONSUMPTION FRUIT PIES Requirements for Specific Standardized Fruit Pies § 152.126 Frozen cherry pie. (a) Identity. (1) Frozen cherry pie (excluding baked and then frozen) is the food prepared...

  4. 21 CFR 152.126 - Frozen cherry pie.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 2 2013-04-01 2013-04-01 false Frozen cherry pie. 152.126 Section 152.126 Food... HUMAN CONSUMPTION FRUIT PIES Requirements for Specific Standardized Fruit Pies § 152.126 Frozen cherry pie. (a) Identity. (1) Frozen cherry pie (excluding baked and then frozen) is the food prepared...

  5. 21 CFR 152.126 - Frozen cherry pie.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 2 2011-04-01 2011-04-01 false Frozen cherry pie. 152.126 Section 152.126 Food... HUMAN CONSUMPTION FRUIT PIES Requirements for Specific Standardized Fruit Pies § 152.126 Frozen cherry pie. (a) Identity. (1) Frozen cherry pie (excluding baked and then frozen) is the food prepared...

  6. 21 CFR 152.126 - Frozen cherry pie.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 2 2014-04-01 2014-04-01 false Frozen cherry pie. 152.126 Section 152.126 Food... HUMAN CONSUMPTION FRUIT PIES Requirements for Specific Standardized Fruit Pies § 152.126 Frozen cherry pie. (a) Identity. (1) Frozen cherry pie (excluding baked and then frozen) is the food prepared...

  7. 21 CFR 152.126 - Frozen cherry pie.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 2 2012-04-01 2012-04-01 false Frozen cherry pie. 152.126 Section 152.126 Food... HUMAN CONSUMPTION FRUIT PIES Requirements for Specific Standardized Fruit Pies § 152.126 Frozen cherry pie. (a) Identity. (1) Frozen cherry pie (excluding baked and then frozen) is the food prepared...

  8. 21 CFR 146.137 - Frozen orange juice.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 2 2011-04-01 2011-04-01 false Frozen orange juice. 146.137 Section 146.137 Food... Beverages § 146.137 Frozen orange juice. (a) Frozen orange juice is orange juice as defined in § 146.135, except that it is frozen. (b) The name of the food is “Frozen orange juice”. Such name may be preceded...

  9. 21 CFR 146.137 - Frozen orange juice.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 2 2013-04-01 2013-04-01 false Frozen orange juice. 146.137 Section 146.137 Food... Beverages § 146.137 Frozen orange juice. (a) Frozen orange juice is orange juice as defined in § 146.135, except that it is frozen. (b) The name of the food is “Frozen orange juice”. Such name may be preceded...

  10. 21 CFR 146.137 - Frozen orange juice.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 2 2012-04-01 2012-04-01 false Frozen orange juice. 146.137 Section 146.137 Food... Beverages § 146.137 Frozen orange juice. (a) Frozen orange juice is orange juice as defined in § 146.135, except that it is frozen. (b) The name of the food is “Frozen orange juice”. Such name may be preceded...

  11. 21 CFR 146.137 - Frozen orange juice.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Frozen orange juice. 146.137 Section 146.137 Food... Beverages § 146.137 Frozen orange juice. (a) Frozen orange juice is orange juice as defined in § 146.135, except that it is frozen. (b) The name of the food is “Frozen orange juice”. Such name may be preceded...

  12. 21 CFR 146.137 - Frozen orange juice.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 2 2014-04-01 2014-04-01 false Frozen orange juice. 146.137 Section 146.137 Food... Beverages § 146.137 Frozen orange juice. (a) Frozen orange juice is orange juice as defined in § 146.135, except that it is frozen. (b) The name of the food is “Frozen orange juice”. Such name may be preceded...

  13. [Surgical standards in perioperative treatment].

    PubMed

    Richter, A

    2012-04-01

    Perioperative medicine includes the areas of clarification, patient safety, hygiene standards, prophylaxis for thrombosis and antibiotics, pain therapy and morbidity and mortality conference. All these procedures show how complex perioperative medicine is.

  14. Lymphedema Prophylaxis Utilizing Perioperative Education

    DTIC Science & Technology

    2003-09-01

    The purpose is to evaluate perioperative training for lymphedema assessment and protection. The hypothesis is that structured perioperative training...in lymphedema protection will decrease lymphedema , the episodes of infection, the time to detection of lymphedema and improve the QOL in patients...incidence of lymphedema and infection during the first three years after surgery among breast cancer patients who received perioperative training in

  15. Perioperative blood management

    PubMed Central

    Manjuladevi, M; Vasudeva Upadhyaya, KS

    2014-01-01

    Perioperative anaemia and allogenic blood transfusion (ABT) are known to increase the risk of adverse clinical outcomes. The quality, cost and availability of blood components are also major limitations with regard to ABT. Perioperative patient blood management (PBM) strategies should be aimed at minimizing and improving utilization of blood components. The goals of PBM are adequate preoperative evaluation and optimization of haemoglobin and bleeding parameters, techniques to minimize blood loss, blood conservation technologies and use of transfusion guidelines with targeted therapy. Attention to these details can help in cost reduction and improved patient outcome. PMID:25535419

  16. 7 CFR 58.349 - Frozen cream.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 3 2010-01-01 2010-01-01 false Frozen cream. 58.349 Section 58.349 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Standards... Products Bearing Usda Official Identification § 58.349 Frozen cream. The flavor shall be sweet,...

  17. Mass Spectrometry Imaging of Drug Related Crystal-Like Structures in Formalin-Fixed Frozen and Paraffin-Embedded Rabbit Kidney Tissue Sections

    NASA Astrophysics Data System (ADS)

    Bruinen, Anne L.; van Oevelen, Cateau; Eijkel, Gert B.; Van Heerden, Marjolein; Cuyckens, Filip; Heeren, Ron M. A.

    2016-01-01

    A multimodal mass spectrometry imaging (MSI) based approach was used to characterize the molecular content of crystal-like structures in a frozen and paraffin embedded piece of a formalin-fixed rabbit kidney. Matrix assisted laser desorption/ionization time-of-flight (MALDI-TOF) imaging and desorption electrospray ionization (DESI) mass spectrometry imaging were combined to analyze the frozen and paraffin embedded sample without further preparation steps to remove the paraffin. The investigated rabbit kidney was part of a study on a drug compound in development, in which severe renal toxicity was observed in dosed rabbits. Histological examination of the kidney showed tubular degeneration with precipitation of crystal-like structures in the cortex, which were assumed to cause the renal toxicity. The MS imaging approach was used to find out whether the crystal-like structures were composed of the drug compound, metabolites, or an endogenous compound as a reaction to the drug administration. The generated MALDI-MSI data were analyzed using principal component analysis. In combination with the MS/MS results, this way of data processing demonstrates that the crystal structures were mainly composed of metabolites and relatively little parent drug.

  18. Mass Spectrometry Imaging of Drug Related Crystal-Like Structures in Formalin-Fixed Frozen and Paraffin-Embedded Rabbit Kidney Tissue Sections.

    PubMed

    Bruinen, Anne L; van Oevelen, Cateau; Eijkel, Gert B; Van Heerden, Marjolein; Cuyckens, Filip; Heeren, Ron M A

    2016-01-01

    A multimodal mass spectrometry imaging (MSI) based approach was used to characterize the molecular content of crystal-like structures in a frozen and paraffin embedded piece of a formalin-fixed rabbit kidney. Matrix assisted laser desorption/ionization time-of-flight (MALDI-TOF) imaging and desorption electrospray ionization (DESI) mass spectrometry imaging were combined to analyze the frozen and paraffin embedded sample without further preparation steps to remove the paraffin. The investigated rabbit kidney was part of a study on a drug compound in development, in which severe renal toxicity was observed in dosed rabbits. Histological examination of the kidney showed tubular degeneration with precipitation of crystal-like structures in the cortex, which were assumed to cause the renal toxicity. The MS imaging approach was used to find out whether the crystal-like structures were composed of the drug compound, metabolites, or an endogenous compound as a reaction to the drug administration. The generated MALDI-MSI data were analyzed using principal component analysis. In combination with the MS/MS results, this way of data processing demonstrates that the crystal structures were mainly composed of metabolites and relatively little parent drug.

  19. 21 CFR 161.176 - Frozen raw lightly breaded shrimp.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 2 2011-04-01 2011-04-01 false Frozen raw lightly breaded shrimp. 161.176 Section... Shellfish § 161.176 Frozen raw lightly breaded shrimp. Frozen raw lightly breaded shrimp complies with the provisions of § 161.175, except that it contains not less than 65 percent of shrimp material, as...

  20. 21 CFR 161.176 - Frozen raw lightly breaded shrimp.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 2 2012-04-01 2012-04-01 false Frozen raw lightly breaded shrimp. 161.176 Section... Shellfish § 161.176 Frozen raw lightly breaded shrimp. Frozen raw lightly breaded shrimp complies with the provisions of § 161.175, except that it contains not less than 65 percent of shrimp material, as...

  1. 21 CFR 161.176 - Frozen raw lightly breaded shrimp.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 2 2013-04-01 2013-04-01 false Frozen raw lightly breaded shrimp. 161.176 Section... Shellfish § 161.176 Frozen raw lightly breaded shrimp. Frozen raw lightly breaded shrimp complies with the provisions of § 161.175, except that it contains not less than 65 percent of shrimp material, as...

  2. 21 CFR 161.176 - Frozen raw lightly breaded shrimp.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 2 2014-04-01 2014-04-01 false Frozen raw lightly breaded shrimp. 161.176 Section... Shellfish § 161.176 Frozen raw lightly breaded shrimp. Frozen raw lightly breaded shrimp complies with the provisions of § 161.175, except that it contains not less than 65 percent of shrimp material, as...

  3. 48 CFR 852.246-72 - Frozen processed foods.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 48 Federal Acquisition Regulations System 5 2011-10-01 2011-10-01 false Frozen processed foods. 852.246-72 Section 852.246-72 Federal Acquisition Regulations System DEPARTMENT OF VETERANS AFFAIRS... Frozen processed foods. As prescribed in 846.302-72, insert the following clause: Frozen Processed...

  4. 48 CFR 852.246-72 - Frozen processed foods.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Frozen processed foods. 852.246-72 Section 852.246-72 Federal Acquisition Regulations System DEPARTMENT OF VETERANS AFFAIRS... Frozen processed foods. As prescribed in 846.302-72, insert the following clause: Frozen Processed...

  5. 48 CFR 852.246-72 - Frozen processed foods.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 48 Federal Acquisition Regulations System 5 2013-10-01 2013-10-01 false Frozen processed foods. 852.246-72 Section 852.246-72 Federal Acquisition Regulations System DEPARTMENT OF VETERANS AFFAIRS... Frozen processed foods. As prescribed in 846.302-72, insert the following clause: Frozen Processed...

  6. 48 CFR 852.246-72 - Frozen processed foods.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 48 Federal Acquisition Regulations System 5 2014-10-01 2014-10-01 false Frozen processed foods. 852.246-72 Section 852.246-72 Federal Acquisition Regulations System DEPARTMENT OF VETERANS AFFAIRS... Frozen processed foods. As prescribed in 846.302-72, insert the following clause: Frozen Processed...

  7. 48 CFR 852.246-72 - Frozen processed foods.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 48 Federal Acquisition Regulations System 5 2012-10-01 2012-10-01 false Frozen processed foods. 852.246-72 Section 852.246-72 Federal Acquisition Regulations System DEPARTMENT OF VETERANS AFFAIRS... Frozen processed foods. As prescribed in 846.302-72, insert the following clause: Frozen Processed...

  8. 21 CFR 161.176 - Frozen raw lightly breaded shrimp.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Frozen raw lightly breaded shrimp. 161.176 Section 161.176 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Shellfish § 161.176 Frozen raw lightly breaded shrimp. Frozen raw lightly breaded shrimp complies with...

  9. 7 CFR 58.650 - Requirements for frozen custard.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 3 2010-01-01 2010-01-01 false Requirements for frozen custard. 58.650 Section 58.650... Products Bearing Usda Official Identification § 58.650 Requirements for frozen custard. The same requirements apply as for ice cream except plain frozen custard shall have a minimum egg yolk solids content...

  10. 21 CFR 146.146 - Frozen concentrated orange juice.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 2 2013-04-01 2013-04-01 false Frozen concentrated orange juice. 146.146 Section... Fruit Juices and Beverages § 146.146 Frozen concentrated orange juice. (a) Frozen concentrated orange juice is the food prepared by removing water from the juice of mature oranges as provided in §...

  11. 21 CFR 146.146 - Frozen concentrated orange juice.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 2 2011-04-01 2011-04-01 false Frozen concentrated orange juice. 146.146 Section... Fruit Juices and Beverages § 146.146 Frozen concentrated orange juice. (a) Frozen concentrated orange juice is the food prepared by removing water from the juice of mature oranges as provided in §...

  12. 21 CFR 146.146 - Frozen concentrated orange juice.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 2 2012-04-01 2012-04-01 false Frozen concentrated orange juice. 146.146 Section... Fruit Juices and Beverages § 146.146 Frozen concentrated orange juice. (a) Frozen concentrated orange juice is the food prepared by removing water from the juice of mature oranges as provided in §...

  13. 21 CFR 146.146 - Frozen concentrated orange juice.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 2 2014-04-01 2014-04-01 false Frozen concentrated orange juice. 146.146 Section... Fruit Juices and Beverages § 146.146 Frozen concentrated orange juice. (a) Frozen concentrated orange juice is the food prepared by removing water from the juice of mature oranges as provided in §...

  14. 21 CFR 146.146 - Frozen concentrated orange juice.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Frozen concentrated orange juice. 146.146 Section... Fruit Juices and Beverages § 146.146 Frozen concentrated orange juice. (a) Frozen concentrated orange juice is the food prepared by removing water from the juice of mature oranges as provided in §...

  15. Perioperative Fluid Restriction

    PubMed Central

    Bleier, Joshua I.S.; Aarons, Cary B.

    2013-01-01

    Perioperative fluid management of the colorectal surgical patient has evolved significantly over the last five decades. Older notions espousing aggressive hydration have been shown to be associated with increased complications. Newer data regarding fluid restriction has shown an association with improved outcomes. Management of perioperative fluid administration can be considered in three primary phases: In the preoperative phase, data suggests that avoidance of preoperative bowel preparation and avoidance of undue preoperative dehydration can improve outcomes. Although the type of intraoperative fluid given does not have a significant effect on outcome, data do suggest that a restrictive fluid regimen results in improved outcomes. Finally, in the postoperative phase of fluid management, a fluid-restrictive regimen, coupled with early enteral feeding also seems to result in improved outcomes. PMID:24436675

  16. Perioperative supply chain management.

    PubMed

    Feistritzer, N R; Keck, B R

    2000-09-01

    Faced with declining revenues and increasing operating expenses, hospitals are evaluating numerous mechanisms designed to reduce costs while simultaneously maintaining quality care. Many facilities have targeted initial cost reduction efforts in the reduction of labor expenses. Once labor expenses have been "right sized," facilities have continued to focus on service delivery improvements by the optimization of the "supply chain" process. This report presents a case study of the efforts of Vanderbilt University Medical Center in the redesign of its supply chain management process in the department of Perioperative Services. Utilizing a multidisciplinary project management structure, 3 work teams were established to complete the redesign process. To date, the project has reduced costs by $2.3 million and enhanced quality patient care by enhancing the delivery of appropriate clinical supplies during the perioperative experience.

  17. Perioperative nutritional support.

    PubMed

    Morán López, Jesús Manuel; Piedra León, María; García Unzueta, María Teresa; Ortiz Espejo, María; Hernández González, Miriam; Morán López, Ruth; Amado Señaris, José Antonio

    2014-01-01

    The relationship between preoperative malnutrition and morbi-mortality has been documented for years. Despite the existence of tools that allow its detection, and therefore treat this entity, their introduction into clinical practice is not wide-spread. Both perioperative insulin resistance and hyperglycemia are associated with increased perioperative morbidity and length of hospital stay. The intake of carbohydrate-rich drinks 2-4h prior to surgery reduces insulin resistance. In the immediate postoperative period, the enteral route is safe and well tolerated and its early use reduces hospital stay and postoperative complications compared with parenteral nutritional support. Inmunonutrition has been proven effective to decrease postoperative complications and hospital stay. In view of these data we opted for the adoption of these measures replacing bowel rest and the indiscriminate use of postoperative parenteral nutrition.

  18. Multiphoton microscopy based cryo-imaging of inflated frozen human lung sections at -60°C in healthy and COPD lungs

    NASA Astrophysics Data System (ADS)

    Abraham, Thomas; Kayra, Damian; Zhang, Angela; Suzuki, Masaru; McDonough, John; Elliott, W. M.; Cooper, Joel D.; Hogg, James C.

    2013-02-01

    Lung is a complex gas exchanger with interfacial area (where the gas exchange takes place) is about the size of a tennis court. Respiratory function is linked to the biomechanical stability of the gas exchange or alveolar regions which directly depends on the spatial distributions of the extracellular matrix fibers such fibrillar collagens and elastin fibers. It is very important to visualize and quantify these fibers at their native and inflated conditions to have correct morphometric information on differences between control and diseased states. This can be only achieved in the ex vivo states by imaging directly frozen lung specimens inflated to total lung capacity. Multiphoton microscopy, which uses ultra-short infrared laser pulses as the excitation source, produces multiphoton excitation fluorescence (MPEF) signals from endogenously fluorescent proteins (e.g. elastin) and induces specific second harmonic generation (SHG) signals from non-centrosymmetric proteins such as fibrillar collagens in fresh human lung tissues [J. Struct. Biol. (2010)171,189-196]. Here we report for the first time 3D image data obtained directly from thick frozen inflated lung specimens (~0.7- 1.0 millimeter thick) visualized at -60°C without prior fixation or staining in healthy and diseased states. Lung specimens donated for transplantation and released for research when no appropriate recipient was identified served as controls, and diseased lung specimens donated for research by patients receiving lung transplantation for very severe COPD (n=4) were prepared as previously described [N. Engl. J. Med. (2011) 201, 1567]. Lung slices evenly spaced between apex and base were examined using multiphoton microscopy while maintained at -60°C using a temperature controlled cold stage with a temperature resolution of 0.1°C. Infrared femto-second laser pulses tuned to 880nm, dry microscopic objectives, and non-de-scanned detectors/spectrophotometer located in the reflection geometry were

  19. Perioperative Hypothermia: Incidence and Prevention

    DTIC Science & Technology

    1990-01-01

    1990 Thesis/" Perioperative Hypothermia: Incidence and Prevention CRodney L. Fisher AFIT Student at: Columbia University AFIT/CI/CIA 90-120 AFT/I/I...Civilian Institution Programs DTIC CTELECTE 0 36 UNCLASSIFIFD 4 PERIOPERATIVE HYPOTHERMIA: INCIDENCE AND PREVENTION By Rodney L. Fisher, CAPT., USAF...Availability Codes Avall and/or Dit Special ABSTRACT Perioperative thermal regulation is discussed. A retrospective audit was conducted to identify the

  20. [Perioperative management of atrial fibrillation].

    PubMed

    Arguis, M J; Navarro, R; Regueiro, A; Arbelo, E; Sierra, P; Sabaté, S; Galán, J; Ruiz, A; Matute, P; Roux, C; Gomar, C; Rovira, I; Mont, L; Fita, G

    2014-05-01

    Atrial fibrillation is a frequent complication in the perioperative period. When it appears there is an increased risk of perioperative morbidity due to stroke, thromboembolism, cardiac arrest, myocardial infarction, anticoagulation haemorrhage, and hospital readmissions. The current article focuses on the recommendations for the management of perioperative atrial fibrillation based on the latest Clinical Practice Guidelines on atrial fibrillation by the European Society of Cardiology and the Spanish Society of Cardiology. This article pays special attention to the preoperative management, as well as to the acute perioperative episode. For this reason, the latest recommendations for the control of cardiac frequency, antiarrhythmic treatment and anticoagulation are included.

  1. Peri-operative anaphylaxis

    PubMed Central

    Nel, Linda; Eren, Efrem

    2011-01-01

    Peri-operative anaphylaxis is an important cause for mortality and morbidity associated with anaesthesia. The true incidence is unknown and is most likely under reported. Diagnosis can be difficult, particularly as a number of drugs are given simultaneously and any of these agents can potentially cause anaphylaxis. This review covers the clinical features, differential diagnosis and management of anaphylaxis associated with anaesthesia. The investigations to confirm the clinical suspicion of anaphylaxis and further tests to identify the likely drug(s) are examined. Finally the salient features of common and rare causes including non-drug substances are described. PMID:21235622

  2. Lymphedema Prophylaxis Utilizing Perioperative Education

    DTIC Science & Technology

    2006-09-01

    AD_________________ Award Number: DAMD17-00-1-0495 TITLE: Lymphedema Prophylaxis Utilizing...REPORT DATE 01-09-2006 2. REPORT TYPE Final 3. DATES COVERED 1 aug 2000 –1 aug 2006 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER Lymphedema ...purpose is to evaluate perioperative training for lymphedema assessment and protection. The hypothesis is that structured perioperative training in

  3. Prevention of unplanned perioperative hypothermia.

    PubMed

    Paulikas, Cynthia A

    2008-09-01

    Hypothermia is one of the most common complications experienced by surgical patients. Better postoperative patient outcomes are achieved when normothermia is maintained. Perioperative nurses should understand how to maintain normothermia, the causes of hypothermia, and adverse patient outcomes that result from hypothermia. Nursing interventions to help prevent hypothermia can be implemented during each phase of perioperative care.

  4. Student Immersion in Perioperative Nursing.

    PubMed

    Penprase, Barbara; Monahan, Janean; Poly-Droulard, Lynda; Prechowski, Stephanie

    2016-02-01

    The aging workforce and the lack of perioperative clinical practice and theoretical content in nursing education programs are factors contributing to the perioperative nursing shortage. This article discusses the implementation of a creatively designed perioperative program, which includes a didactic course and a 210-hour clinical course, developed by the faculty members of a Michigan school of nursing in collaboration with administrators at area hospitals. The didactic content covers materials presented during the first three months of orientation for newly employed perioperative nurses. Interested baccalaureate nursing students in their senior year are selected to participate in the program after being interviewed by hospital personnel and university faculty members. To date, the program has 18 student graduates in two semesters; all have been offered positions in the perioperative setting, and 14 have accepted positions. The active learning strategies used in the course are described with examples.

  5. 9 CFR 327.21 - Inspection procedures for chilled fresh and frozen boneless manufacturing meat.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... fresh and frozen boneless manufacturing meat. 327.21 Section 327.21 Animals and Animal Products FOOD....21 Inspection procedures for chilled fresh and frozen boneless manufacturing meat. (a) Definitions; sampling; standards. (1) Frozen boneless manufacturing meat is meat, frozen in the fresh state from...

  6. 9 CFR 327.21 - Inspection procedures for chilled fresh and frozen boneless manufacturing meat.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... fresh and frozen boneless manufacturing meat. 327.21 Section 327.21 Animals and Animal Products FOOD....21 Inspection procedures for chilled fresh and frozen boneless manufacturing meat. (a) Definitions; sampling; standards. (1) Frozen boneless manufacturing meat is meat, frozen in the fresh state from...

  7. 9 CFR 327.21 - Inspection procedures for chilled fresh and frozen boneless manufacturing meat.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... fresh and frozen boneless manufacturing meat. 327.21 Section 327.21 Animals and Animal Products FOOD....21 Inspection procedures for chilled fresh and frozen boneless manufacturing meat. (a) Definitions; sampling; standards. (1) Frozen boneless manufacturing meat is meat, frozen in the fresh state from...

  8. 9 CFR 327.21 - Inspection procedures for chilled fresh and frozen boneless manufacturing meat.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... fresh and frozen boneless manufacturing meat. 327.21 Section 327.21 Animals and Animal Products FOOD....21 Inspection procedures for chilled fresh and frozen boneless manufacturing meat. (a) Definitions; sampling; standards. (1) Frozen boneless manufacturing meat is meat, frozen in the fresh state from...

  9. 9 CFR 327.21 - Inspection procedures for chilled fresh and frozen boneless manufacturing meat.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... fresh and frozen boneless manufacturing meat. 327.21 Section 327.21 Animals and Animal Products FOOD....21 Inspection procedures for chilled fresh and frozen boneless manufacturing meat. (a) Definitions; sampling; standards. (1) Frozen boneless manufacturing meat is meat, frozen in the fresh state from...

  10. Perioperative Haemodynamic Optimisation.

    PubMed

    Aya, Hollmann D; Cecconi, Maurizio; Rhodes, Andrew

    2014-04-01

    During the latest years, a number of studies have confirmed the benefits of perioperative haemodynamic optimisation on surgical mortality and postoperative complication rate. This process requires the use of advanced haemodynamic monitoring with the purpose of guiding therapies to reach predefined goals. This review aim to present recent evidence on perioperative goal directed therapy (GDT), with an emphasis in some aspects that may merit further investigation. In order to maximise the benefits on outcomes, GDT must be implemented as early as possible; intravascular volume optimisation should be in accordance with the response of the preload-reserve, goals should be individualised and adequacy of the intervention must be also assessed; non-invasive or minimally invasive monitoring should be used and, finally, side effects of every therapy should be taken into account in order to avoid undesired complications. New drugs and technologies, particularly those exploring the venous side of the circulation, may improve in the future the effectiveness and facilitate the implementation of this group of therapeutic interventions.

  11. Perioperative thermal insulation.

    PubMed

    Bräuer, Anselm; Perl, Thorsten; English, Michael J M; Quintel, Michael

    2007-01-01

    Perioperative hypothermia remains a common problem during anesthesia and surgery. Unfortunately, the implementation of new minimally invasive surgical procedures has not lead to a reduction of this problem. Heat losses from the skin can be reduced by thermal insulation to avoid perioperative hypothermia. However, only a small amount of information is available regarding the physical properties of insulating materials used in the Operating Room (OR). Therefore, several materials using validated manikins were tested. Heat loss from the surface of the manikin can be described as:"Q = h . DeltaT . A" where Q = heat flux, h = heat exchange coefficient, DeltaT = temperature gradient between the environment and surface, and A = covered area. Heat flux per unit area and surface temperature were measured with calibrated heat flux transducers. Environmental temperature was measured using a thermoanemometer. The temperature gradient between the surface and environment (DeltaT) was varied and "h" was determined by linear regression analysis as the slope of "DeltaT" versus heat flux per unit area. The reciprocal of the heat exchange coefficient defines the insulation. The insulation values of the materials varied between 0.01 Clo (plastic bag) to 2.79 Clo (2 layers of a hospital duvet). Given the range of insulating materials available for outdoor activities, significant improvement in insulation of patients in the OR is both possible and desirable.

  12. 21 CFR 101.95 - “Fresh,” “freshly frozen,” “fresh frozen,” “frozen fresh.”

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 2 2014-04-01 2014-04-01 false âFresh,â âfreshly frozen,â âfresh frozen,â âfrozen fresh.â 101.95 Section 101.95 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION FOOD LABELING Specific Requirements...

  13. Managing variability in perioperative services.

    PubMed

    Dempsey, Christina J

    2009-11-01

    Variability within perioperative services has come to be something physicians, perioperative nurses, and managers expect. Peaks and valleys in schedules; differences in physician preferences for surgical implants, instruments, and supplies; staffing competencies; and inpatient bed availability are just a few examples of day-to-day variability that affects perioperative services personnel. Rather than simply responding to variability, however, the goal should be to eliminate variability in patient flow as much as possible and effectively manage what cannot be eliminated. Combining the hard science of queuing theory and simulation modeling with the soft science of change management and operations improvement expertise is the key to success, and a collaborative team makes it possible.

  14. Diathermy in perioperative practice.

    PubMed

    Potty, Anish G; Khan, Wasim; Tailor, Hitesh D

    2010-11-01

    Diathermy has revolutionised modern surgery and is an important tool for efficient and safe surgical practice. It has evolved to become the modern day scalpel, being used for cutting and coagulating tissues. This article addresses the functioning and safe use of diathermy in the perioperative setting. The various precautionary checks before surgery, which are prerequisite for safe usage, are highlighted along with the necessary safety drills during and after operation. A specific note is included about the use of electrical equipment in specialised surgeries like cardiac and laparoscopic surgery. The issues regarding the maintenance and repair of equipment are acknowledged and finally, the anticipation for a future with precise and safer cutting and coagulation devices is addressed.

  15. Applying nursing theory to perioperative nursing practice.

    PubMed

    Gillette, V A

    1996-08-01

    The perioperative nursing role has evolved from that of task-oriented specialists to patient-centered professionals. The concept of caring is significant to perioperative nurses and is manifested by the many caring behaviors perioperative nurses demonstrate toward surgical patients. This article describes how the element of caring is an essential function of perioperative nursing and relates the perioperative nursing role to the work of three nursing theorists (le, Florence Nightingale; Virginia Henderson, RN, AM; Carol L. Montgomery, RN, PhD).

  16. 21 CFR 146.126 - Frozen concentrate for colored lemonade.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 2 2014-04-01 2014-04-01 false Frozen concentrate for colored lemonade. 146.126 Section 146.126 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... section 721 of the Federal Food, Drug, and Cosmetic Act. (b) The name of the food is “Frozen...

  17. 21 CFR 146.126 - Frozen concentrate for colored lemonade.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 2 2013-04-01 2013-04-01 false Frozen concentrate for colored lemonade. 146.126 Section 146.126 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... section 721 of the Federal Food, Drug, and Cosmetic Act. (b) The name of the food is “Frozen...

  18. Big Data and Perioperative Nursing.

    PubMed

    Westra, Bonnie L; Peterson, Jessica J

    2016-10-01

    Big data are large volumes of digital data that can be collected from disparate sources and are challenging to analyze. These data are often described with the five "Vs": volume, velocity, variety, veracity, and value. Perioperative nurses contribute to big data through documentation in the electronic health record during routine surgical care, and these data have implications for clinical decision making, administrative decisions, quality improvement, and big data science. This article explores methods to improve the quality of perioperative nursing data and provides examples of how these data can be combined with broader nursing data for quality improvement. We also discuss a national action plan for nursing knowledge and big data science and how perioperative nurses can engage in collaborative actions to transform health care. Standardized perioperative nursing data has the potential to affect care far beyond the original patient.

  19. Perioperative Jehovah's Witnesses: a review.

    PubMed

    Lawson, T; Ralph, C

    2015-11-01

    There are many patient groups who may refuse blood products; the most well known amongst them is the Jehovah's Witness faith. Treatment of anaemia and bleeding in such patients presents a challenge to medical, anaesthetic, and surgical teams. This review examines the perioperative issues and management of Jehovah's Witnesses. The history and beliefs of Jehovah's Witnesses are outlined together with their impact on ethics and the law, and different management options throughout the perioperative period are discussed.

  20. 78 FR 39708 - Certain Frozen Fish Fillets From the Socialist Republic of Vietnam: Final Results of Antidumping...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-02

    ... International Trade Administration Certain Frozen Fish Fillets From the Socialist Republic of Vietnam: Final... reviews of the antidumping duty order on certain frozen fish fillets (``frozen fish fillets'') from the... below in the ``Final Results of Review'' section of this notice. \\1\\ See Certain Frozen Fish...

  1. 75 FR 12726 - Certain Frozen Fish Fillets from the Socialist Republic of Vietnam: Final Results of the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-17

    ... 351.401(f) of the Department's regulations define single entities as those affiliated producers who... the scope are frozen whole fish (whether or not dressed), frozen steaks, and frozen belly-flap nuggets. Frozen whole dressed fish are deheaded, skinned, and eviscerated. Steaks are bone-in, cross- section...

  2. 76 FR 35403 - Certain Frozen Fish Fillets From the Socialist Republic of Vietnam: Final Results of the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-17

    ... dressed), frozen steaks, and frozen belly-flap nuggets. Frozen whole dressed fish are deheaded, skinned, and eviscerated. Steaks are bone-in, cross- section cuts of dressed fish. Nuggets are the belly-flaps... tariff article codes 1604.19.4000, 1604.19.5000, 0305.59.4000, 0304.29.6033 (Frozen Fish Fillets of...

  3. Habits in perioperative nursing culture.

    PubMed

    Lindwall, Lillemor; von Post, Iréne

    2008-09-01

    This study focuses on investigating habits in perioperative nursing culture, which are often simply accepted and not normally considered or discussed. A hermeneutical approach was chosen as the means of understanding perioperative nurses' experiences of and reflections on operating theatre culture. Focus group discussions were used to collect data, which was analysed using hermeneutical text analysis. The results revealed three main categories of habits present in perioperative nursing culture: habits that promote ethical values (by temporary friendship with patients, showing respect for each other, and spending time on reflection on ethics and caring); habits that hinder progress (by seeing the patient as a surgical case, not acknowledging colleagues, and not talking about ethics); and habits that set the cultural tone (the hidden power structure and achieving more in less time).

  4. 21 CFR 135.110 - Ice cream and frozen custard.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Ice cream and frozen custard. 135.110 Section 135....110 Ice cream and frozen custard. (a) Description. (1) Ice cream is a food produced by freezing, while... accomplish specific functions. Ice cream is sweetened with safe and suitable sweeteners and may...

  5. 21 CFR 146.120 - Frozen concentrate for lemonade.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... lemonade is the frozen food prepared from one or both of the lemon juice ingredients specified in paragraph... percent by weight. (b) The lemon juice ingredients referred to in paragraph (a) of this section are: (1) Lemon juice or frozen lemon juice or a mixture of these. (2) Concentrated lemon juice or...

  6. 21 CFR 146.120 - Frozen concentrate for lemonade.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... lemonade is the frozen food prepared from one or both of the lemon juice ingredients specified in paragraph... percent by weight. (b) The lemon juice ingredients referred to in paragraph (a) of this section are: (1) Lemon juice or frozen lemon juice or a mixture of these. (2) Concentrated lemon juice or...

  7. 21 CFR 146.120 - Frozen concentrate for lemonade.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... lemonade is the frozen food prepared from one or both of the lemon juice ingredients specified in paragraph... percent by weight. (b) The lemon juice ingredients referred to in paragraph (a) of this section are: (1) Lemon juice or frozen lemon juice or a mixture of these. (2) Concentrated lemon juice or...

  8. 21 CFR 146.120 - Frozen concentrate for lemonade.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... lemonade is the frozen food prepared from one or both of the lemon juice ingredients specified in paragraph... percent by weight. (b) The lemon juice ingredients referred to in paragraph (a) of this section are: (1) Lemon juice or frozen lemon juice or a mixture of these. (2) Concentrated lemon juice or...

  9. 21 CFR 146.120 - Frozen concentrate for lemonade.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... lemonade is the frozen food prepared from one or both of the lemon juice ingredients specified in paragraph... percent by weight. (b) The lemon juice ingredients referred to in paragraph (a) of this section are: (1) Lemon juice or frozen lemon juice or a mixture of these. (2) Concentrated lemon juice or...

  10. [Perioperative management of Parkinson's disease].

    PubMed

    Mariscal, A; Medrano, I Hernández; Cánovas, A Alonso; Lobo, E; Loinaz, C; Vela, L; Espiga, P García-Ruiz; Castrillo, J C Martínez

    2012-01-01

    One of the particular characteristics of Parkinson's disease (PD) is the wide clinical variation as regards the treatment that can be found in the same patient. This occurs with specific treatment for PD, as well as with other drug groups that can make motor function worse. For this reason, the perioperative management of PD requires experience and above all appropriate planning. In this article, the peculiarities of PD and its treatment are reviewed, and a strategy is set out for the perioperative management of these patients.

  11. Fresh Frozen Plasma

    DTIC Science & Technology

    2009-03-01

    therapeutic means). FFP can be prepared either by separation from whole blood or collection via plasmapheresis . Fresh frozen plasma contains the...FFP can be further separated into cryoprecipitate and what is known as “cryo-poor plasma,” a product rarely used for therapeutic means. Plasma is the

  12. The Frozen Price Game

    ERIC Educational Resources Information Center

    Alden, Lori

    2003-01-01

    In this article, the author discusses the educational frozen price game she developed to teach the basic economic principle of price allocation. In addition to demonstrating the advantages of price allocation, the game also illustrates such concepts as opportunity costs, cost benefit comparisons, and the trade-off between efficiency and equity.…

  13. Molecular interactions of ErbB1 (EGFR) and integrin-β1 in astrocytoma frozen sections predict clinical outcome and correlate with Akt-mediated in vitro radioresistance

    PubMed Central

    Petrás, Miklós; Lajtos, Tamás; Friedländer, Elza; Klekner, Álmos; Pintye, Éva; Feuerstein, Burt G.; Szöllősi, János; Vereb, György

    2013-01-01

    Introduction Treatment of astrocytoma is frequently hampered by radioresistance of the tumor. In addition to overexpression of ErbB1/EGFR, functional crosstalk between receptor tyrosine kinases and cell adhesion molecules may also contribute to therapy resistance. Methods Acceptor photobleaching FRET was implemented on frozen sections of clinical astrocytoma to check the role of ErbB1–integrin-β1 interaction. U251 glioma subclones were obtained by introducing extra CHR7 material or the ErbB1 gene to test the relevance and mechanism of this interaction in vitro. Results Grade IV tumors showed higher ErbB1 and integrin-β1 expression and greater ErbB1–integrin-β1 heteroassociation than did grade II tumors. Of these, the extent of molecular association was a single determinant of tumor grade and prognosis in stepwise logistic regression. In vitro, integrin-β1 was upregulated, and radiosensitivity was diminished by ectopic ErbB1 expression. Great excess of ErbB1 provided colony forming advantage over medium excess but did not yield better radiation resistance or faster proliferation and decreased to medium level over time, whereas integrin-β1 levels remained elevated and defined the extent of radioresistance. Increased expression of ErbB1 and integrin-β1 was paralleled by decreasing ErbB1 homoassociation and increasing ErbB1–integrin-β1 heteroassociation. Microscopic two-sided FRET revealed that pixels with higher ErbB1–integrin-β1 heteroassociation exhibited lowed ErbB1 homoassociation, indicating competition for association partners among these molecules. Boosted Akt phosphorylation response to EGF accompanied this shift toward heteroassociation, and the consequentially increased radioresistance could be reverted by inhibiting PI3K. Conclusion The clinically relevant ErbB1–integrin-β1 heteroassociation may be used as a target of both predictive diagnostics and molecular therapy. PMID:23595626

  14. 40 CFR 407.40 - Applicability; description of the frozen potato products subcategory.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... frozen potato products subcategory. 407.40 Section 407.40 Protection of Environment ENVIRONMENTAL... PROCESSING POINT SOURCE CATEGORY Frozen Potato Products Subcategory § 407.40 Applicability; description of the frozen potato products subcategory. The provisions of this subpart are applicable to...

  15. 40 CFR 407.40 - Applicability; description of the frozen potato products subcategory.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... frozen potato products subcategory. 407.40 Section 407.40 Protection of Environment ENVIRONMENTAL... PROCESSING POINT SOURCE CATEGORY Frozen Potato Products Subcategory § 407.40 Applicability; description of the frozen potato products subcategory. The provisions of this subpart are applicable to...

  16. 40 CFR 407.40 - Applicability; description of the frozen potato products subcategory.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... frozen potato products subcategory. 407.40 Section 407.40 Protection of Environment ENVIRONMENTAL... PROCESSING POINT SOURCE CATEGORY Frozen Potato Products Subcategory § 407.40 Applicability; description of the frozen potato products subcategory. The provisions of this subpart are applicable to...

  17. 40 CFR 407.40 - Applicability; description of the frozen potato products subcategory.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... frozen potato products subcategory. 407.40 Section 407.40 Protection of Environment ENVIRONMENTAL... PROCESSING POINT SOURCE CATEGORY Frozen Potato Products Subcategory § 407.40 Applicability; description of the frozen potato products subcategory. The provisions of this subpart are applicable to...

  18. 40 CFR 407.40 - Applicability; description of the frozen potato products subcategory.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... frozen potato products subcategory. 407.40 Section 407.40 Protection of Environment ENVIRONMENTAL... PROCESSING POINT SOURCE CATEGORY Frozen Potato Products Subcategory § 407.40 Applicability; description of the frozen potato products subcategory. The provisions of this subpart are applicable to...

  19. Foods - fresh vs. frozen or canned

    MedlinePlus

    Frozen foods vs. fresh or canned; Fresh foods vs. frozen or canned; Frozen vegetables versus fresh ... a well-balanced diet. Many people wonder if frozen and canned vegetables are as healthy for you ...

  20. 21 CFR 102.26 - Frozen “heat and serve” dinners.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Frozen âheat and serveâ dinners. 102.26 Section... Nonstandardized Foods § 102.26 Frozen “heat and serve” dinners. (a) A frozen “heat and serve” dinner: (1) Shall... consists of all of the following: (1) The phrase “frozen ‘heat and serve’ dinner,” except that the name...

  1. Texture of Frozen Food

    NASA Astrophysics Data System (ADS)

    Wani, Kohmei

    Quantitative determination of textural quality of frozen food due to freezing and storage conditions is complicated,since the texture is consisted of multi-dimensiona1 factors. The author reviewed the importance of texture in food quality and the factors which is proposed by a priori estimation. New classification of expression words of textural properties by subjective evaluation and an application of four elements mechanical model for analysis of physical characteristics was studied on frozen meat patties. Combination of freezing-thawing condition on the subjective properties and physiochemical characteristics of beef lean meat and hamachi fish (Yellow-tail) meat was studied. Change of the plasticity and the deformability of these samples differed by freezing-thawing rate and cooking procedure. Also optimum freezing-thawing condition was differed from specimens.

  2. Curation of Frozen Samples

    NASA Technical Reports Server (NTRS)

    Fletcher, L. A.; Allen, C. C.; Bastien, R.

    2008-01-01

    NASA's Johnson Space Center (JSC) and the Astromaterials Curator are charged by NPD 7100.10D with the curation of all of NASA s extraterrestrial samples, including those from future missions. This responsibility includes the development of new sample handling and preparation techniques; therefore, the Astromaterials Curator must begin developing procedures to preserve, prepare and ship samples at sub-freezing temperatures in order to enable future sample return missions. Such missions might include the return of future frozen samples from permanently-shadowed lunar craters, the nuclei of comets, the surface of Mars, etc. We are demonstrating the ability to curate samples under cold conditions by designing, installing and testing a cold curation glovebox. This glovebox will allow us to store, document, manipulate and subdivide frozen samples while quantifying and minimizing contamination throughout the curation process.

  3. Communication in the perioperative setting.

    PubMed

    Cvetic, Elizabeth

    2011-09-01

    Poor communication in the perioperative setting contributes to an unsafe OR culture and affects patient safety and employee engagement, decision making, productivity, morale, and retention. Communication breakdowns can lead to surgical delays, patient inconvenience, and serious errors. Simplification and standardization of communication processes and the use of effective communication skills (eg, clear verbal communication, awareness of the effects of nonverbal communication, use of listening and conflict management skills) are ways to improve OR interactions and minimize or prevent errors.

  4. [Perioperative hypothermia. Impact on wound healing].

    PubMed

    Pietsch, A P; Lindenblatt, N; Klar, E

    2007-09-01

    Mild perioperative hypothermia is a common complication of anesthesia and surgery associated with several adverse effects including impaired wound healing and more frequently leads to wound infections. Perioperative hypothermia affects the hemostasis and various immune functions and therefore interferes with the initial phases of the wound healing process. Furthermore, perioperative hypothermia contributes to wound complications by inhibition of deposition of collagen and prolongation of postoperative catabolism. Wound complications prolong hospitalization and substantially increase medical costs. Thus, maintaining normothermia perioperatively is essential to reduce the number of wound complications.

  5. Frozen Carbon Dioxide

    NASA Technical Reports Server (NTRS)

    2005-01-01

    1 August 2005 This Mars Global Surveyor (MGS) Mars Orbiter Camera (MOC) image shows a south polar residual cap landscape, formed in frozen carbon dioxide. There is no place on Earth that one can go to visit a landscape covering thousands of square kilometers with frozen carbon dioxide, so mesas, pits, and other landforms of the martian south polar region are as alien as they are beautiful. The scarps of the south polar region are known from thousands of other MGS MOC images to retreat at a rate of about 3 meters (3 yards) per martian year, indiating that slowly, over the course of the MGS mission, the amount of carbon dioxide in the martian atmosphere has probably been increasing.

    Location near: 86.9oS, 25.5oW Image width: width: 3 km (1.9 mi) Illumination from: upper left Season: Southern Spring

  6. Perioperative considerations in Walker–Warburg syndrome

    PubMed Central

    Valk, Madelous JA; Loer, Stephan A; Schober, Patrick; Dettwiler, Saskia

    2015-01-01

    Key Clinical Message Walker–Warburg syndrome is a rare congenital disorder. Several features, including muscular dystrophy, hydrocephalus, and oropharyngeal abnormalities, have important implications in the perioperative setting. We present a case of general anesthesia in an infant and discuss perioperative considerations to guide clinicians faced with the management of patients with this syndrome. PMID:26401279

  7. Coagulation testing in the perioperative period.

    PubMed

    Thiruvenkatarajan, Venkatesan; Pruett, Ashlee; Adhikary, Sanjib Das

    2014-09-01

    Perioperative coagulation management is a complex task that has a significant impact on the perioperative journey of patients. Anaesthesia providers play a critical role in the decision-making on transfusion and/or haemostatic therapy in the surgical setting. Various tests are available in identifying coagulation abnormalities in the perioperative period. While the rapidly available bedside haemoglobin measurements can guide the transfusion of red blood cells, blood product administration is guided by many in vivo and in vitro tests. The introduction of newer anticoagulant medications and the implementation of the modified in vivo coagulation cascade have given a new dimension to the field of perioperative transfusion medicine. A proper understanding of the application and interpretation of the coagulation tests is vital for a good perioperative outcome.

  8. Preventing Unplanned Perioperative Hypothermia in Children.

    PubMed

    Beedle, Susan E; Phillips, Amy; Wiggins, Shirley; Struwe, Leeza

    2017-02-01

    Unplanned perioperative hypothermia is a common surgical risk. Unplanned hypothermia is defined as a body temperature below 36° C (96.8° F) during any phase of the perioperative period. Perioperative nurses at a Midwestern tertiary pediatric hospital developed an evidence-based clinical practice guideline (CPG) designed to maintain normothermia for the pediatric surgical population. This CPG outlined standard thermoregulation nursing interventions and required the consistent use of a temporal artery thermometer. A test of this CPG before full implementation established a baseline incidence of unplanned hypothermia at 16.3% (n = 80). The purpose of this study was to measure the rate of perioperative hypothermia in children after implementing the evidence-based CPG. The study results demonstrated that the CPG, guiding research-based nursing practice, consistently prevented unplanned hypothermia. The incidence rate of unplanned perioperative hypothermia after CPG implementation was 1.84% (n = 1,196).

  9. Nitrous oxide and perioperative outcomes.

    PubMed

    Ko, Hanjo; Kaye, Alan David; Urman, Richard D

    2014-06-01

    There is emerging evidence related to the effects of nitrous oxide on important perioperative patient outcomes. Proposed mechanisms include metabolic effects linked to elevated homocysteine levels and endothelial dysfunction, inhibition of deoxyribonucleic acid and protein formation, and depression of chemotactic migration by monocytes. Newer large studies point to possible risks associated with the use of nitrous oxide, although data are often equivocal and inconclusive. Cardiovascular outcomes such as stroke or myocardial infarction were shown to be unchanged in previous studies, but the more recent Evaluation of Nitrous Oxide in the Gas Mixture for Anesthesia I trial shows possible associations between nitrous oxide and increased cardiovascular and pulmonary complications. There are also possible effects on postoperative wound infections and neuropsychological function, although the multifactorial nature of these complications should be considered. Teratogenicity linked to nitrous oxide use has not been firmly established. The use of nitrous oxide for routine anesthetic care may be associated with significant costs if complications such as nausea, vomiting, and wound infections are taken into consideration. Overall, definitive data regarding the effect of nitrous oxide on major perioperative outcomes are lacking. There are ongoing prospective studies that may further elucidate its role. The use of nitrous oxide in daily practice should be individualized to each patient's medical conditions and risk factors.

  10. Epigenetics in the perioperative period

    PubMed Central

    Lirk, P; Fiegl, H; Weber, N C; Hollmann, M W

    2015-01-01

    The perioperative period is characterized by profound changes in the body's homoeostatic processes. This review seeks to address whether epigenetic mechanisms may influence an individual's reaction to surgery and anaesthesia. Evidence from animal and human studies suggests that epigenetic mechanisms can explain many facets of susceptibility to acute and chronic pain, making them potential therapeutic targets. Modern pain management is still based upon opiates, and both the developmental expression of opioid receptors and opioid-induced hyperalgesia have been linked to epigenetic mechanisms. In general, opiates seem to increase global DNA methylation levels. This is in contrast to local anaesthetics, which have been ascribed a global demethylating effect. Even though no direct investigations have been carried out, the potential influence of epigenetics on the inflammatory response that follows surgery seems a promising area for research. There is a considerable body of evidence that supports the involvement of epigenetics in the complex process of wound healing. Epigenetics is an important emerging research topic in perioperative medicine, with a huge potential to positively influence patient outcome. PMID:25073649

  11. Perioperative Acupuncture and Related Techniques

    PubMed Central

    Chernyak, Grigory V.; Sessler, Daniel I.

    2005-01-01

    Acupuncture and related techniques are increasingly practiced in conventional medical settings, and the number of patients willing to use these techniques is increasing. Despite more than 30 years of research, the exact mechanism of action and efficacy of acupuncture have not been established. Furthermore, most aspects of acupuncture have yet to be adequately tested. There thus remains considerable controversy about the role of acupuncture in clinical medicine. Acupuncture apparently does not reduce volatile anesthetic requirement by a clinically important amount. However, preoperative sedation seems to be a promising application of acupuncture in perioperative settings. Acupuncture may be effective for postoperative pain relief but requires a high level of expertise by the acupuncture practitioner. Acupuncture and related techniques can be used for treatment and prophylaxis of postoperative nausea and vomiting in routine clinical practice in combination with, or as an alternative to, conventional antiemetics when administered before induction of general anesthesia. Summary Statement: The use of acupuncture for perioperative analgesia, nausea and vomiting, sedation, anesthesia, and complications is reviewed. PMID:15851892

  12. Perioperative thermoregulation and temperature monitoring.

    PubMed

    Insler, Steven R; Sessler, Daniel I

    2006-12-01

    Traditionally, hypothermia has been thought of and used perioperatively as a presumptive strategy to reduce cerebral and myocardial tissue sensitivity to ischemia. Evidence, however, is mounting that maintenance of perioperative normothermia is associated with improved outcomes in patients undergoing all types of surgery, even cardiac surgery. Ambient environmental temperature is sensed by free nerve endings in the dermal and epidermal layers of the skin, which are the axonal extensions of thermosensitive neurons found in the dorsal root ganglia. Free nerve endings in the skin, by means of transient receptor ion channels that are specifically thermosensitive, also may directly sense environmental temperature. This information is transmitted to the preoptic/anterior hypothalamic region of the brainstem, which coordinates efferent responses to abnormal temperature deviation. People have evolved a highly integrated thermoregulatory system that maintains core body temperature in a relatively narrow temperature range. This system, though, is impaired by the stress of regional and general anesthesia, and the added exposure that occurs during the surgical procedure. When combined, these factors can lead to unwanted thermal disturbances. In a cold operating room environment, hypothermia is the usual perioperative consequence; however, hyperthermia is more dangerous and demands immediate diagnosis. Intraoperative hypothermia usually develops in three phases. The first is a rapid decrease in core temperature following anesthetic induction, which mostly results from redistribution of heat from the core thermal compartment to the outer shell of the body. This is followed by a slower, linear reduction in the core temperature that may last several hours. Finally, a core temperature plateau is reached, after which core temperature remains virtually unchanged for the remainder of the procedure. The plateau can be passive or result from re-emergence of thermoregulatory control in

  13. 40 CFR 405.70 - Applicability; description of the fluid mix for ice cream and other frozen desserts subcategory.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... mix for ice cream and other frozen desserts subcategory. 405.70 Section 405.70 Protection of... PROCESSING POINT SOURCE CATEGORY Fluid Mix for Ice Cream and Other Frozen Desserts Subcategory § 405.70 Applicability; description of the fluid mix for ice cream and other frozen desserts subcategory. The...

  14. X-ray microanalysis of frozen-hydrated specimens.

    PubMed

    Zierold, K

    1983-01-01

    The preparation of frozen-hydrated bulk specimens and sections for X-ray microanalysis starts with cryofixation, which is done either by rapid immersion into liquid propane, propane jet fixation or metal mirror fixation. Bulk specimens appropriate for the analysis in a scanning electron microscope (SEM) are obtained by cryofracturing the samples, coating, usually by a thin carbon layer, and cold transfer into the cold stage of the microscope. The X-ray microanalysis of bulk specimens is affected by an internal space charge which makes quantification difficult. Frozen-hydrated dry cut sections, varying in thickness between 60 and 2000 nm, are prepared by means of cryoultramicrotomy. After cold transfer into the cold stage of a scanning electron microscope or a scanning transmission electron microscope (STEM) the sections are analyzed in the frozen-hydrated and freeze-dried state. The reliability of the results with regard to structural recognizability and X-ray spectra depends considerably on the state of hydration. Particularly ultrathin sections in STEM show very low contrast and a great mass loss in the frozen-hydrated state in comparison with the freeze-dried state. In spite of the available concepts for quantification of X-ray data to obtain physiologically important wet weight concentrations of diffusible elements, the radiation damage at present turns out to be the most serious problem for X-ray microanalysis of frozen-hydrated sections.

  15. 21 CFR 146.121 - Frozen concentrate for artificially sweetened lemonade.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 2 2014-04-01 2014-04-01 false Frozen concentrate for artificially sweetened lemonade. 146.121 Section 146.121 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND... pursuant to section 409 of the act. (b) (c) The name of the food is “Frozen concentrate for...

  16. 21 CFR 146.121 - Frozen concentrate for artificially sweetened lemonade.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 2 2013-04-01 2013-04-01 false Frozen concentrate for artificially sweetened lemonade. 146.121 Section 146.121 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND... pursuant to section 409 of the act. (b) (c) The name of the food is “Frozen concentrate for...

  17. [Patient's Risk Factors for Perioperative Aspiration Pneumonia].

    PubMed

    Ishikawa, Teruhiko; Isono, Shiroh

    2016-01-01

    This article reviews patient's own risk factors for perioperative aspiration pneumonia. Maintaining the function of the lower esophageal sphincter (LES), the airway protective reflex, and the oral hygiene are the most important to prevent the pneumonia. The LES is adversely affected by excessive stomach distention, some medication given in perioperative periods, and habitual smoking, as well as pathological status such as esophageal hiatus hernia and achalasia. Postapoplectic patients may have insufficient airway protective reflex including swallowing and laryngeal reflex. It is emphasized that the perioperative oral care is increasing in its importance for the prevention of aspiration pneumonia.

  18. Integrating perioperative information from divergent sources.

    PubMed

    Frost, Elizabeth A M

    2012-01-01

    The enormous diversity of physician practices, including specialists, and patient requirements and comorbidities make integration of appropriate perioperative information difficult. Lack of communicating computer systems adds to the difficulty of assembling data. Meta analysis and evidence-based studies indicate that far too many tests are performed perioperatively. Guidelines for appropriate perioperative management have been formulated by several specialties. Education as to current findings and requirements should be better communicated to surgeons, consultants, and patients to improve healthcare needs and at the same time decrease costs. Means to better communication by interpersonal collaboration are outlined.

  19. Controversies in Pediatric Perioperative Airways

    PubMed Central

    Klučka, Jozef; Štourač, Petr; Štoudek, Roman; Ťoukálková, Michaela; Harazim, Hana; Kosinová, Martina

    2015-01-01

    Pediatric airway management is a challenge in routine anesthesia practice. Any airway-related complication due to improper procedure can have catastrophic consequences in pediatric patients. The authors reviewed the current relevant literature using the following data bases: Google Scholar, PubMed, Medline (OVID SP), and Dynamed, and the following keywords: Airway/s, Children, Pediatric, Difficult Airways, and Controversies. From a summary of the data, we identified several controversies: difficult airway prediction, difficult airway management, cuffed versus uncuffed endotracheal tubes for securing pediatric airways, rapid sequence induction (RSI), laryngeal mask versus endotracheal tube, and extubation timing. The data show that pediatric anesthesia practice in perioperative airway management is currently lacking the strong evidence-based medicine (EBM) data that is available for adult subpopulations. A number of procedural steps in airway management are derived only from adult populations. However, the objective is the same irrespective of patient age: proper securing of the airway and oxygenation of the patient. PMID:26759809

  20. Perioperative thermoregulation and heat balance.

    PubMed

    Sessler, Daniel I

    2016-06-25

    Core body temperature is normally tightly regulated to within a few tenths of a degree. The major thermoregulatory defences in humans are sweating, arteriovenous shunt vasoconstriction, and shivering. The core temperature triggering each response defines its activation threshold. General anaesthetics greatly impair thermoregulation, synchronously reducing the thresholds for vasoconstriction and shivering. Neuraxial anaesthesia also impairs central thermoregulatory control, and prevents vasoconstriction and shivering in blocked areas. Consequently, unwarmed anaesthetised patients become hypothermic, typically by 1-2°C. Hypothermia results initially from an internal redistribution of body heat from the core to the periphery, followed by heat loss exceeding metabolic heat production. Complications of perioperative hypothermia include coagulopathy and increased transfusion requirement, surgical site infection, delayed drug metabolism, prolonged recovery, shivering, and thermal discomfort. Body temperature can be reliably measured in the oesophagus, nasopharynx, mouth, and bladder. The standard-of-care is to monitor core temperature and to maintain normothermia during general and neuraxial anaesthesia.

  1. [Prevention of Perioperative Aspiration Pneumonitis].

    PubMed

    Fukuda, Kazuhiko

    2016-01-01

    To prevent perioperative aspiration pneumonitis, it is necessary to reduce the volume and acidity of gastric content. The guideline for preoperative fasting published by Japanese Society of Anesthesiologists recommends fasting from intake of clear fluids, breast milk and nonhuman milk at least 2h, 4h and 6h, respectively, before elective procedures requiring general anesthesia, regional anesthesia or sedation/analgesia. Gastrointestinal stimulants, histamine-2 receptor antagonists, proton pump inhibitors, antacids, antiemetics, anticholinergics are effective for reduction of the volume or acidity of gastric content. However, the routine preoperative use of these drugs to reduce the risk of pulmonary aspiration in patients who have no apparent increased risk for pulmonary aspiration is not recommended.

  2. The new frozen spin target at MAMI

    NASA Astrophysics Data System (ADS)

    Thomas, A.; Borisov, N. S.; Arends, H.-J.; Fedorov, A. N.; Gurevich, G. M.; Kondratiev, R. L.; Korolija, M.; Lazarev, A. B.; Martinez, M.; Meyer, W.; Mironov, S. V.; Neganov, A. B.; Pavlov, V. N.; Ortega, H.; Reicherz, G.; Usov, Yu. A.

    2013-11-01

    The new frozen spin polarized target for experiments at the polarized beam of the real photon facility A2 of the MAMI accelerator is described. The A2-collaboration at the Mainz Microtron MAMI is measuring photon absorption cross section using circularly and linearly polarized photons up to the energy of 1.5 GeV. The photons are produced in the' Bremsstrahlungs' process. In the years 2005/2006 the Crystal Ball detector with its unique capability to cope with multi photon final states was set up in Mainz. Since 2010 the experimental apparatus has been completed by a polarized target. The horizontal dilution refrigerator of the Frozen-Spin Target has been constructed and is operated in close cooperation with the Joint Institute for Nuclear Research in Dubna, Russia. The system offers the opportunity to provide longitudinally and transversely polarized protons and deuteron. In this paper the operation experience of this new Frozen-Spin Target and first results from the runs in 2010 and 2011 are presented.

  3. [Monitoring of blood coagulation in perioperative care].

    PubMed

    Ishii, Hisanari

    2012-01-01

    Coagulation disorders often occur perioperatively and monitoring of blood coagulation should be fast and adequate to treat these disorders to protect patients from massive bleeding. Control of hemostasis is one of the main issues in major surgeries. Coagulation test results from a central laboratory may delay making such a perioperative decision. Recently, point-of-care monitoring (POCM), which is able to examine coagulation disorder in an operation theater with short waiting time, has become important. Both prothrombin time (PT) and activated clotting time (ACT) are very useful and popular, but also criticized because they can be monitored only until fibrin formation. On the other hand, viscoelastic monitorings of whole blood, are able to estimate fibrin formation, clot fixation, platelet function and fibrinolysis. In this review article, among variable perioperative POCMs of blood coagulation, three thromboelastographic monitorings, such as TEG ROTEM, and Sonoclot as well as PT and ACT, are described along with their utilities and limits to examine perioperative coagulation.

  4. [Perioperative Pulmonary Aspiration: Preface and Comments].

    PubMed

    Asai, Takashi

    2016-01-01

    Since the risk of pulmonary aspiration was recognized in obstetric anesthesia in 1930's, numerous efforts have been made to reduce the incidence and severity of perioperative pulmonary aspiration: preoperative fasting, preoperative assessment of risk factors in perioperative pulmonary aspiration, emptying the stomach, rapid-sequence induction of anesthesia with cricoid pressure, and the use of a cuffed tracheal tube. With these efforts, the incidence of pulmonary aspiration has been reduced drastically, and aspiration is now rare. Nevertheless, recent large studies have shown that perioperative pulmonary aspiration is the main cause of anesthesia-related death or irreversible brain damage. In this special issue, experts summarize the current state of perioperative pulmonary aspiration, its diagnosis and treatment, risk factors of pulmonary aspiration, preoperative preventative methods, and appropriate anesthesia methods and airway management in patients at increased risk of pulmonary aspiration.

  5. [Significance of Multi-center Obstetrics Perioperative Team Training Including Various Medical Staffs].

    PubMed

    Komasawa, Nobuyasu; Fujita, Daisuke; Nakayama, Mai; Fujiwara, Shunsuke; Mihara, Ryosuke; Okada, Daisuke; Omoto, Haruka; Tanaka, Motoshige; Nishihara, Isao; Minami, Toshiaki

    2016-02-01

    We report the development of a multi-center/multispecialist obstetrics perioperative team training program. Participants were members of the team, including anesthesiologists, obstetricians, and operation nurses. A questionnaire survey was conducted prior to course participation to clarify any questions team members had. The courses included a lecture and simulation training with scenario-based discussions or the use of a simulator. Scenarios included massive bleeding during cesarean section, massive bleeding after vaginal delivery, and emergency cesarean section for premature placental abruption. After each course, participants discussed problems associated with obstetrics medical safety in the context of each theme. Simulation-based perioperative team training with anesthesiologists, obstetricians, and operation nurses may serve as a vehicle to promote perioperative obstetrics patient safety.

  6. Perioperative Acid-Base and Electrolyte Disturbances.

    PubMed

    Beer, Kari Santoro; Waddell, Lori S

    2015-09-01

    Obtaining and interpreting blood gas and electrolyte levels is essential in the management of perioperative veterinary patients. Metabolic and electrolyte alterations are common in critically ill surgical patients, and can lead to alterations in cardiovascular function, neurologic status, respiratory function, and even response to various drug therapies. Several common perioperative conditions are discussed in this article, including metabolic disturbances, electrolyte abnormalities (hyponatremia and hypernatremia, hyperkalemia), and respiratory abnormalities.

  7. Perioperative assistants are a new resource.

    PubMed

    Speers, A T; Ziolkowski, L

    1998-02-01

    In the current health care environment, buzzwords such as redesign, reengineering, restructuring, right-sizing, customer service, diversity, quality, multiskilled workers, and unlicensed assistive personnel conjure up many notions about how perioperative nurses can meet the needs and wants of their patients. Unlicensed assistive personnel are becoming commonplace in our hospitals and have assumed a variety of positions and functions. This article describes a project that one hospital undertook to create unlicensed, multiskilled workers in the perioperative area.

  8. The perioperative dialogue: holistic nursing in practice.

    PubMed

    Rudolfsson, Gudrun; von Post, Iréne; Eriksson, Katie

    2007-01-01

    This article is a synthesis of 2 qualitative studies focusing on patients', anesthetists', and operating-room nurses' experiences of the perioperative dialogue and employing grounded theory as the method of analysis. The aim of the synthesis was to achieve a new holistic understanding of health in the perioperative dialogue. The synthesis highlights the importance of being in communion in a continuous whole due to continuity of care for the creation of health in both patients and nurses.

  9. 21 CFR 102.26 - Frozen “heat and serve” dinners.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 2 2014-04-01 2014-04-01 false Frozen âheat and serveâ dinners. 102.26 Section 102.26 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... Nonstandardized Foods § 102.26 Frozen “heat and serve” dinners. (a) A frozen “heat and serve” dinner: (1)...

  10. Tuberous Sclerosis Complex: Perioperative Considerations

    PubMed Central

    Rabito, Matthew J.; Kaye, Alan David

    2014-01-01

    Background Tuberous sclerosis complex (TSC), also known as Bourneville disease, is an inherited, progressive neurocutaneous disorder characterized by the potential for hamartoma formation throughout the body. TSC is an autosomal dominant genetic disorder, but more than two-thirds of cases are sporadic. Methods Clinical manifestations and treatment options are discussed. Both surgical and anesthetic perioperative considerations are described in this review. Results Routine monitoring is appropriate for minor surgical procedures for patients with TSC who have mild disease manifestations. More extensive monitoring is indicated for major procedures that have the potential for significant blood loss and for patients with more severe pathology. Postoperatively, TSC patients should be admitted for monitoring and treatment after more extensive procedures or if significant organ dysfunction occurs. Postoperative complications, which may be related to either the surgery or the TSC pathology itself, may have origins in many different organs and may include seizures, severe hypertension, and bradyarrhythmias. Conclusion TSC is a rare disease with a highly variable clinical presentation and provides a multitude of challenges for the patient, the family, and the healthcare team. PMID:24940133

  11. Assessment of an updated double-vasopressor automated system using Nexfin for the maintenance of haemodynamic stability to improve peri-operative outcome during spinal anaesthesia for caesarean section.

    PubMed

    Sng, B L; Wang, H; Assam, P N; Sia, A T

    2015-06-01

    Hypotension occurs commonly during spinal anaesthesia for caesarean section, associated with maternal and fetal adverse effects. We developed a double-vasopressor automated system with a two-step algorithm and continuous non-invasive haemodynamic monitoring using the Nexfin device. The system delivered 25 μg phenylephrine every 30 s when systolic blood pressure was between 90% and 100% of baseline, or 2 mg ephedrine at this blood pressure range and heart rate < 60 beats.min(-1) ; and 50 μg phenylephrine or 4 mg ephedrine when systolic blood pressure was < 90% of baseline with the same heart rate criterion. Fifty-seven women received standardised spinal anaesthesia. Twenty-seven (47.4%) had at least one reading of hypotension defined as systolic blood pressure < 80% baseline. Systolic blood pressure was within 20% of the baseline in a mean (SD) of 79.8 (20.9)% of measurements. Fifty-three (93.0%) women required phenylephrine before delivery while 10 (17.5%) required ephedrine. Six women (10.5%) experienced nausea and three (5.3%) vomited. The system was able to achieve a low incidence of maternal hypotension with good maternal and fetal outcomes.

  12. 49 CFR 173.229 - Chloric acid solution or chlorine dioxide hydrate, frozen.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 2 2013-10-01 2013-10-01 false Chloric acid solution or chlorine dioxide hydrate, frozen. 173.229 Section 173.229 Transportation Other Regulations Relating to Transportation PIPELINE AND... Than Class 1 and Class 7 § 173.229 Chloric acid solution or chlorine dioxide hydrate, frozen. When...

  13. 49 CFR 173.229 - Chloric acid solution or chlorine dioxide hydrate, frozen.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 2 2011-10-01 2011-10-01 false Chloric acid solution or chlorine dioxide hydrate, frozen. 173.229 Section 173.229 Transportation Other Regulations Relating to Transportation PIPELINE AND... Than Class 1 and Class 7 § 173.229 Chloric acid solution or chlorine dioxide hydrate, frozen. When...

  14. 49 CFR 173.229 - Chloric acid solution or chlorine dioxide hydrate, frozen.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 2 2012-10-01 2012-10-01 false Chloric acid solution or chlorine dioxide hydrate, frozen. 173.229 Section 173.229 Transportation Other Regulations Relating to Transportation PIPELINE AND... Than Class 1 and Class 7 § 173.229 Chloric acid solution or chlorine dioxide hydrate, frozen. When...

  15. 49 CFR 173.229 - Chloric acid solution or chlorine dioxide hydrate, frozen.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 2 2014-10-01 2014-10-01 false Chloric acid solution or chlorine dioxide hydrate, frozen. 173.229 Section 173.229 Transportation Other Regulations Relating to Transportation PIPELINE AND... Than Class 1 and Class 7 § 173.229 Chloric acid solution or chlorine dioxide hydrate, frozen. When...

  16. 49 CFR 173.229 - Chloric acid solution or chlorine dioxide hydrate, frozen.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 2 2010-10-01 2010-10-01 false Chloric acid solution or chlorine dioxide hydrate, frozen. 173.229 Section 173.229 Transportation Other Regulations Relating to Transportation PIPELINE AND... Than Class 1 and Class 7 § 173.229 Chloric acid solution or chlorine dioxide hydrate, frozen. When...

  17. 7 CFR 52.812 - Score sheet for frozen red tart pitted cherries.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 2 2011-01-01 2011-01-01 false Score sheet for frozen red tart pitted cherries. 52.812 Section 52.812 Agriculture Regulations of the Department of Agriculture AGRICULTURAL MARKETING... Pitted Cherries Score Sheet § 52.812 Score sheet for frozen red tart pitted cherries. Size and kind...

  18. 7 CFR 52.812 - Score sheet for frozen red tart pitted cherries.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 2 2012-01-01 2012-01-01 false Score sheet for frozen red tart pitted cherries. 52.812 Section 52.812 Agriculture Regulations of the Department of Agriculture AGRICULTURAL MARKETING... Pitted Cherries Score Sheet § 52.812 Score sheet for frozen red tart pitted cherries. Size and kind...

  19. Perioperative death: Its implications and management

    PubMed Central

    Attri, JP; Makhni, R; Chatrath, V; Bala, N; Kumar, R; Jain, P

    2016-01-01

    Death to most people is a major life event. Nothing in this world prepares us to face and manage the perioperative death although the majority of anesthesiologists will be involved in an intraoperative death during the course of their careers. Whether death on the table was expected or occurred when least expected or may be even later, the anesthesiologist is most likely to be affected emotionally, physically in his personal life, and as well as will have an influence on his professional career. Anesthesiologists as perioperative physicians are likely to experience death on the operating table at some time in their careers. In case of perioperative death, meticulous record keeping including time of occurrence of event and methods and medications used during resuscitation, nature of the problem, and all sequence of events should be adopted to breaking bad news with relatives and blame game should be avoided. The anesthesiologist and the relatives of the patient should also be given emotional support to come out of this untoward event. In this article, we have highlighted the various factors and causes leading on to perioperative death and if in case such an event occurs, what are the protocols to be followed, including medicolegal aspects, giving emotional support to the concerned anesthesiologist, dealing with the relatives of the patient sympathetically, etc. We have also enumerated the various precautions to be taken to prevent perioperative mortality in this article. PMID:27833489

  20. Microheterogeneity in Frozen Protein Solutions

    PubMed Central

    Twomey, Alan; Kurata, Kosaku; Nagare, Yutaka; Takamatsu, Hiroshi; Aksan, Alptekin

    2015-01-01

    In frozen and lyophilized systems, the biological to be stabilized (e.g. therapeutic protein, biomarker, drug-delivery vesicle) and the cryo-/lyoprotectant should be co-localized for successful stabilization. During freezing and drying, many factors cause physical separation of the biological from the cryo-/lyoprotectant, called microheterogeneity (MH), which may result in poor stabilization efficiency. We have developed a novel technique that utilized confocal Raman microspectroscopy in combination with counter-gradient freezing to evaluate the effect of a wide range of freezing temperatures (−20 < TF < 0°C) on the MH generated within a frozen formulation in only a few experiments. The freezing experiments conducted with a model system (albumin and trehalose) showed the presence of different degrees of MH in the freeze-concentrated liquid (FCL) in all solutions tested. Mainly, albumin tended to accumulate near the ice interface, where it was physically separated from the cryoprotectant. In frozen 10 wt% trehalose solutions, heterogeneity in FCL was relatively low at any TF. In frozen 20 wt% trehalose solutions, the optimum albumin to trehalose ratio in the FCL can only be ensured if the solution was frozen within a narrow range of temperatures (−16 < TF < −10°C). In the 30 wt% trehalose solutions, freezing within a much more narrow range (−12 < TF < −10°C) was needed to ensure a fairly homogeneous FCL. The method developed here will be helpful for the development of uniformly frozen and stable formulations and freezing protocols for biological as MH is presumed to directly impact stability. PMID:25888798

  1. Microheterogeneity in frozen protein solutions.

    PubMed

    Twomey, Alan; Kurata, Kosaku; Nagare, Yutaka; Takamatsu, Hiroshi; Aksan, Alptekin

    2015-06-20

    In frozen and lyophilized systems, the biological to be stabilized (e.g. therapeutic protein, biomarker, drug-delivery vesicle) and the cryo-/lyo-protectant should be co-localized for successful stabilization. During freezing and drying, many factors cause physical separation of the biological from the cryo-/lyo-protectant, called microheterogeneity (MH), which may result in poor stabilization efficiency. We have developed a novel technique that utilized confocal Raman microspectroscopy in combination with counter-gradient freezing to evaluate the effect of a wide range of freezing temperatures (-20frozen formulation in only a few experiments. The freezing experiments conducted with a model system (albumin and trehalose) showed the presence of different degrees of MH in the freeze-concentrated liquid (FCL) in all solutions tested. Mainly, albumin tended to accumulate near the ice interface, where it was physically separated from the cryoprotectant. In frozen 10wt% trehalose solutions, heterogeneity in FCL was relatively low at any TF. In frozen 20wt% trehalose solutions, the optimum albumin to trehalose ratio in the FCL can only be ensured if the solution was frozen within a narrow range of temperatures (-16frozen and stable formulations and freezing protocols for biological as MH is presumed to directly impact stability.

  2. Preparation of biological material for X-ray microanalysis of diffusible elements. I. Rapid freezing of biological tissue in nitrogen slush and preparation of ultrathin frozen sections in the absence of trough liquid.

    PubMed

    Sevéus, L

    1978-04-01

    Any method used for the analysis of diffusible elements within a cell should involve conditions which eliminate the redistribution of those elements. Redistribution of diffusible substances is caused by (a) ice damage during freezing, (b) thawing during sectioning, and (c) thawing during handling of sections. To eliminate this sections were cut (a) in the 5-8 micrometer ice crystal free surface layer obtained by freezing in melting nitrogen, (b) at a specimen temperature of 133 K and a knife temperature of 173 K to 153 K, and the temperature of the chamber was kept low by evaporating nitrogen from an extra reservoir inside the chamber, by regulating the output of a foil heater. A grid carrier was designed to simplify the section collection and the sections were affixed on to the grid in a press assembly. The sections were hard and translucent, and showed faint interference colours.

  3. Current perioperative management of pheochromocytomas

    PubMed Central

    Ramachandran, Rashmi; Rewari, Vimi

    2017-01-01

    Neuroendocrine tumors which have the potential to secrete catecholamines are either associated with sympathetic adrenal (pheochromocytoma) or nonadrenal (paraganglioma) tissue. Surgical removal of these tumors is always indicated to cure and prevent cardiovascular and other organ system complications associated with catecholamine excess. Some of these tumors have malignant potential as well. The diagnosis, localization and anatomical delineation of these tumors involve measurement of catecholamines and their metabolic end products in plasma and urine, 123I-metaiodobenzylguanidine scintigraphy, computed tomography, and/or magnetic resonance imaging. Before surgical removal of the tumors, the optimization of blood pressure, as well as intravascular volume, is an important measure to avoid and suppress perioperative adverse hemodynamic events. Preoperative preparation includes the use of alpha-adrenergic antagonists, beta-adrenergic antagonists with or without other antihypertensive agents, fluid therapy as well as insulin therapy for hyperglycemia if required. Due attention should be given to type and dose of alpha-receptor antagonists to be used and the duration of this therapy to achieve an optimal level of preoperative “alpha-blockade.” Despite this preoperative preparation, many patients will have hypertensive crises intraoperatively which need to be promptly and carefully managed by the anesthesia team which requires intensive and advanced monitoring techniques. The most common complication after tumor removal is hypotension which may require fluid therapy and vasopressor support for a few hours. With advancement in surgical and anesthetic techniques, the incidence of severe morbidity and mortality associated with the surgery is low in high volume centers. PMID:28197025

  4. 21 CFR 146.126 - Frozen concentrate for colored lemonade.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... concentrate for pink lemonade”. (c) Label declaration. Each of the ingredients used in the food shall be... 21 Food and Drugs 2 2012-04-01 2012-04-01 false Frozen concentrate for colored lemonade. 146.126 Section 146.126 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN...

  5. 21 CFR 146.126 - Frozen concentrate for colored lemonade.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... concentrate for pink lemonade”. (c) Label declaration. Each of the ingredients used in the food shall be... 21 Food and Drugs 2 2011-04-01 2011-04-01 false Frozen concentrate for colored lemonade. 146.126 Section 146.126 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN...

  6. Thermal care in the perioperative period.

    PubMed

    Kurz, Andrea

    2008-03-01

    Perioperative hypothermia is a common and serious complication of anesthesia and surgery. Core body temperature, which is normally regulated to within a few tenths of a degree centigrade, can fall by as much as 6 degrees C during anesthesia. The combination of anesthetic-induced impairment of thermoregulatory control and exposure to a cool operating room environment causes most surgical patients to become hypothermic. Mild intraoperative hypothermia triples the incidence of postoperative wound infections, triples the incidence of postoperative myocardial events and increases perioperative blood loss. Furthermore, it prolongs postoperative recovery and prolongs the duration of action of almost all anesthestic drugs. Effective methods are available for preventing inadvertent perioperative hypothermia. Consequently, it is now routine to maintain intraoperative normothermia. There is no widely accepted definition for the term 'mild hypothermia'. Furthermore, the term is not used consistently within the literature. For the purpose of this review, mild hypothermia refers to core temperatures between 34 and 36 degrees C.

  7. Reducing the risk of unplanned perioperative hypothermia.

    PubMed

    Lynch, Susan; Dixon, Jacqueline; Leary, Donna

    2010-11-01

    Maintaining normothermia is important for patient safety, positive surgical outcomes, and increased patient satisfaction. Causes of unplanned hypothermia in the OR include cold room temperatures, the effects of anesthesia, cold IV and irrigation fluids, skin and wound exposure, and patient risk factors. Nurses at Riddle Memorial Hospital in Media, Pennsylvania, performed a quality improvement project to evaluate the effectiveness of using warm blankets, warm irrigation fluids, or forced-air warming on perioperative patients to maintain their core temperature during the perioperative experience. Results of the project showed that 75% of patients who received forced-air warming perioperatively had temperatures that reached or were maintained at 36° C (96.8° F) or higher within 15 minutes after leaving the OR.

  8. Perioperative morbidity of intracavitary gynecologic brachytherapy

    SciTech Connect

    Lanciano, R.; Corn, B.; Martin, E.; Schulthesis, T.; Hogan, W.M.; Rosenblum, N.

    1994-07-30

    The purpose was to define the incidence and severity of perioperative morbidity and its subsequent management with standard tandem and ovoid insertions to evaluate pretreatment and treatment factors associated with an increased risk of perioperative morbidity. Intraoperative complications were seen in 3% of implants and included two perforations and a vaginal laceration in two patients. Twenty-four percent of implants (16 patients) developed temperatures of > 100.5 (range 100.6 to 103), although only one patient required implant removal because of fever. Management of fever included antibiotics in 35% and acetaminophen only in 65%. Five implants were removed emergently secondary to presumed sepsis, exacerbation of chronic obstructive pulmonary disease, hypotension, change in mental status, and myocardial infarction/congestive heart failure. No patient developed a deep-vein thrombosis, pulmonary embolism, gastrointestinal obstruction, or died of a postoperative complication. Univariate analysis of pretreatment and treatment factors revealed older age and spinal/epidural anesthesia to be associated with increased perioperative morbidity, and older age and higher ASA classification to be associated with severe complications requiring removal of implant. Multivariate analysis revealed only older age to be significantly related to perioperative morbidity. Fever of > 100.5 was seen in 24% of implants and can be managed successfully without removal of the implant in 96% of cases. Use of antibiotics preoperatively and intraoperatively did not reduce the risk of perioperative temperature elevation. Use of routine diphenoxylate hydrochloride prophylaxis was tolerated without ileus or gastrointestinal obstruction clinically. Although routine deep-vein thrombosis prophylaxis is reasonable, the data would support a low risk of deep-vein thrombosis for untreated patients. Severe perioperative morbidity necessitated premature implant removal in only 5% of cases. 24 refs., 2 tabs.

  9. Perioperative pain management for total knee arthroplasty.

    PubMed

    Baratta, Jaime L; Gandhi, Kishor; Viscusi, Eugene R

    2014-01-01

    Pain management following total knee arthroplasty (TKA) can be challenging. Inadequate pain management following TKA may inhibit rehabilitation, increase morbidity and mortality, decrease patient satisfaction, and lead to chronic persistent postsurgical pain. Traditionally the mainstay of postoperative pain management was opioids; however, the current recommendations to pain management emphasize a multimodal approach and minimizing opioids whenever possible. With careful planning and a multimodal analgesic approach instituted perioperatively, appropriate pain management following TKA can be achieved. Utilizing an extensive review of the literature, this article discusses the analgesic techniques available for the perioperative management of TKA.

  10. Service Dogs in the Perioperative Setting.

    PubMed

    Levey, Janet A; Chappy, Sharon L

    2017-04-01

    Service dogs are critical for the independence of individuals with disabilities because they assist with daily living activities and help these individuals navigate society. Perioperative nurses need a working knowledge of disability laws pertaining to service dogs to provide patient-centered care for individuals using service dogs. This article provides information on the Americans With Disabilities Act regulations regarding service dogs, makes recommendations for the care of patients with service dogs across the perioperative continuum, and offers policy directives to ensure that safe, high-quality care is delivered to patients using service dogs.

  11. Resolving disputes over frozen embryos.

    PubMed

    Robertson, J A

    1989-01-01

    The relation between respect for family and reproductive choice and use of IVF technology is in dispute in recent legal cases on the disposition of frozen embryos. Couples in IVF programs should be encouraged to stipulate in advance binding instructions regarding the disposition of such embryos.

  12. Frozen Scope and Grammatical Optimization

    ERIC Educational Resources Information Center

    Freedman, Michael

    2014-01-01

    The literature on quantifier scope has repeatedly observed that some otherwise expected permutations of scope taking elements are unavailable. Various methods have been proffered explaining these facts. This thesis aims to unify three disparate areas where the scope of operators seems to be frozen: the interaction of universal quantifiers with…

  13. 7 CFR 58.327 - Frozen cream.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... Specifications for Dairy Plants Approved for USDA Inspection and Grading Service 1 Quality Specifications for Raw Material § 58.327 Frozen cream. To produce frozen cream eligible for official certification, the quality...

  14. 7 CFR 58.327 - Frozen cream.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... Specifications for Dairy Plants Approved for USDA Inspection and Grading Service 1 Quality Specifications for Raw Material § 58.327 Frozen cream. To produce frozen cream eligible for official certification, the quality...

  15. 7 CFR 58.327 - Frozen cream.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... Specifications for Dairy Plants Approved for USDA Inspection and Grading Service 1 Quality Specifications for Raw Material § 58.327 Frozen cream. To produce frozen cream eligible for official certification, the quality...

  16. 7 CFR 58.327 - Frozen cream.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... Specifications for Dairy Plants Approved for USDA Inspection and Grading Service 1 Quality Specifications for Raw Material § 58.327 Frozen cream. To produce frozen cream eligible for official certification, the quality...

  17. The Eccentric Behavior of Nearly Frozen Orbits

    NASA Technical Reports Server (NTRS)

    Sweetser, Theodore H.; Vincent, Mark A.

    2013-01-01

    Frozen orbits are orbits which have only short-period changes in their mean eccentricity and argument of periapse, so that they basically keep a fixed orientation within their plane of motion. Nearly frozen orbits are those whose eccentricity and argument of periapse have values close to those of a frozen orbit. We call them "nearly" frozen because their eccentricity vector (a vector whose polar coordinates are eccentricity and argument of periapse) will stay within a bounded distance from the frozen orbit eccentricity vector, circulating around it over time. For highly inclined orbits around the Earth, this distance is effectively constant over time. Furthermore, frozen orbit eccentricity values are low enough that these orbits are essentially eccentric (i.e., off center) circles, so that nearly frozen orbits around Earth are bounded above and below by frozen orbits.

  18. [Perioperative psychobehavioural changes in children].

    PubMed

    Cohen-Salmon, D

    2010-04-01

    during induction has been shown to effectively reduce preoperative anxiety in children in certain contexts (when the parent is calm and the child is anxious). It is worthwhile if it is integrated into a family-centered anxiety management program and remains one of several options offered to families. Overall, taking into account the child's psychological needs should be considered an essential part of paediatric anaesthesia. Tools and techniques are available for assessing and managing the perioperative distress experienced by children.

  19. Focused transthoracic echocardiography in the perioperative period.

    PubMed

    Cowie, B S

    2010-09-01

    Ultrasound applications in perioperative medicine have expanded enormously over the past decade. Transoesophageal echocardiography has been performed by anaesthetists during cardiac surgery for over 20 years. With the increasing availability of portable ultrasound systems, the use of ultrasound to assist in vascular cannulation and regional anaesthesia has been well described. Portable ultrasound systems come with a range of probes for different applications, including transthoracic echocardiography. While transthoracic echocardiography has traditionally been the domain of cardiologists, its use has been increasing in critical care, the emergency room and, recently, by anaesthetists in the perioperative period. Unlike formal cardiology-based transthoracic echocardiography, focused, goal-directed transthoracic echocardiography is often more appropriate in the perioperative period to address a particular question and can be performed in just a few minutes. Transthoracic echocardiography allows rapid, noninvasive, point-of-care assessment of ventricular function, valvular integrity volume status and fluid responsiveness. It can help distinguish undifferentiated systolic murmurs preoperatively, give valuable information on the aetiology of unexplained hypotension and cardiovascular collapse and assess response to therapeutic interventions such as vasoactive drugs and volume resuscitation. Focused transthoracic echocardiography should include qualitative assessment of left and right ventricular function, an estimate of aortic valve gradient, right ventricular systolic pressure and intravascular volume status as minimum requirements. Transthoracic echocardiography is a valuable tool in the perioperative period and ideally the equipment and expertise should be available in all operating rooms.

  20. The perioperative surgical home: An innovative, patient-centred and cost-effective perioperative care model.

    PubMed

    Desebbe, Olivier; Lanz, Thomas; Kain, Zeev; Cannesson, Maxime

    2016-02-01

    Contrary to the intraoperative period, the current perioperative environment is known to be fragmented and expensive. One of the potential solutions to this problem is the newly proposed perioperative surgical home (PSH) model of care. The PSH is a patient-centred micro healthcare system, which begins at the time the decision for surgery is made, is continuous through the perioperative period and concludes 30 days after discharge from the hospital. The model is based on multidisciplinary involvement: coordination of care, consistent application of best evidence/best practice protocols, full transparency with continuous monitoring and reporting of safety, quality, and cost data to optimize and decrease variation in care practices. To reduce said variation in care, the entire continuum of the perioperative process must evolve into a unique care environment handled by one perioperative team and coordinated by a leader. Anaesthesiologists are ideally positioned to lead this new model and thus significantly contribute to the highest standards in transitional medicine. The unique characteristics that place Anaesthesiologists in this framework include their systematic role in hospitals (as coordinators between patients/medical staff and institutions), the culture of safety and health care metrics innate to the specialty, and a significant role in the preoperative evaluation and counselling process, making them ideal leaders in perioperative medicine.

  1. The JLab Frozen Spin Target

    SciTech Connect

    Keith, C. D.

    2009-08-04

    A polarized, frozen spin target has been designed and constructed at Jefferson Lab for use inside the CEBAF Large Acceptance Spectrometer. Protons in TEMPO-doped butanol are polarized via dynamic nuclear polarization (DNP) to approximately 90% using microwaves and an external, 5 T solenoid magnet. The target sample is then cooled to approximately 30 mK while an internal 0.56 T superconducting magnet is used to maintain the polarization. Relaxation times in excess of 3500 hours have been observed.

  2. Thawing of Frozen Tuna Meat

    NASA Astrophysics Data System (ADS)

    Tanaka, Takeo; Nishiwaki, Kôji; Kakuda, Kitonari; Tomimatsu, Takao

    Frozen southern bluefin tuna meat discolors easily and sometimes contracts when thawed caused by thaw rigor. These phenomenon often become problematic in the transaction or handling of this kind of frozen tuna. Frozen meat blocks of southern Bluefin tuna were thawed separately by air thawing, running water thawing and microwave thawing. Changes occurring during thawing were checked for meat color by met-myoglobin ratio determination and for contract by microscopic observation. Results are as follows : (1) Discoloration scarcely occurred in the process of running water thawing (at 10°C for 50 min, or at 0°C for 6 hr). (2) No contraction was observed during thawing with running water described above and air thawing (at 18-20°C for 6 hr). (3) Discoloration and contraction seemed to be minimized, as to latently contractile blocks, when meat temperature passed through rapidly between -10°C and -5°C, and slowly (for 5-6 hr) between -5°C and -1°C. When the block was originally not contractile, discloration was minimized by rising meat temperature rapidly from -10°C to -l°C.

  3. Pediatric orthotopic heart transplant requiring perioperative exchange transfusion: a case report.

    PubMed

    McNeer, Brian; Dickason, Brent; Niles, Scott; Ploessl, Jay

    2004-12-01

    An 11-month-old patient with idiopathic cardiomyopathy was scheduled for orthotopic heart transplantation. A perioperative exchange transfusion was performed because of elevated panel reactive antibody levels. This process was accomplished in the operating room prior to instituting cardiopulmonary bypass using a modified cardiopulmonary bypass circuit. In preparation for the procedure, the cardiopulmonary bypass circuit was primed with washed leukocyte-filtered banked packed red blood cells, fresh-frozen plasma, albumin, and heparin. Pump prime laboratory values were normalized prior to beginning the exchange transfusion. The patient's blood was downloaded from the venous line just proximal to the venous reservoir while simultaneously transfusing the normalized prime at normothermia. Approximately 125% of the patients calculated blood volume was exchanged. This technique greatly reduces the likelihood of hyperacute rejection. The exchange transfusion process, in addition to the patient immature immune system, provides additional options in orthotopic heart transplantation for patients that may otherwise not be considered suitable candidates.

  4. The perioperative implications of posttraumatic stress disorder.

    PubMed

    Wofford, Ken; Hertzberg, Michael; Vacchiano, Charles

    2012-12-01

    Posttraumatic stress disorder (PTSD) is an anxiety disorder that develops after exposure to a traumatic event and is characterized by symptoms of reexperiencing, emotional numbing, persistent arousal, and avoidance. Approximately 6.8% of the people in the United States will be diagnosed with PTSD at some point in their lives. The presence of PTSD in a surgical patient can be important because PTSD is associated with the use of psychoactive medications, risky health behaviors, cardiovascular comorbidities, depression, chronic pain, and cognitive dysfunction, all of which may influence the risk of perioperative morbidity and mortality. In addition, patients with PTSD are anxious around unfamiliar people and in unfamiliar environments. The purposes of this journal course are to provide anesthetists with a working knowledge of the symptoms, treatments, and comorbidities associated with PTSD and to suggest ways of interacting with patients with the disorder that increase trust and decrease the risk of evoking posttraumatic symptoms in the perioperative environment.

  5. Optimizing perioperative care in bariatric surgery patients.

    PubMed

    Lemanu, Daniel P; Srinivasa, Sanket; Singh, Primal P; Johannsen, Sharon; MacCormick, Andrew D; Hill, Andrew G

    2012-06-01

    Enhanced recovery after surgery (ERAS) programs have been shown to minimise morbidity in other types of surgery, but comparatively less data exist investigating ERAS in bariatric surgery. This article reviews the existing literature to identify interventions which may be included in an ERAS program for bariatric surgery. A narrative literature review was conducted. Search terms included 'bariatric surgery', 'weight loss surgery', 'gastric bypass', 'ERAS', 'enhanced recovery', 'enhanced recovery after surgery', 'fast-track surgery', 'perioperative care', 'postoperative care', 'intraoperative care' and 'preoperative care'. Interventions recovered by the database search, as well as interventions garnered from clinical experience in ERAS, were used as individual search terms. A large volume of evidence exists detailing the role of multiple interventions in perioperative care. However, efficacy and safety for a proportion of these interventions for ERAS in bariatric surgery remain unclear. This review concludes that there is potential to implement ERAS programs in bariatric surgery.

  6. [Interdisciplinary position paper "Perioperative pain management"].

    PubMed

    Likar, R; Jaksch, W; Aigmüller, T; Brunner, M; Cohnert, T; Dieber, J; Eisner, W; Geyrhofer, S; Grögl, G; Herbst, F; Hetterle, R; Javorsky, F; Kress, H G; Kwasny, O; Madersbacher, S; Mächler, H; Mittermair, R; Osterbrink, J; Stöckl, B; Sulzbacher, M; Taxer, B; Todoroff, B; Tuchmann, A; Wicker, A; Sandner-Kiesling, A

    2017-04-13

    Despite many positive developments, postoperative pain and its treatment is still not always given the necessary attention. Severe pain after surgical procedures affects a significant proportion of patients. This very fact is not only detrimental to the immediate recovery process, but can also form the basis for the development of chronic pain conditions.An adequate and effective management of perioperative pain requires appropriate organizational structures. This multidisciplinary paper which was initiated by the Austrian Society for Anaesthesiology and Intensive Care and the Austrian Pain Society and developed together with numerous specialist and professional societies dealing with the subject aims at supporting the organization of perioperative pain management structures and to make best use of proven concepts. Additional recommendations describe specific interventions for selected types of intervention.

  7. Reduction and management of perioperative anxiety.

    PubMed

    Stirling, Laura

    Patient anxiety is a normal part of the surgical patient's 'career' and would be anticipated by nurses in a variety of settings. Anxiety causes a number of undesirable effects which may place the patient at greater perioperative risk. Factors that mitigate against the nurse being able to devote adequate time to this important aspect of patient care will not disappear overnight and arguably, without quality psychological care, patients are being placed at greater risk. This article considers the issue of perioperative anxiety with the aim to revise the concept and highlight the serious implications of giving it a lesser priority within patient care. Alternative strategies should be sought that might also help patients take back some control over their own challenging situations. Practitioners must acknowledge that there is a need to investigate their current practice and that they have a responsibility to address patient anxiety effectively.

  8. Perception of intimidation in a perioperative setting.

    PubMed

    Dull, David L; Fox, Linda

    2010-01-01

    Intimidation in health care settings can negatively affect patient safety. Following an adverse event in 2006 at Spectrum Health, a 7-hospital health care system in Grand Rapids, Michigan, leadership of the Grand Rapids perioperative services department led an initiative to evaluate and reduce the incidence of intimidation in the department. Physicians were surveyed to ascertain their beliefs about behaviors that constitute intimidation and to correlate those findings with definitions of intimidation identified by several national professional organizations. Our findings suggest that a majority of physicians in perioperative services agree that behaviors identified as intimidating by national organizations actually constitute intimidation in only 4 of 9 instances and that, for even the most egregious behaviors, there is lack of complete agreement that the behavior constitutes intimidation.These findings suggest reasons why traditional means of addressing intimidating behavior may not be effective and also suggest alternative means of handling behaviors that disrupt the care environment.

  9. Testing Proposed National Guidelines for Perioperative Normothermia

    DTIC Science & Technology

    2000-10-01

    Theoretical Framework Hypothermia is a serious concern in the perioperative period. Sister Callista Roy s Adaptation Model ( Roy , 1984) is useful for explaining...every step of the way. viii LIST OF FIGURES Figure 1. Graphic Depiction of Roy s Adaptation Model........4 Figure 2. Graphic Depiction of Roy s...presented. Roy s Adaptation Model (1984) is explained, and variables of interest are defined conceptually, and operationally. Finally, assumptions and

  10. Testing Proposed National Guidelines for Perioperative Normothermia

    DTIC Science & Technology

    2000-12-06

    identify? Theoretical Framework Hypothermia is a serious concern in the perioperative period. Sister Callista Roy’s Adaptation Model ( Roy , 1984) is...useful for explaining hypothermia in patients undergoing surgery. Roy views adaptation in a systems framework that includes input, process, and...two types of control processes patients can utilize for coping: the regulator and the cognator ( Roy , 1984) . Patients primarily use the cognator to

  11. Perioperative complications in infant cleft repair

    PubMed Central

    Fillies, Thomas; Homann, Christoph; Meyer, Ulrich; Reich, Alexander; Joos, Ulrich; Werkmeister, Richard

    2007-01-01

    Background Cleft surgery in infants includes special risks due to the kind of the malformation. These risks can be attributed in part to the age and the weight of the patient. Whereas a lot of studies investigated the long-term facial outcome of cleft surgery depending on the age at operation, less is known about the complications arising during a cleft surgery in early infancy. Methods We investigated the incidence and severity of perioperative complications in 174 infants undergoing primary cleft surgery. The severity and the complications were recorded during the intraoperative and the early postoperative period according to the classification by Cohen. Results Our study revealed that minor complications occurred in 50 patients. Severe complications were observed during 13 operations. There was no fatal complication in the perioperative period. The risk of complications was found to be directly correlated to the body weight at the time of the surgery. Most of the problems appeared intraoperatively, but they were also followed by complications immediately after the extubation. Conclusion In conclusion, cleft surgery in infancy is accompanied by frequent and sometimes severe perioperative complications that may be attributed to this special surgical field. PMID:17280602

  12. Perioperative care in elderly cardiac surgery patients

    PubMed Central

    Kiecak, Katarzyna; Urbańska, Ewa; Maciejewski, Tomasz; Kaliś, Robert; Pakosiewicz, Waldemar; Kołodziej, Tadeusz; Knapik, Piotr; Przybylski, Roman; Zembala, Marian

    2016-01-01

    Introduction Surgery is an extreme physiological stress for the elderly. Aging is inevitably associated with irreversible and progressive cellular degeneration. Patients above 75 years of age are characterized by impaired responses to operative stress and a very narrow safety margin. Aim To evaluate perioperative complications in patients aged ≥ 75 years who underwent cardiac surgery in comparison to outcomes in younger patients. Material and methods The study was conducted at the Silesian Centre for Heart Diseases in Zabrze in 2009–2014 after a standard of perioperative care in seniors was implemented to reduce complications, in particular to decrease the duration of mechanical ventilation and reduce postoperative delirium. The study group included 1446 patients. Results The mean duration of mechanical ventilation was 13.8 h in patients aged ≥ 75 years and did not differ significantly compared to younger patients. In-hospital mortality among seniors was 3.8%, a value significantly higher than that observed among patients younger than 75 years of age. Patients aged ≥ 75 years undergoing cardiac surgery have significantly more concomitant conditions involving other organs, which affects treatment outcomes (duration of hospital stay, mortality). Conclusions The implementation of a standard of perioperative care in this age group reduced the duration of mechanical ventilation and lowered the rate of postoperative delirium. PMID:28096832

  13. Perioperative management of patients with Parkinson's disease.

    PubMed

    Katus, Linn; Shtilbans, Alexander

    2014-04-01

    Parkinson's disease is the second most common neurodegenerative disease worldwide, leading to a wide range of disability and medical complications. Managing patients with Parkinson's disease in the perioperative hospital setting can be particularly challenging. Suboptimal management can lead to medical complications, prolonged hospital stays, and delayed recovery. This review aims to address the most important issues related to caring for patients with Parkinson's disease perioperatively who are undergoing emergent or planned general surgery. It also intends to help hospitalists, internists, and other health care providers mitigate potential in-hospital morbidity and prevent prolonged recovery. Challenges in managing patients with Parkinson's disease in the perioperative hospital setting include disruption of medication schedules, "nothing by mouth" status, reduced mobility, and medication interactions and their side effects. Patients with Parkinson's disease are more prone to immobility and developing dysphagia, respiratory dysfunction, urinary retention, and psychiatric symptoms. These issues lead to higher rates of pneumonia, urinary tract infections, deconditioning, and falls compared with patients without Parkinson's disease, as well as prolonged hospital stays and a greater need for post-hospitalization rehabilitation. Steps can be taken to decrease these complications, including minimizing nothing by mouth status duration, using alternative routes of drugs administration when unable to give medications orally, avoiding drug interactions and medications that can worsen parkinsonism, assessing swallowing ability frequently, encouraging incentive spirometry, performing bladder scans, avoiding Foley catheters, and providing aggressive physical therapy. Knowing and anticipating these potential complications allow hospital physicians to mitigate nosocomial morbidity and shorten recovery times and hospital stays.

  14. Towards personalized perioperative treatment for advanced gastric cancer

    PubMed Central

    Miao, Ru-Lin; Wu, Ai-Wen

    2014-01-01

    Gastric cancer is one of the most frequently diagnosed cancers worldwide. Although the rate of gastric cancer has declined dramatically over the past decades in most developed Western countries, it has not declined in East Asia. Currently, a radical gastrectomy is still the only curative treatment for gastric cancer. Over the last twenty years, however, surgery alone has been replaced by a multimodal perioperative approach. To achieve the maximum benefit from the perioperative treatment, a thorough evaluation of the tumor must first be performed. A complete assessment of gastric cancer is divided into two parts: staging and histology. According to the stage and histology of the cancer, perioperative chemotherapy or radiochemotherapy can be implemented, and perioperative targeted therapies such as trastuzumab may also play a role in this field. However, perioperative treatment approaches have not been widely accepted until a series of clinical trials were performed to evaluate the value of perioperative treatment. Although multimodal perioperative treatment has been widely applied in clinical practice, personalization of perioperative treatment represents the next stage in the treatment of gastric cancer. Genomic-guided treatment and efficacy prediction using molecular biomarkers in perioperative treatment are of great importance in the evolution of treatment and may become an ideal treatment method. PMID:25206266

  15. 40 CFR 405.80 - Applicability; description of the ice cream, frozen desserts, novelties and other dairy desserts...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... cream, frozen desserts, novelties and other dairy desserts subcategory. 405.80 Section 405.80 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS DAIRY PRODUCTS PROCESSING POINT SOURCE CATEGORY Ice Cream, Frozen Desserts, Novelties and Other Dairy...

  16. Protein changes in frozen fish.

    PubMed

    Sikorski, Z; Olley, J; Kostuch, S

    1976-09-01

    Storage of frozen fish brings about a decrease of extractability of myofibrillar proteins. There is also deterioration of the texture and functional properties of the flesh. In model systems, aggregation of myosin, actin, tropomyosin, and whole myofibrils have been described. These changes are caused by concurrent action of partial dehydration due to the freezing out of water, exposure of the proteins to inorganic salts which are concentrated in the remaining nonfrozen fluid, interactions with free fatty acids liberated from phospholipids and with lipid oxidation products, and cross-linking by formaldehyde produced in some species of fish as a result of enzymic decomposition of trimethylamine oxide. The extent of protein alterations increases with time and temperature of storage as well as with advanced disintegration of the tissues and intermixing of their components. The role played by the individual factors and the significance of different types of bonds, i.e., hydrophobic adherences, ionic bonds, and covalent cross-links in particular cases are not yet fully disclosed. Retardation of the deteriorative changes of proteins in frozen fish is possible by avoiding high storage temperatures and oxidation of lipids, removing hematin compounds and other constituents promoting cross-linking reactions, and by adding cryoprotectors like sugars, several organic acids, amino acids, or peptides.

  17. Risk factors for the effect of anticoagulant and antiplatelet agents on perioperative blood loss following proximal femoral fractures.

    PubMed

    Akaoka, Yusuke; Yamazaki, Hiroshi; Kodaira, Hiroyuki; Kato, Hiroyuki

    2016-07-01

    To examine the effect of oral anticoagulant and antiplatelet agents on perioperative blood loss following proximal femoral fractures and to identify the risk factors associated with perioperative blood loss.Retrospective cross-sectional study.In a retrospective cross-sectional study, we treated 334 consecutive patients with proximal femoral fractures (100 who received anticoagulant or antiplatelet drugs and 234 who did not) and an overall mean age of 85.5 years (standard deviation 8.2 years). We performed retrospective multivariate analysis to determine the independent factors related to perioperative decreases in the hemoglobin (Hb) level, a proxy for blood loss.Multivariate analysis confirmed that anticoagulant or antiplatelet drugs significantly affected decreases in the Hb level (regression coefficient [RC], 0.61; 95% confidence interval [CI], 0.14-1.08; P = 0.01). In addition to anticoagulant or antiplatelet drugs, multivariate analysis confirmed that the fracture type (Orthopedic Trauma Association classification A2: RC, 1.19; 95% CI, 0.71-1.67; P < 0.01; A3: RC, 2.47; 95% CI, 1.41-3.53; P < 0.01), platelet count (RC, -0.08; 95% CI, -0.12 to -0.04; P < 0.01), and operative time (RC, 0.02; 95% CI, 0.004-0.03; P = 0.01) affected the decreases in Hb level.The use of anticoagulants and antiplatelet agents is an independent risk factor for perioperative blood loss following proximal femoral fractures. Fracture type, platelet count, and operative time also affect perioperative blood loss. The fracture type was the greatest contributing factor to perioperative blood loss.Level of evidence grade: Prognostic level III.

  18. Risk factors for the effect of anticoagulant and antiplatelet agents on perioperative blood loss following proximal femoral fractures

    PubMed Central

    Akaoka, Yusuke; Yamazaki, Hiroshi; Kodaira, Hiroyuki; Kato, Hiroyuki

    2016-01-01

    Abstract To examine the effect of oral anticoagulant and antiplatelet agents on perioperative blood loss following proximal femoral fractures and to identify the risk factors associated with perioperative blood loss. Retrospective cross-sectional study. In a retrospective cross-sectional study, we treated 334 consecutive patients with proximal femoral fractures (100 who received anticoagulant or antiplatelet drugs and 234 who did not) and an overall mean age of 85.5 years (standard deviation 8.2 years). We performed retrospective multivariate analysis to determine the independent factors related to perioperative decreases in the hemoglobin (Hb) level, a proxy for blood loss. Multivariate analysis confirmed that anticoagulant or antiplatelet drugs significantly affected decreases in the Hb level (regression coefficient [RC], 0.61; 95% confidence interval [CI], 0.14–1.08; P = 0.01). In addition to anticoagulant or antiplatelet drugs, multivariate analysis confirmed that the fracture type (Orthopedic Trauma Association classification A2: RC, 1.19; 95% CI, 0.71–1.67; P < 0.01; A3: RC, 2.47; 95% CI, 1.41–3.53; P < 0.01), platelet count (RC, −0.08; 95% CI, −0.12 to −0.04; P < 0.01), and operative time (RC, 0.02; 95% CI, 0.004–0.03; P = 0.01) affected the decreases in Hb level. The use of anticoagulants and antiplatelet agents is an independent risk factor for perioperative blood loss following proximal femoral fractures. Fracture type, platelet count, and operative time also affect perioperative blood loss. The fracture type was the greatest contributing factor to perioperative blood loss. Level of evidence grade: Prognostic level III. PMID:27399119

  19. Testing the frozen flow approximation

    NASA Technical Reports Server (NTRS)

    Lucchin, Francesco; Matarrese, Sabino; Melott, Adrian L.; Moscardini, Lauro

    1993-01-01

    We investigate the accuracy of the frozen-flow approximation (FFA), recently proposed by Matarrese, et al. (1992), for following the nonlinear evolution of cosmological density fluctuations under gravitational instability. We compare a number of statistics between results of the FFA and n-body simulations, including those used by Melott, Pellman & Shandarin (1993) to test the Zel'dovich approximation. The FFA performs reasonably well in a statistical sense, e.g. in reproducing the counts-in-cell distribution, at small scales, but it does poorly in the crosscorrelation with n-body which means it is generally not moving mass to the right place, especially in models with high small-scale power.

  20. Perioperative management of hereditary arrhythmogenic syndromes.

    PubMed

    Staikou, C; Chondrogiannis, K; Mani, A

    2012-05-01

    Patients with inherited cardiac channel disorders are at high risk of perioperative lethal arrhythmias. Preoperative control of symptoms and a multidisciplinary approach are required for a well-planned management. Good haemodynamic monitoring, adequate anaesthesia and analgesia, perioperative maintenance of normocarbia, normothermia, and normovolaemia are important. In congenital long QT syndrome, torsades de pointes should be prevented with magnesium sulphate infusion and avoidance of drugs such as droperidol, succinylcholine, ketamine, and ondansetron. Propofol and epidural anaesthesia represent safe choices, while caution is needed with volatile agents. In Brugada syndrome, β-blockers, α-agonists, and cholinergic drugs should be avoided, while isoproterenol reverses the ECG changes. Propofol, thiopental, and volatiles have been used uneventfully. In congenital sick sinus syndrome, severe bradycardia resistant to atropine may require isoproterenol or epinephrine. Anaesthetics with vagolytic properties are preferable, while propofol and vecuronium should be given with caution due to risk of inducing bradyarrhythmias. Neuraxial anaesthesia should produce the least autonomic imbalance. Arrhythmogenic right ventricular dysplasia/cardiomyopathy induces ventricular tachyarrhythmias, which should be treated with β-blockers. Generally, β-adrenergic stimulation and catecholamine release should be avoided. Halothane and pancuronium are contraindicated, while large doses of local anaesthetics and epinephrine should be avoided in neuraxial blocks. In catecholaminergic polymorphic ventricular tachycardia, β-blocker treatment should be continued perioperatively. Catecholamine release and β-agonists, such as isoproterenol, should be avoided. Propofol and remifentanil are probably safe, while halothane and pancuronium are contraindicated. Regional anaesthesia, without epinephrine, is relatively safe. In suspicious cardiac deaths, postmortem examination and familial

  1. Perioperative Management Center (PERIO) for Neurosurgical Patients

    PubMed Central

    YASUHARA, Takao; HISHIKAWA, Tomohito; AGARI, Takashi; KUROZUMI, Kazuhiko; ICHIKAWA, Tomotsugu; KAMEDA, Masahiro; SHINKO, Aiko; ISHIDA, Joji; HIRAMATSU, Masafumi; KOBAYASHI, Motomu; MATSUOKA, Yoshikazu; SASAKI, Toshihiro; SOGA, Yoshihiko; YAMANAKA, Reiko; ASHIWA, Takako; ARIOKA, Akemi; HASHIMOTO, Yasuko; MISAKI, Ayasa; ISHIHARA, Yuriko; SATO, Machiko; MORIMATSU, Hiroshi; DATE, Isao

    2016-01-01

    Perioperative management is critical for positive neurosurgical outcomes. In order to maintain safe and authentic perioperative management, a perioperative management center (PERIO) was introduced to patients of our Neurosurgery Department beginning in June 2014. PERIO involves a multidisciplinary team consisting of anesthesiologists, dentists/dental hygienists/technicians, nurses, physical therapists, pharmacists, and nutritionists. After neurosurgeons decide on the course of surgery, a preoperative evaluation consisting of blood sampling, electrocardiogram, chest X-ray, and lung function test was performed. The patients then visited the PERIO clinic 7–14 days before surgery. One or two days before surgery, the patients without particular issues enter the hospital and receive a mouth cleaning one day before surgery. After surgery, postoperative support involving eating/swallowing evaluation, rehabilitation, and pain control is provided. The differences in duration from admission to surgery, cancellation of surgery, and postoperative complications between PERIO and non-PERIO groups were examined. Eighty-five patients were enrolled in the PERIO group and 131 patients in the non-PERIO group. The duration from admission to surgery was significantly decreased in the PERIO group (3.6 ± 0.3 days), compared to that in the non-PERIO group (4.7 ± 0.2 days). There was one cancelled surgery in the PERIO group and six in the non-PERIO group. Postoperative complications and the overall hospital stay did not differ between the two groups. The PERIO system decreased the duration from admission to surgery, and it is useful in providing high-quality medical service, although the system should be improved so as not to increase the burden on medical staff. PMID:27396396

  2. Prevention of perioperative hypothermia in plastic surgery.

    PubMed

    Young, V Leroy; Watson, Marla E

    2006-01-01

    While inadvertent perioperative hypothermia has received serious attention in many surgical specialties, few discussions of hypothermia have been published in the plastic surgery literature. This article reviews the physiology of thermoregulation, describes how both general and regional anesthesia alter the normal thermoregulatory mechanisms, indicates risk factors particularly associated with hypothermia, and discusses the most effective current methods for maintaining normothermia. Hypothermia is typically defined as a core body temperature of /=36.5 degrees C is maintained. Unless preventive measures are instituted, inadvertent hypothermia occurs in 50% to 90% of surgical patients, even those undergoing relatively short procedures lasting one to one-and-a-half hours. During either general or regional anesthesia, a patient's natural behavioral and autonomic responses to cold are unavailable or impaired, and the combination of general and neuraxial anesthesia produces the highest risk for inadvertent perioperative hypothermia. Unless hypothermia is prevented, the restoration of normothermia can take more than 4 hours once anesthesia is stopped. Consequences of hypothermia are serious and affect surgical outcomes in plastic surgery patients. Potential complications include morbid cardiac events, coagulation disorders and blood loss, increased incidence of surgical wound infection, postoperative shivering, longer hospital stays, and increased costs associated with surgery. Measures for preventing hypothermia are emphasized in this article, especially those proven most effective in prospective and controlled clinical studies. Perhaps the most important step in maintaining normothermia is to prewarm patients in the preoperative area with forced-air heating systems. Intraoperative warming with forced-air and fluid warming are also essential. Other strategies

  3. Perioperative and Anesthetic Considerations in Ebstein's Anomaly.

    PubMed

    Ross, Faith J; Latham, Gregory J; Richards, Michael; Geiduschek, Jeremy; Thompson, Douglas; Joffe, Denise

    2016-03-01

    Ebstein's anomaly is a complex and heterogeneous form of congenital heart disease characterized by malformation and apical displacement of the tricuspid valve leaflets. Patients may present at any time from the neonatal period to adulthood with symptoms ranging from cardiac failure and cyanosis to paroxysmal arrhythmias. Depending on the timing of presentation, various surgical options are available for the management of symptomatic patients. This review will discuss the perioperative and anesthetic management of patients with Ebstein's anomaly with reference to the more common surgical approaches.

  4. Melatonin in perioperative medicine: Current perspective

    PubMed Central

    Maitra, Souvik; Baidya, Dalim Kumar; Khanna, Puneet

    2013-01-01

    Melatonin, a new addition to the armamentarium of anesthesiologist, has some unique properties that are highly desirable in routine peri-operative care. Available clinical data show that preoperative melatonin is as effective as benzodiazepines in reducing preoperative anxiety with minimal action on psychomotor performance and sleep wake cycle. It may be considered as a safe and effective alternative of benzodiazepines as preoperative anxiolytic. It may have opioid sparing effect, may reduce intraocular pressure, and have role in prevention of postoperative delirium. The short-term administration of melatonin is free from significant adverse effects also. PMID:24015137

  5. Perioperative circulating tumor cell detection: Current perspectives

    PubMed Central

    Kaifi, Jussuf T.; Li, Guangfu; Clawson, Gary; Kimchi, Eric T.; Staveley-O'Carroll, Kevin F.

    2016-01-01

    ABSTRACT Primary cancer resections and in selected cases surgical metastasectomies significantly improve survival, however many patients develop recurrences. Circulating tumor cells (CTCs) function as an independent marker that could be used in the prognostication of different cancers. Sampling of blood and bone marrow compartments during cancer resections is a unique opportunity to increase individual tumor cell capture efficiency. This review will address the diagnostic and therapeutic potentials of perioperative tumor isolation and highlight the focus of future studies on characterization of single disseminated cancer cells to identify targets for molecular therapy and immune escape mechanisms. PMID:27045201

  6. Lateral violence in the perioperative setting.

    PubMed

    Bigony, Lorraine; Lipke, Tammy G; Lundberg, Ashley; McGraw, Carrie A; Pagac, Gretchen L; Rogers, Anne

    2009-04-01

    Lateral violence is disruptive, bullying, intimidating, or unsettling behavior that occurs between nurses in the workplace. The perioperative setting fosters lateral violence because of the inherent stress of performing surgery; high patient acuity; a shortage of experienced personnel; work demands; and the restriction and isolation of the OR, which allows negative behaviors to be concealed more easily. Lateral violence affects nurses' health and well-being and their ability to care for patients. Interventions to reduce lateral violence include empowerment of staff members and zero tolerance for lateral violence.

  7. Perioperative management of classic bladder exstrophy

    PubMed Central

    Massanyi, Eric Z; Gearhart, John P; Kost-Byerly, Sabine

    2013-01-01

    The exstrophy-epispadias complex is a rare congenital malformation of the genitourinary system, abdominal wall muscles, and pelvic structures. Modern surgical repairs focus on reconstruction of the bladder and its adjacent structures, with the goal of achieving urinary continence, a satisfactory cosmetic result, and a high quality of life. Complex surgery in neonates and young children, as well as a prolonged postoperative course require close collaboration between surgeons, anesthesiologists, intensivists, pediatricians, and an experienced nursing staff. This article will review the spectrum of bladder exstrophy anomalies, the surgical repair, and the perioperative interdisciplinary management. PMID:24400236

  8. Supply chain optimization for pediatric perioperative departments.

    PubMed

    Davis, Janice L; Doyle, Robert

    2011-09-01

    Economic challenges compel pediatric perioperative departments to reduce nonlabor supply costs while maintaining the quality of patient care. Optimization of the supply chain introduces a framework for decision making that drives fiscally responsible decisions. The cost-effective supply chain is driven by implementing a value analysis process for product selection, being mindful of product sourcing decisions to reduce supply expense, creating logistical efficiency that will eliminate redundant processes, and managing inventory to ensure product availability. The value analysis approach is an analytical methodology for product selection that involves product evaluation and recommendation based on consideration of clinical benefit, overall financial impact, and revenue implications.

  9. Critical Elements for the Pediatric Perioperative Anesthesia Environment.

    PubMed

    Polaner, David M; Houck, Constance S

    2015-12-01

    The American Academy of Pediatrics proposes guidance for the pediatric perioperative anesthesia environment. Essential components are identified to optimize the perioperative environment for the anesthetic care of infants and children. Such an environment promotes the safety and well-being of infants and children by reducing the risk of adverse events.

  10. Old, New and Hidden Causes of Perioperative Hypersensitivity.

    PubMed

    Garvey, Lene Heise

    2016-01-01

    Perioperative hypersensitivity reactions are rare, often life-threatening events, and subsequent investigations to identify the culprit are important to avoid re-exposure. All exposures in the perioperative setting may potentially be the cause of a hypersensitivity reaction, but drugs administered intravenously such as neuromuscular blocking agents (NMBA), induction agents and antibiotics have traditionally been reported to be implicated most commonly. It has recently become apparent that there are geographical differences in sensitization patterns related to variation in exposures, referral patterns and performance and interpretation of investigations. Differences in sensitization to NMBAs are partly explained by cross sensitization to pholcodine, an ingredient in cough-medicines available in some countries. While NMBAs are the most common causes of perioperative hypersensitivity in some countries, this may not necessarily be the case in all countries. New and hidden allergens have emerged as causes of perioperative hypersensitivity such as blue dyes, chlorhexidine and excipients. Detailed knowledge of the events at the time of reaction is necessary to identify potential culprits including rare and hidden allergens. Cooperation between allergists and anaesthetists, or other staff present perioperatively, is often needed to identify hidden or even undocumented exposures. The objectives of this review are to provide an overview of the history of investigation of perioperative hypersensitivity, to describe the differences in causes of perioperative hypersensitivity emerging over time and to increase awareness about the "hidden allergens" in the perioperative setting. Some practical advice on how to approach the patient testing negative on all initial investigations is also included.

  11. The use of emergency manuals in perioperative crisis management: a cautious approach.

    PubMed

    Szabo, Ashley; August, David A; Klainer, Suzanne; Miller, Andrew D; Kaye, Alan D; Raemer, Daniel B; Urman, Richard D

    2015-01-01

    When an unexpected perioperative crisis arises, simulation studies have suggested that the use of an emergency manual (EM) may offset the large cognitive load involved in crisis management, facilitating the efficient performance of key steps in treatment. However, little is known about how well EMs will translate into actual practice and what is required to use them optimally. While EMs are a promising tool in the management of perioperative critical events, more research is needed to define best practices and their limitations. In the interim, cautious use of these cognitive aids is recommended, especially when the diagnosis is not straightforward, falls "in between" sections of the EM, or falls outside of the EM itself. Further research should focus on the efficacy of EMs as measured by the percentage of critical steps correctly performed by their users in scenarios that do not closely mirror one of the listed EM scenarios from the beginning or as the situation evolves.

  12. Pediatric Perioperative Stress Responses and Anesthesia

    PubMed Central

    Yuki, Koichi; Matsunami, Erika; Tazawa, Kazumasa; Wang, Wei; DiNardo, James A.; Koutsogiannaki, Sophia

    2017-01-01

    Summary Surgical stress responses cause an array of endocrinological, metabolic and immunological changes in patients. The landmark studies in the 1980s showed that adequate anesthesia dramatically improved the outcomes of pediatric surgical patients by attenuating stress hormonal responses, pointing out the harm of ‘inadequate’ anesthesia. Subsequent studies questioned the role of administering very high-dose anesthetics to further attenuate stress responses. Here we review the feature of surgical stress responses in pediatric patients including their difference from those in adult patients. Overall, pediatric patients show minimal or no resting energy expenditure change postoperatively. In adult patients, increased resting energy expenditure has been described. Pediatric patients demonstrated robust cortisol and catecholamine responses than adult patients. However, the duration of these surges is often short-lived. Systemic proinflammatory and anti-inflammatory cytokine levels have been measured. Pediatric patients showed less proinflammatory cytokine elevation, but had similar anti-antiinflamatory responses. We also review in detail the immunological changes in response to surgical stress. Based on our current knowledge, we attempted to understand the underlying mechanism how adequate anesthesia dramatically improved the outcome of patients. Although more work is needed to be done, understanding how pediatric patients respond to perioperative stress, and its mechanism and consequence will allow us to direct us into a better, perioperative management in this population. PMID:28217718

  13. Perioperative nutritional therapy in liver transplantation.

    PubMed

    Hammad, Ahmed; Kaido, Toshimi; Uemoto, Shinji

    2015-03-01

    Protein-energy malnutrition is frequently seen in patients with end-stage liver disease who undergo liver transplantation. This causes a deterioration of the patients' clinical condition and affects their post-transplantation survival. Accurate assessment of the nutritional status and adequate intervention are prerequisites for perioperative nutritional treatment. However, the metabolic abnormalities induced by liver failure make the traditional assessment of the nutritional status difficult. The methods that were recently developed for accurately assessing the nutritional status by body bioelectrical impedance may be implemented in pre-transplant management. Because preoperative malnutrition and the loss of skeletal muscle mass, called sarcopenia, have a significant negative impact on the post-transplantation outcome, it is essential to provide adequate nutritional support during all phases of liver transplantation. Oral nutrition is preferred, but tube enteral nutrition may be required to provide the necessary caloric intake. We herein discuss both bioelectrical impedance and the latest findings in the current perioperative nutritional interventions in liver transplant patients regarding synbiotics, micronutrients, branched-chain amino acid supplementation, the use of immune system modulating formulas, the fluid balance and the offering of nocturnal meals.

  14. Infection control and prevention in perioperative practice.

    PubMed

    Williams, Marilyn

    2008-07-01

    The personal and financial consequences of avoidable infection are enormous in personal and global terms (DH 2003, Stone, Larson & Kawar 2002). Patients expect to be treated and cared for in clean conditions, and not be exposed to the risks of acquiring an infection by poor practice on the part of healthcare workers (DH 2005, Health Care Commission 2005). Infection control and prevention in perioperative settings assumes an even greater significance because of the vulnerability of patients who are already ill or injured, and because surgery, anaesthesia and immediate postoperative recovery may expose them to invasive procedures, allowing more portals of entry for infection. There is ample evidence, widely available, to support best practice in all healthcare settings. The methods are cheap, easy to apply and very effective (Wright 2004, Pratt et al 2007). This article will examine a range of evidence applicable to perioperative infection control and prevention, including an assessment of current practice and how it may be improved, with a particular emphasis on surgical site infection associated with Meticillin Resistant Staphylococcus Aureus (MRSA) and Clostridium Difficile (C.diff).

  15. Developing a perioperative educational video web site.

    PubMed

    O'Dowd Bell, Lynn

    2012-04-01

    Nurses frequently have to adjust to changes in technology, particularly in the OR, but cataloging the wealth of resources commonly used in the OR (eg, equipment, supplies, how to use them) has not kept pace. To address this, I worked with the information systems administrative coordinator at the University of Texas Medical Branch, Galveston, to design and implement a perioperative intranet site that includes videos and fact sheets about equipment and supplies and that can be accessed by all perioperative staff members. This required promoting the idea and getting stakeholder sign-on, soliciting videotapes and DVDs and screening all submissions for appropriateness, choosing and formatting applicable resources for use on the site, working with members of the information systems department to create a web site after the video library was assembled, and helping staff members use and accept the site as a valuable educational resource. This intranet web site has been available to staff members for two years, and data from a recent survey of staff members and from mandatory intranet inservice compliance programs show evidence of its effectiveness.

  16. AORN guidance statement: safe on-call practices in perioperative practice settings. Association of periOperative Registered Nurses.

    PubMed

    2005-05-01

    Call staffing and the associated long work hours can be challenging for both perioperative staff members and the health care organization. A change in culture is needed to recognize exhaustion as an unacceptable risk to patients and perioperative personnel safety. Perioperative health care providers have a personal responsibility to arrive at work fully rested. Health care organizations have a responsibility to create work and call schedules that consider the effect of long work hours on patient safety as well as perioperative staff members' welfare. The development of standardized safe work hours and call practices should reflect current recommendations emerging from authoritative sources, legislation, and empirical data. Prolonged work periods without adequate rest may contribute to diminished performance by perioperative personnel, placing both patients and workers at risk. This guidance statement may assist managers and clinicians in developing policies and procedures for safe call practices.

  17. 78 FR 2946 - United States Standards for Grades of Frozen Vegetables

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-15

    ... standards covered by these proposed revisions are: frozen asparagus, frozen lima beans, frozen speckled butter beans, frozen cooked squash, frozen summer squash, frozen sweet potatoes, frozen turnip greens... document. United States Standards for Grades of Frozen Lima Beans Update address for AMS. Change...

  18. Hospitalists and anesthesiologists as perioperative physicians: Are their roles complementary?

    PubMed Central

    Joshi, Girish P.

    2007-01-01

    In recent years, there has been an increased emphasis on the role of anesthesiologists as perioperative physicians. However, a new group of physicians called hospitalists has emerged and established a role as perioperative physicians. Most hospitalists have specialized in internal medicine and its subspecialties. We reviewed American medical literature over the last 13 years on the roles of anesthesiologists and hospitalists as perioperative physicians. Results showed that the concept of the anesthesiologist as the perioperative physician is strongly supported by the American Board of Anesthesiology and the leaders of the specialty. However, most anesthesiologists limit their practice to intraoperative care and immediate acute postoperative care in the postanesthesia care unit. The hospitalists may fill a different role by caring for patients in the preoperative and sometimes in the postoperative period, allowing the surgeon to focus on surgery. These roles of the anesthesiologists and the hospitalists as perioperative physicians may be complementary. We conclude that if anesthesiologists and hospitalists work together as peri-operative physicians, with each specialty bringing its expertise to the care of the perioperative patient, care is likely to improve. It is necessary to be proactive and identify areas of future cooperation and collaboration. PMID:17431448

  19. Perioperative myocardial infarction in patients undergoing myocardial revascularization surgery

    PubMed Central

    Pretto, Pericles; Martins, Gerez Fernandes; Biscaro, Andressa; Kruczan, Dany David; Jessen, Barbara

    2015-01-01

    Introduction Perioperative myocardial infarction adversely affects the prognosis of patients undergoing coronary artery bypass graft and its diagnosis was hampered by numerous difficulties, because the pathophysiology is different from the traditional instability atherosclerotic and the clinical difficulty to be characterized. Objective To identify the frequency of perioperative myocardial infarction and its outcome in patients undergoing coronary artery bypass graft. Methods Retrospective cohort study performed in a tertiary hospital specialized in cardiology, from May 01, 2011 to April 30, 2012, which included all records containing coronary artery bypass graft records. To confirm the diagnosis of perioperative myocardial infarction criteria, the Third Universal Definition of Myocardial Infarction was used. Results We analyzed 116 cases. Perioperative myocardial infarction was diagnosed in 28 patients (24.1%). Number of grafts and use and cardiopulmonary bypass time were associated with this diagnosis and the mean age was significantly higher in this group. The diagnostic criteria elevated troponin I, which was positive in 99.1% of cases regardless of diagnosis of perioperative myocardial infarction. No significant difference was found between length of hospital stay and intensive care unit in patients with and without this complication, however patients with perioperative myocardial infarction progressed with worse left ventricular function and more death cases. Conclusion The frequency of perioperative myocardial infarction found in this study was considered high and as a consequence the same observed average higher troponin I, more cases of worsening left ventricular function and death. PMID:25859867

  20. Chemical Effects during Storage of Frozen Foods.

    ERIC Educational Resources Information Center

    Powrie, W. D.

    1984-01-01

    Discusses (1) characteristics, interrelationships, and distribution of food constituents (including water) in unfrozen food systems; (2) the freezing process; and (3) chemical changes in food during frozen storage. Protein alterations and lipid oxidation are emphasized. (JN)

  1. Artificial insemination of cranes with frozen semen

    USGS Publications Warehouse

    Gee, G.F.; Sexton, T.J.; Lewis, J.C.

    1979-01-01

    For the first time (1978) artificial insemination (AI) with frozen greater sandhill crane (Grus canadensis tabida) semen resulted in fertile eggs and chicks. During the 2 year (1977-78) study, 6 of 27 eggs produced were fertile. Three chicks hatched. Semen samples used for insemination were frozen and stored in liquid nitrogen for two months or less. Recent improvements in the laboratory indicated that a more effective sample can be prepared and greater fertility rates should be expected.

  2. Managing Opioid-Tolerant Patients in the Perioperative Surgical Home.

    PubMed

    Wenzel, John T; Schwenk, Eric S; Baratta, Jaime L; Viscusi, Eugene R

    2016-06-01

    Management of acute postoperative pain is important to decrease perioperative morbidity and improve patient satisfaction. Opioids are associated with potential adverse events that may lead to significant risk. Uncontrolled pain is a risk factor in the transformation of acute pain to chronic pain. Balancing these issues can be especially challenging in opioid-tolerant patients undergoing surgery, for whom rapidly escalating opioid doses in an effort to control pain can be associated with increased complications. In the perioperative surgical home model, anesthesiologists are positioned to coordinate a comprehensive perioperative analgesic plan that begins with the preoperative assessment and continues through discharge.

  3. Prescription of perioperative analgesics by UK small animal veterinary surgeons in 2013.

    PubMed

    Hunt, J R; Knowles, T G; Lascelles, B D X; Murrell, J C

    2015-05-09

    Data from a survey conducted in 1996-1997 suggested a low level of perioperative analgesic administration to cats and dogs in the UK. In order to evaluate current practice and attitudes with regards to perioperative analgesic prescription, a cross-sectional survey of UK practising small animal veterinary surgeons was undertaken in spring 2013. Four thousand one hundred paper questionnaires were distributed and the survey was made available online. Seven hundred and twenty valid responses were received and analysed. All respondents had access to at least one non-steroidal anti-inflammatory drug (NSAID) and one opioid within their practice. Respondents considered analgesic efficacy, and degree of intraoperative pain, the most important factors governing their selection of NSAID and opioid analgesics. Perioperative NSAIDs were administered by approximately 98 per cent of respondents to dogs and cats undergoing neutering. Multimodal (opioid+NSAID) analgesia was prescribed by the majority of respondents. Neutering was considered more painful in dogs than in cats, and lower rates of opioid and postdischarge NSAID prescription were reported for cats. Orthopaedic, abdominal and dental surgeries were considered equally painful in dogs and cats. Local analgesic techniques were not commonly used. Analgesic prescription has increased since previous surveys, which should translate to improved animal welfare.

  4. Stroke assessment in the perioperative orthopaedic patient.

    PubMed

    Weinhardt, Janice; Jacobson, Kristine

    2012-01-01

    A growing elderly population with an increasing number of comorbidities is presenting for orthopaedic procedures and interventions, lending themselves to greater risk for complications, including stroke. Prior stroke or transient ischemic attack, hypertension, diabetes mellitus, atrial fibrillation, carotid stenosis, and advanced age are the most common risk factors for perioperative stroke. A comprehensive neurologic assessment should include a thorough history including identification of risk factors, pertinent medications, and a physical examination. This assessment is important to establish a baseline for subsequent neurologic evaluations in the postoperative period. Neurologic physical assessment can be an intimidating task, especially for the orthopaedic nurse who lacks experience in caring for the neurologic patient. Patients who are found with a focal neurologic deficit that is suspicious for stroke require urgent assessment, exclusion of stroke mimics, and activation of the institution's stroke team to allow for brain saving interventions. Time is brain.

  5. Effective Perioperative Communication to Enhance Patient Care.

    PubMed

    Garrett, J Hudson

    2016-08-01

    Breakdowns in health care communication are a significant cause of sentinel events and associated patient morbidity and mortality. Effective communication is a necessary component of a patient safety program, which enables all members of the interdisciplinary health care team to effectively manage their individual roles and responsibilities in the perioperative setting; set expectations for safe, high-reliability care; and measure and assess outcomes. To sustain a culture of safety, effective communication should be standardized, complete, clear, brief, and timely. Executive leadership and support helps remove institutional barriers and address challenges to support the engagement of patients in health care communication, which has been shown to improve outcomes, reduce costs, and improve the patient experience.

  6. [Correlation between pholcodine and perioperative anaphylaxis].

    PubMed

    Dumancić, Jelena; Marković, Asja Stipić

    2012-05-01

    A large number of individuals experiencing anaphylactic reaction to neuromuscular blocking agents have not previously been in contact with them. The search for a substance inducing sensitization to muscle relaxants has led Norwegian and Swedish scientists to pholcodine, a cough suppressant, which is widely used in Europe and worldwide. Ammonium ion is an epitope common to pholcodine and neuromuscular blocking agents and it is the basis of their cross-reactivity. Based on the results of published studies that pointed to a connection of the use of pholcodine and perioperative anaphylactic reaction, pholcodine was withdrawn from the Norwegian market and subsequent research revealed a reduction of anaphylactic reactions in that country. In its latest report, the European Medicines Agency made a decision not to withdraw pholcodine mixtures from the market but it urged further research with the aim to clarify the cross-reactivity between pholcodine and neuromuscular blocking agents.

  7. Promoting Resilience in New Perioperative Nurses.

    PubMed

    Stephens, Teresa M; Smith, Pamela; Cherry, Caitlin

    2017-03-01

    New nursing graduates experience many challenges when transitioning from the academic environment to the practice setting. For many, the period of transition from student to employee is less than optimal, with many still experiencing reality shock, cognitive dissonance, and theory-practice gaps. The Stephens Model of Nursing Student Resilience addresses the unique issues faced by new graduate nurses to assist them in developing healthy coping strategies and to promote resilience. This model forms the basis of the RN Personal Resilience Enhancement Plan, a supplemental onboarding program created to assist new nurses in confidently facing challenges encountered during orientation and successfully moving forward as nursing professionals. This article describes the concept of resilience and explains how to link the RN Personal Resilience Enhancement Plan to the onboarding process in the perioperative setting.

  8. Redefining the future of perioperative nursing education: a conceptual framework.

    PubMed

    Dumchin, Mark

    2010-07-01

    Perioperative nursing is practiced in a technologically advanced, fast-paced environment, and there is a continuing shortage of qualified and competent perioperative nurses. The expansion of nursing education programs into web-based environments has the potential to address this shortage. Online learning is both effective and efficient and particularly appropriate for adult learners compared with traditional, lecture-style programs. This article proposes a conceptual framework that combines social constructivism, Benner's Novice to Expert theory, and the principles of adult learning to provide a basis for the design and implementation of future perioperative curricula. Although the proposed framework needs to be questioned and empirically tested through research, the application of this framework could potentially shift the quality of perioperative education to a higher level and result in safer, more highly reliable patient care.

  9. [Diagnosis and transfusion algorithm for the management of perioperative coagulopathy].

    PubMed

    Azma, Toshiharu; Yamasaki, Kyoko; Mimasu, Masashi; Nakao, Masakazu; Kikuchi, Hirosato

    2008-09-01

    The present article reviewed the management of coagulopathy in the perioperative setting, following the Japanese practical guidelines for the blood component therapy, edited by the Ministry of Health, Labour and Welfare of Japan in 2005. The threshold concentrations of platelets, prothrombin time international normalized ratio (PT-INR) and activated partial thromboplastin time (APTT) were optimized for the perioperative critical care under active and/or microvascular bleeding, based on currently available randomized controlled trials. Discontinuation or modification of anticoagulants as well as antiplatelets is essential for the safe perioperative care. Several factors, including normothermia, normovolemia, as well as the maintenance of plasma calcium levels within normal range, are important for the management of coagulopathy. Platelet counts, PT, APTT, and if possible, other point-of-care testing including thromboelastography and its modified techniques should be performed following visual inspection of abnormal bleeding. The transfusion algorithms based on causal diagnosis of coagulopathy optimize the risk/ benefit ratio of perioperative transfusion therapy.

  10. Gestalt operating room display design for perioperative team situation awareness.

    PubMed

    Lai, Fuji; Spitz, Gabriel; Brzezinski, Philip

    2006-01-01

    The perioperative environment is a complex, high risk environment that requires real-time coordination by all perioperative team members and accurate, up-to-date information for situation assessment and decision-making. There is the need for a "Gestalt" holistic awareness of the perioperative environment to enable synthesis and contextualization of the salient information such as: patient information, case and procedure information, staff information, operative site view, physiological data, resource availability. One potential approach is to augment the medical toolkit with a large screen wall display that integrates and makes accessible information that currently resides in different data systems and care providers. The objectives are to promote safe workflows, team coordination and communication, and to enable diagnosis, anticipation of events, and information flow from upstream to downstream care providers. We used the human factors engineering design process to design and develop a display that provides a common operational picture for shared virtual perioperative team situation awareness to enhance patient safety.

  11. Perioperative glucocorticosteroid supplementation is not supported by evidence.

    PubMed

    de Lange, Dylan W; Kars, Marleen

    2008-10-01

    Ever since the first descriptions of adrenal insufficiency following exogenous supplementation physicians dread to abolish perioperative glucocorticosteroid supplementation. Now, 55 years after the first publications we can challenge those first reports. However, these cases have resulted in the supplementation of supraphysiological doses of glucocorticosteroids to patients that use exogenous corticosteroids: the so-called perioperative glucocorticosteroid supplementation or "(gluco)corticosteroid stress scheme". It is very questionable whether a dose that exceeds the normal daily production of 5.7 mg cortisol per square meter of body surface area is necessary to prevent perioperative hypotension. Retrospective, prospective and randomised studies, though all methodologically flawed, are discussed and show that continuation of the "basal" amount of glucocorticosteroids is sufficient to counterbalance surgical stress. The current and rather defensive strategy of perioperative supraphysiological glucocorticosteroid supplementation is not embedded in medical evidence. Additionally, high doses of glucocorticosteroids have disadvantages that should not be ignored.

  12. Perioperative leadership: managing change with insights, priorities, and tools.

    PubMed

    Taylor, David L

    2014-07-01

    The personal leadership of the perioperative director is a critical factor in the success of any change management initiative. This article presents an approach to perioperative nursing leadership that addresses obstacles that prevent surgical departments from achieving high performance in clinical and financial outcomes. This leadership approach consists of specific insights, priorities, and tools: key insights include self-understanding of personal barriers to leadership and accuracy at understanding economic and strategic considerations related to the OR environment; key priorities include creating a customer-centered organization, focusing on process improvement, and concentrating on culture change; and key tools include using techniques (e.g., direct engagement, collaborative leadership) to align surgical organizations with leadership priorities and mitigate specific perioperative management risks. Included in this article is a leadership development plan for perioperative directors.

  13. Mineralization of cellulose in frozen boreal soils

    NASA Astrophysics Data System (ADS)

    Oquist, Mats G.; Segura, Javier; Sparrman, Tobias; Nilsson, Mats; Schleucher, Jurgen

    2015-04-01

    Soils of high-latitude ecosystems store a large fraction of the global soil carbon. In boreal forests, the microbial mineralization of soil organic matter (SOM) during winter can affect the ecosystems net carbon balance. Recent research has shown that microorganisms in the organic surface layer of boreal forest soil can mineralize and grow on simple, soluble monomeric substrates under frozen conditions. However, any substantial impacts of microbial activity in frozen soils on long-term soil carbon balances ultimately depends on whether soil microorganisms can utilize and grow the more complex, polymeric constituents of SOM. In order to evaluate the potential for soil microorganisms to metabolize carbon polymers at low temperatures, we incubated boreal forest soil samples amended with [13C]-cellulose and studied the microbial catabolic and anabolic utilization of the substrate under frozen and unfrozen conditions (-4 and +4°C). Freezing of the soil markedly reduced microbial utilization of the cellulose. The [13C]-CO2 production rate in the samples at +4°C were 0.52 mg CO2 SOM -1 day-1 while rates in the frozen samples (-4°C) were 0.01 mg CO2 SOM -1 day-1. However, newly synthetized [13C]-enriched cell membrane lipids, PLFAs, were detected in soil samples incubated both above and below freezing, confirming that cellulose can sustain also anabolic activity of the microbial populations under frozen conditions. The reduced metabolic rates induced by freezing indicate constraints on exoenzymatic activity, as well as substrate diffusion rates that we can attribute to reduced liquid water content of the frozen soil. We conclude that the microbial population in boreal forest soil has the capacity to metabolize, and grow, on polymeric substrates at temperatures below zero, which involves maintaining exoenzymatic activity in frozen soils. This capacity manifests the importance of SOM mineralization during the winter season and its importance for the net carbon balance of

  14. Vancouver Island Health Authority (VIHA) in house Perioperative Nursing Program.

    PubMed

    Christensen, Fern

    2005-12-01

    The Vancouver Island Health Authority (VIHA) in liaison with the University of Victoria (UVIC) offers an introduction to Perioperative Nursing Program to 4th Year undergraduate nursing students. The aim of this program is to help recruit Registered Nurses to the Operating Room. It has been advantageous to the recruitment and retention of nurses graduating from UVIC. Its importance is increased by the fact that a significant quantity of Victoria's perioperative nurses will be retiring in the next few years. Due to the high cost of nursing education and the financial investment that has already been committed by nursing students, the Perioperative nursing program is free to the student as the program can be included, for the successful candidate, as part of the UVIC nursing course. The intention is to encourage participation by reducing the financial burden, stress, and anxiety for the new graduate who intends to specialize. In return, the student is required to work in the VIHA for a minimum of one year, thus supporting the retention efforts of the hospital. For eligible nursing students, this program provides access to extensive perioperative nursing experience. Over the course of 3 months they are exposed to extensive theory in a classroom setting as well as clinical practice through a preceptorship program. The mentoring relationships that develop between perioperative nurses and students lead to meaningful relationships and professional growth for staff. The perioperative focus of the program improves the knowledge and skill set of nursing students. The intent is to increase nursing student's interest in pursuing a career as a perioperative nurse and to help ensure continued growth of the perioperative nursing profession in Victoria.

  15. I need to know! Timely accessing of perioperative user manuals.

    PubMed

    Landreneau, Raphael

    2010-12-01

    Ready access to equipment or product information is essential for the safe operation of the many items that a perioperative nurse is asked to use, troubleshoot, or maintain. One institution's solution for making manufacturer information available in the practice setting was to create a facility intranet site dedicated to OR equipment manuals. This site provides information access to perioperative nurses and support staff members and, ultimately, helps improve patient care.

  16. [Prevention of perioperative hypothermia : Implementation of the S3 guideline].

    PubMed

    Horn, E-P; Klar, E; Höcker, J; Bräuer, A; Bein, B; Wulf, H; Torossian, A

    2017-01-09

    To improve perioperative quality and patient safety, the German S3 guideline should be consistently implemented to avoid perioperative hypothermia. Perioperative normothermia is a quality indicator and should be achieved by anesthesiologists and surgeons. To detect hypothermia early during the perioperative process, measuring body temperature should be started 1-2 h preoperatively. Patients should be actively warmed for 20-30 min before starting anesthesia. Prewarming is most effective and should be included in the preoperative process. Patients should be informed about the risks of perioperative hypothermia and members of the perioperative team should be educated. A standard operating procedure (SOP) to avoid hypothermia should be introduced in every operative unit. The incidence of postoperative hypothermia should be evaluated in operative patients every 3-6 months. The goals should be to measure body temperature in >80% of patients undergoing surgery and for >70% to exhibit a core temperature >36 °C at the end of surgery.

  17. Perioperative management of antithrombotic therapy in cardiovascular patients.

    PubMed

    Nuttall, Marc T; Rodgers, George M

    2011-01-01

    Many patients with underlying cardiovascular disease require long-term anticoagulation. The perioperative or periprocedural management of patients who require temporary interruption of anticoagulant or antiplatelet medications is a common and often challenging clinical problem. It requires a fine balance between the risk of thromboembolic events during anticoagulant interruption and the risk of bleeding in the setting of antithrombotic therapy administered around the time of surgery. Interruption of anticoagulation is associated with an increased risk of thromboembolic events. Stratifying patients into thromboembolic risk groups may be helpful in directing anticoagulation management in the perioperative setting. Bridging anticoagulation, generally with low-molecular-weight heparin (LMWH), is often an integral part of perioperative thrombosis risk reduction. Perioperative anticoagulation management varies depending on the indication for anticoagulation and the anticoagulant or antiplatelet agent being used by the patient. In this article, we review some of the general principles involved with perioperative anticoagulation and discuss the perioperative management of patients taking vitamin K antagonists (VKAs), bridging regimens for anticoagulants and antiplatelet agents, and strategies for managing patients on the newer oral anticoagulants.

  18. 78 FR 45907 - United States Standards for Grades of Frozen Vegetables

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-30

    .... The grade standards covered by these revisions are: frozen asparagus, frozen lima beans, frozen speckled butter beans, frozen cooked squash, frozen summer squash, frozen sweetpotatoes, frozen turnip..., lima beans, speckled butter beans, cooked squash, summer squash, etc., and not other vegetables....

  19. Perioperative visual loss after spine surgery.

    PubMed

    Nickels, Travis J; Manlapaz, Mariel R; Farag, Ehab

    2014-04-18

    Perioperative visual loss (POVL) is an uncommon, but devastating complication that remains primarily associated with spine and cardiac surgery. The incidence and mechanisms of visual loss after surgery remain difficult to determine. According to the American Society of Anesthesiologists Postoperative Visual Loss Registry, the most common causes of POVL in spine procedures are the two different forms of ischemic optic neuropathy: anterior ischemic optic neuropathy and posterior ischemic optic neuropathy, accounting for 89% of the cases. Retinal ischemia, cortical blindness, and posterior reversible encephalopathy are also observed, but in a small minority of cases. A recent multicenter case control study has identified risk factors associated with ischemic optic neuropathy for patients undergoing prone spinal fusion surgery. These include obesity, male sex, Wilson frame use, longer anesthetic duration, greater estimated blood loss, and decreased percent colloid administration. These risk factors are thought to contribute to the elevation of venous pressure and interstitial edema, resulting in damage to the optic nerve by compression of the vessels that feed the optic nerve, venous infarction or direct mechanical compression. This review will expand on these findings as well as the recently updated American Society of Anesthesiologists practice advisory on POVL. There are no effective treatment options for POVL and the diagnosis is often irreversible, so efforts must focus on prevention and risk factor modification. The role of crystalloids versus colloids and the use of α-2 agonists to decrease intraocular pressure during prone spine surgery will also be discussed as a potential preventative strategy.

  20. Perioperative management of the chronically anticoagulated patient.

    PubMed

    Heit, J A

    2001-09-01

    Common indications for chronic anticoagulation include mechanical prosthetic heart valve, non-rheumatic atrial fibrillation, and venous thromboembolism. Perioperative management of the chronically anticoagulated patient is a complex medical problem, and includes the following issues: urgency of surgery, risk of thromboembolism in the absence of anticoagulation, bleeding risk, consequences of bleeding, ability to control bleeding physically, and duration of bleeding risk after the procedure. Most patients can be managed safely by stopping oral anticoagulants 4-5 days before surgery and restarting anticoagulation after the procedure at the patient's usual daily dose. In general, dental procedures and cataract extraction can be performed without interrupting anticoagulation. Most other procedures can be safely performed with an INR < or = 1.4. For patients with double-wing prosthetic valves (e.g., St. Jude, Carbomedics) in the aortic position, uncomplicated atrial fibrillation, or a remote (>3 months) history of venous thromboembolism, oral anticoagulants can be stopped 4-5 days before surgery and restarted at the usual daily dose immediately after surgery. For other patients at higher risk of thrombosis, "bridging therapy" with outpatient low molecular weight heparin is safe and effective. For urgent procedures, a small dose of oral vitamin K usually will reduce the INR within 24-36 hours to a level sufficient for surgery and avoids exposure to transfused blood products.

  1. [Perioperative antibiotic prophylaxis in cancer surgery].

    PubMed

    Vilar-Compte, Diana; García-Pasquel, María José

    2011-01-01

    The effectiveness of perioperative antibiotic prophylaxis in reducing surgical site infections has been demonstrated. Its utility is recognized for clean-contaminated procedures and some clean surgeries. Prophylactic antibiotics are used as intended to cover the most common germs in the surgical site; first and second generation cephalosporins are the most used. For optimal prophylaxis, an antibiotic with a targeted spectrum should be administered at sufficiently high concentrations in serum, tissue, and the surgical wound during the time that the incision is open and risk of bacterial contamination. The infusion of the first dose of antimicrobial should begin within 60 min before surgical incision and should be discontinued within 24 h after the end of surgery The prolonged use of antibiotic prophylaxis leads to emergence of bacterial resistance and high costs. The principles of antimicrobial prophylaxis in cancer surgery are the same as those described for general surgery; it is recommended to follow and comply with the standard criteria. In mastectomies and clean head and neck surgery there are specific recommendations that differ from non-cancer surgery. In the case of very extensive surgeries, such as pelvic surgery or bone surgery with reconstruction, extension of antibiotics for 48-72 h should be considered.

  2. 7 CFR 318.13-13 - Movement of frozen fruits and vegetables.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 5 2012-01-01 2012-01-01 false Movement of frozen fruits and vegetables. 318.13-13 Section 318.13-13 Agriculture Regulations of the Department of Agriculture (Continued) ANIMAL AND PLANT... be held at a temperature not higher than 20 °F during shipping and upon arrival in the...

  3. 7 CFR 318.13-13 - Movement of frozen fruits and vegetables.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 5 2011-01-01 2011-01-01 false Movement of frozen fruits and vegetables. 318.13-13 Section 318.13-13 Agriculture Regulations of the Department of Agriculture (Continued) ANIMAL AND PLANT... be held at a temperature not higher than 20 °F during shipping and upon arrival in the...

  4. 77 FR 1053 - Certain Frozen Warmwater Shrimp From the Socialist Republic of Vietnam: Preliminary Results of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-01-09

    ..., 1066- 1068 (Review), USITC Publication 4221, March 2011 (``ITC Review Final''). Non-Market Economy... non-market (``NME'') country. In accordance with section 771(18)(C)(i) of the Act, any determination... applies to NME countries. \\10\\ See Certain Frozen Fish Fillets from the Socialist Republic of...

  5. 76 FR 20627 - Certain Frozen Warmwater Shrimp From the Socialist Republic of Vietnam: Preliminary Results of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-13

    ...-Market Economy Country Status In every case conducted by the Department involving Vietnam, Vietnam has been treated as a non-market (``NME'') country. In accordance with section 771(18)(C)(i) of the Act... NME countries. \\6\\ See Certain Frozen Fish Fillets From the Socialist Republic of Vietnam:...

  6. 9 CFR 381.148 - Processing and handling requirements for frozen poultry products.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... for frozen poultry products. 381.148 Section 381.148 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE AGENCY ORGANIZATION AND TERMINOLOGY; MANDATORY MEAT AND POULTRY PRODUCTS INSPECTION AND VOLUNTARY INSPECTION AND CERTIFICATION POULTRY PRODUCTS INSPECTION...

  7. 9 CFR 381.148 - Processing and handling requirements for frozen poultry products.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... for frozen poultry products. 381.148 Section 381.148 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE AGENCY ORGANIZATION AND TERMINOLOGY; MANDATORY MEAT AND POULTRY PRODUCTS INSPECTION AND VOLUNTARY INSPECTION AND CERTIFICATION POULTRY PRODUCTS INSPECTION...

  8. 9 CFR 381.148 - Processing and handling requirements for frozen poultry products.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... for frozen poultry products. 381.148 Section 381.148 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE AGENCY ORGANIZATION AND TERMINOLOGY; MANDATORY MEAT AND POULTRY PRODUCTS INSPECTION AND VOLUNTARY INSPECTION AND CERTIFICATION POULTRY PRODUCTS INSPECTION...

  9. 9 CFR 381.148 - Processing and handling requirements for frozen poultry products.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... for frozen poultry products. 381.148 Section 381.148 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE AGENCY ORGANIZATION AND TERMINOLOGY; MANDATORY MEAT AND POULTRY PRODUCTS INSPECTION AND VOLUNTARY INSPECTION AND CERTIFICATION POULTRY PRODUCTS INSPECTION...

  10. 9 CFR 381.148 - Processing and handling requirements for frozen poultry products.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... for frozen poultry products. 381.148 Section 381.148 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE AGENCY ORGANIZATION AND TERMINOLOGY; MANDATORY MEAT AND POULTRY PRODUCTS INSPECTION AND VOLUNTARY INSPECTION AND CERTIFICATION POULTRY PRODUCTS INSPECTION...

  11. 21 CFR 104.47 - Frozen “heat and serve” dinner.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Frozen âheat and serveâ dinner. 104.47 Section 104.47 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION NUTRITIONAL QUALITY GUIDELINES FOR FOODS Specific Nutritional...

  12. Three-dimensional reconstruction of frozen and thawed plant tissues from microscopic images

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Histological analysis of frozen and thawed plants has been conducted for many years but the observation of individual sections only provides a 2 dimensional representation of a 3 dimensional phenomenon. Most techniques for viewing internal plant structure in 3 dimensions is either low in resolution...

  13. 21 CFR 146.121 - Frozen concentrate for artificially sweetened lemonade.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 403(j) of the act. (f) Label declaration. Each of the ingredients used in the food shall be declared... 21 Food and Drugs 2 2011-04-01 2011-04-01 false Frozen concentrate for artificially sweetened lemonade. 146.121 Section 146.121 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH...

  14. 21 CFR 146.121 - Frozen concentrate for artificially sweetened lemonade.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 403(j) of the act. (f) Label declaration. Each of the ingredients used in the food shall be declared... 21 Food and Drugs 2 2012-04-01 2012-04-01 false Frozen concentrate for artificially sweetened lemonade. 146.121 Section 146.121 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH...

  15. Maintaining perioperative normothermia in the patient undergoing cesarean delivery.

    PubMed

    Carpenter, Lavenia; Baysinger, Curtis L

    2012-07-01

    Anesthesia and surgery interfere with normal thermoregulation, and nearly all patients will become hypothermic unless compensatory measures are used. Preoperative patient warming and intraoperative methods using forced air and warmed intravenous fluids are important methods for maintaining patient's core temperature during the perioperative period. The benefits of maintaining normothermia include reductions in postoperative wound infection, the risk of perioperative coagulopathy, and myocardial ischemia. These advantages, demonstrated in patients undergoing general surgery, would be expected in patients undergoing gynecological surgery but have not been specifically studied in that population. Few studies have examined the maternal and neonatal effects of hypothermia after cesarean delivery. The results conflict as to the effectiveness of maternal warming techniques used to prevent it and the effects on neonatal temperature and acid-base status at delivery. Large prospective studies will be required to show significant effects on rates of maternal wound infection after cesarean delivery. European and American national obstetrical organizations have not published recommendations regarding the perioperative thermal regulation for cesarean delivery. We review the physiology of thermal regulation and perioperative thermal management in surgical patients and the literature that has examined perioperative maternal warming for cesarean delivery.

  16. Life after death: the aftermath of perioperative catastrophes.

    PubMed

    Gazoni, Farnaz M; Durieux, Marcel E; Wells, Lynda

    2008-08-01

    Most anesthesiologists will experience the perioperative death of a patient or a major perioperative catastrophe in the course of their careers. Anesthesia training, however, does not prepare individuals to handle the aftermath of such a stressful event. Multiple surveys have shown that the death of a patient has a major emotional impact on up to 75% of health care providers involved, regardless of whether the death was expected or whether the patient was well known to the practitioner. Psychological recovery often takes weeks or months and is hampered by lack of emotional and professional support. Data indicate that the majority of anesthesiologists would prefer a more formal support structure, including the option to take time off from clinical work. Although a formal assessment of professional functioning after a perioperative catastrophe has not been done, the Association of Anaesthetists of Great Britain and Ireland instituted guidelines recommending support at multiple levels, and the "Adverse Event Protocol" available on the Anesthesia Patient Safety Foundation website provides a suggested series of steps to minimize patient injury and identify the cause of an adverse anesthesia event after it occurs. The negative consequences of failure to cope well after these events are significant to individuals and health care systems alike. Further study into the short-term and long-term impact of perioperative catastrophes on providers and health systems is needed. Additionally, education on how to handle the aftermath of perioperative catastrophes and formal support structures should be provided to practitioners at all levels of training.

  17. 21 CFR 158.170 - Frozen peas.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ..., frozen peas shall contain not less than 80 percent by weight of peas of the size declared or of smaller sizes. The sample unit may not contain more than 20 percent by weight of peas of the next two larger sizes, of which not more than one quarter by weight of such peas may be of the larger of these two...

  18. Using frozen sugarcane for alcohol production

    SciTech Connect

    Irvine, J.E.

    1980-01-01

    The three areas that produce sugarcane in the mainland US are subject to crop-damaging freezes. Florida has fewer freezes. Texas and Louisiana are hurt frequently. Hard freezes end processing for sugar production when dextrans form and prevent crystallization. Dextran is formed from sugar by bacteria. Work at the Audubon Sugar Institute, LSU, has shown that crystallization of sucrose can be achieved with juice from frozen sugarcane when enzymes are used to reduce the size of the dextran molecule. Frozen cane may also be processed for alcohol production. How long the cane would be suitable as feedstock was questioned; its use would depend on sugar content. Sugarcane has been tested for post-freeze deterioration at the US Sugarcane Field Laboratory for over 50 years, and the emphasis has been on the response of varieties selected for sugar production in post-freeze deterioration. The data indicated that juice from frozen sugarcane in any of the tests would be adequate for alcohol production; fermentation based on mash with a sugar content of 9 to 11% for rum, and 15% for industrial alcohol. Total fermentable carbohydrates in frozen cane would be even higher since the data did not include invert sugars or starch. 1 table. (DP)

  19. 7 CFR 58.349 - Frozen cream.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... Products Bearing Usda Official Identification § 58.349 Frozen cream. The flavor shall be sweet, pleasing and desirable, but may possess the following flavors to a slight degree: Aged, bitter, flat, smothered, storage; and cooked and feed flavors to a definite degree. It shall be free from rancid, oxidized or...

  20. Exclusion of Nitrate from Frozen Aqueous Solutions

    NASA Astrophysics Data System (ADS)

    Marrocco, H. A.; Michelsen, R. R.

    2013-12-01

    Reactions occurring at the surface of ice, sea ice, and snow in Earth's cryosphere have an impact on the composition of the overlying atmosphere. In order to elucidate reaction mechanisms and model their contributions to atmospheric processes, the morphology of frozen aqueous surfaces and amounts of reactants contained therein must be determined. To this end, the exclusion of nitrate ions to the surface of frozen aqueous solutions has been studied by attenuated total reflection infrared spectroscopy (ATR-IR). In this technique the near-surface region of the frozen films are interrogated to a depth of a few hundred nanometers from the film-crystal interface. Aqueous solutions (0.001 to 0.01 M) of sodium nitrate (NaNO3), magnesium nitrate (Mg(NO3)2), and nitric acid (HNO3) were quickly frozen on the germanium ATR crystal and observed at a constant temperature of about -18°C. In addition to ice and the solutes, liquid water in varying amounts was observed in the spectra. The amount of nitrate in the surface liquid is three to four orders of magnitude higher than in the unfrozen solution. While all the nitrate salts exhibit exclusion to the unfrozen surface, the dynamics are different for different counter-ions. Results are compared to freezing point depression data and the predictions of equilibrium thermodynamics.

  1. Frozen yogurt with added inulin and isomalt.

    PubMed

    Isik, U; Boyacioglu, D; Capanoglu, E; Erdil, D Nilufer

    2011-04-01

    The objective of this study was to produce a frozen yogurt containing low fat and no added sugar. Samples containing 5% polydextrose, 0.065% aspartame and acesulfame-K mixture, and different levels of inulin and isomalt (5.0, 6.5, and 8.0%) were produced at pilot scale and analyzed for their physical and chemical properties including proximate composition, viscosity, acidity, overrun, melting rate, heat shock stability, as well as sensory characteristics, and viability of lactic acid bacteria. With the addition of inulin and isomalt, viscosity increased by 19 to 52% compared with that of sample B (reduced-fat control). The average calorie values of samples substituted with sweeteners were about 43% lower than that of original sample. Low-calorie frozen yogurt samples melted about 33 to 48% slower than the reduced-fat control sample at 45 min. Based on quantitative descriptive profile test results, statistically significant differences among products were observed for hardness, iciness, foamy melting, whey separation, and sweetness characteristics. The results of principal component analysis showed that the sensory properties of the sample containing 6.5% inulin and 6.5% isomalt were similar to those of control. Lactic acid bacteria counts of frozen yogurt were found to be between 8.12 and 8.49 log values, 3 mo after the production. The overall results showed that it is possible to produce an attractive frozen yogurt product with the incorporation of inulin and isomalt with no added sugar and reduced fat.

  2. Perioperative medical management of patients with COPD

    PubMed Central

    Licker, Marc; Schweizer, Alexandre; Ellenberger, Christoph; Tschopp, Jean-Marie; Diaper, John; Clergue, François

    2007-01-01

    Chronic obstructive pulmonary disease (COPD) and heart diseases are considered independent risk factors for mortality and major cardiopulmonary complications after surgery. Coronary artery disease, heart failure and COPD share common risk factors and are often encountered, - isolated or combined -, in many surgical candidates. Perioperative optimization of these high-risk patients deserves a thorough understanding of the patient cardiopulmonary diseases as well as the respiratory consequences of surgery and anesthesia. In contrast with cardiac risk stratification where the extent of heart disease largely influences postoperative cardiac outcome, surgical-related factors (ie, upper abdominal and intra-thoracic procedures, duration of anesthesia, presence of a nasogastric tube) largely dominate patient’s comorbidities as risk factors for postoperative pulmonary complications. Although most COPD patients tolerate tracheal intubation under “smooth” anesthetic induction without serious adverse effects, regional anesthetic blockade and application of laryngeal masks or non-invasive positive pressure ventilation should be considered whenever possible, in order to provide optimal pain control and to prevent upper airway injuries as well as lung baro-volotrauma. Minimally-invasive procedures and modern multimodal analgesic regimen are helpful to minimize the surgical stress response, to speed up the physiological recovery process and to shorten the hospital stay. Reflex-induced bronchoconstriction and hyperdynamic inflation during mechanical ventilation could be prevented by using bronchodilating volatile anesthetics and adjusting the ventilatory settings with long expiration times. Intraoperatively, the depth of anesthesia, the circulatory volume and neuromuscular blockade should be assessed with modern physiological monitoring tools to titrate the administration of anesthetic agents, fluids and myorelaxant drugs. The recovery of postoperative lung volume can be

  3. [Pathophysiology and management of perioperative hypothermia].

    PubMed

    Witkowski, Wojciech; Maj, Jakub

    2006-06-01

    The paper is a review of pathophysiology and management of perioperative hypothermia. The advanced methods of rewarming, such as passive and active: external and core used in clinic allow for efficient management ant prophylactics of hypothermia. Thermotherapy with use of infrared ceiling heaters CTS and mobile MTC as well as Infutherm system applying by authors are desirable and even indispensable in contemporary equipment of surgery clinics, cardiovascular surgery clinics and burn centers. The ideal rewarming method should be safe and enable fast, reliable and predictable warming or rewarming. The clinical parameter to determine the efficacy of rewarming is the change of core temperature. There is no doubt that active warming with forced-air warmers (Warm Touch 5700 and Bair Hugger 500) or radiative heaters (IR-A:Hydrosun 500, IR-C radiation: CTC X, MTC) is more effective than use of standard, passive insulation hospital blankets or convectional heaters. Actually the forced-air warmers are counted to be more useful in cardiovascular surgery hypothermia management, because of fast rate core temperature rise and faster rise in mean skin temperature compared to the control group. CTC X and MTC Aragona radiative heaters are useful in burn management being the most effective when the distance of heater from the patient body is less than 80 cm. The observation of 60 consecutive extensive burns leads to conclusion that long-lasting dressings in burn patients when the whole body is not covered and protected, can be performed safely only in conditions excluding heat losses and core temperature drop. While the cold intravenous fluids may significantly contribute to the temperature drop depending on the volume infused, the use of fluids warming systems as well as external heat application is absolutely indicated to improve the heat balance of the patient body.

  4. 21 CFR 864.9145 - Processing system for frozen blood.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Processing system for frozen blood. 864.9145... Blood and Blood Products § 864.9145 Processing system for frozen blood. (a) Identification. A processing system for frozen blood is a device used to glycerolize red blood cells prior to freezing to...

  5. 21 CFR 864.9145 - Processing system for frozen blood.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Processing system for frozen blood. 864.9145... Blood and Blood Products § 864.9145 Processing system for frozen blood. (a) Identification. A processing system for frozen blood is a device used to glycerolize red blood cells prior to freezing to...

  6. 21 CFR 864.9145 - Processing system for frozen blood.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Processing system for frozen blood. 864.9145... Blood and Blood Products § 864.9145 Processing system for frozen blood. (a) Identification. A processing system for frozen blood is a device used to glycerolize red blood cells prior to freezing to...

  7. 21 CFR 864.9145 - Processing system for frozen blood.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Processing system for frozen blood. 864.9145... Blood and Blood Products § 864.9145 Processing system for frozen blood. (a) Identification. A processing system for frozen blood is a device used to glycerolize red blood cells prior to freezing to...

  8. 21 CFR 864.9145 - Processing system for frozen blood.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Processing system for frozen blood. 864.9145... Blood and Blood Products § 864.9145 Processing system for frozen blood. (a) Identification. A processing system for frozen blood is a device used to glycerolize red blood cells prior to freezing to...

  9. 48 CFR 870.111-5 - Frozen processed food products.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 48 Federal Acquisition Regulations System 5 2011-10-01 2011-10-01 false Frozen processed food... DEPARTMENT SUPPLEMENTARY REGULATIONS SPECIAL PROCUREMENT CONTROLS Controls 870.111-5 Frozen processed food products. (a) The following frozen processed food products must have a label complying with the...

  10. 48 CFR 846.302-72 - Frozen processed foods.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Frozen processed foods... CONTRACT MANAGEMENT QUALITY ASSURANCE Contract Clauses 846.302-72 Frozen processed foods. The contracting officer shall insert the clause at 852.246-72, Frozen processed foods, in solicitations and contracts...

  11. 48 CFR 870.111-5 - Frozen processed food products.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Frozen processed food... DEPARTMENT SUPPLEMENTARY REGULATIONS SPECIAL PROCUREMENT CONTROLS Controls 870.111-5 Frozen processed food products. (a) The following frozen processed food products must have a label complying with the...

  12. 48 CFR 846.302-72 - Frozen processed foods.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 48 Federal Acquisition Regulations System 5 2011-10-01 2011-10-01 false Frozen processed foods... CONTRACT MANAGEMENT QUALITY ASSURANCE Contract Clauses 846.302-72 Frozen processed foods. The contracting officer shall insert the clause at 852.246-72, Frozen processed foods, in solicitations and contracts...

  13. 48 CFR 846.302-72 - Frozen processed foods.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 48 Federal Acquisition Regulations System 5 2014-10-01 2014-10-01 false Frozen processed foods... CONTRACT MANAGEMENT QUALITY ASSURANCE Contract Clauses 846.302-72 Frozen processed foods. The contracting officer shall insert the clause at 852.246-72, Frozen processed foods, in solicitations and contracts...

  14. 48 CFR 870.111-5 - Frozen processed food products.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 48 Federal Acquisition Regulations System 5 2013-10-01 2013-10-01 false Frozen processed food... DEPARTMENT SUPPLEMENTARY REGULATIONS SPECIAL PROCUREMENT CONTROLS Controls 870.111-5 Frozen processed food products. (a) The following frozen processed food products must have a label complying with the...

  15. 48 CFR 870.111-5 - Frozen processed food products.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 48 Federal Acquisition Regulations System 5 2012-10-01 2012-10-01 false Frozen processed food... DEPARTMENT SUPPLEMENTARY REGULATIONS SPECIAL PROCUREMENT CONTROLS Controls 870.111-5 Frozen processed food products. (a) The following frozen processed food products must have a label complying with the...

  16. 48 CFR 846.302-72 - Frozen processed foods.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 48 Federal Acquisition Regulations System 5 2013-10-01 2013-10-01 false Frozen processed foods... CONTRACT MANAGEMENT QUALITY ASSURANCE Contract Clauses 846.302-72 Frozen processed foods. The contracting officer shall insert the clause at 852.246-72, Frozen processed foods, in solicitations and contracts...

  17. 48 CFR 846.302-72 - Frozen processed foods.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 48 Federal Acquisition Regulations System 5 2012-10-01 2012-10-01 false Frozen processed foods... CONTRACT MANAGEMENT QUALITY ASSURANCE Contract Clauses 846.302-72 Frozen processed foods. The contracting officer shall insert the clause at 852.246-72, Frozen processed foods, in solicitations and contracts...

  18. 48 CFR 870.111-5 - Frozen processed food products.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... DEPARTMENT SUPPLEMENTARY REGULATIONS SPECIAL PROCUREMENT CONTROLS Controls 870.111-5 Frozen processed food products. (a) The following frozen processed food products must have a label complying with the Federal... 48 Federal Acquisition Regulations System 5 2014-10-01 2014-10-01 false Frozen processed...

  19. Work-related trauma: the experiences of perioperative nurses.

    PubMed

    Michael, R; Jenkins, H J

    2001-01-01

    Traumatic experiences in the workplace are an integral part of the role of the perioperative nurse. The atypical nature and characteristics of these experiences is such that perioperative nurses may suddenly encounter reactions and feelings that are very different and more intense than anything they will have encountered previously. Furthermore, these events may increase the risk of them experiencing subsequent trauma stress reactions and place them at risk of profound distress and significantly impaired functioning. A survey of 233 nurses working in rural and metropolitan operating theatres assessed the range and types of traumatic work experiences. Results showed that exposure to traumatic events was reported by 161 (69%) of all respondents and a wide range of traumatic experiences were reported to have affected their well-being. The findings have implications for the formulation of trauma management strategies, both at individual and organisational levels and suggest new directions for education and research in promoting a recovery environment in which perioperative nurses can work.

  20. Perioperative normothermia during major surgery: is it important?

    PubMed

    Esnaola, Nestor F; Cole, David J

    2011-01-01

    PH caused by anesthesia-induced thermoregulatory inhibition and exposure to cold operating room environments still occurs in a significant proportion of patients undergoing major surgery. Although the association between specific perioperative temperatures (in and of themselves) and postoperative morbidity remains unclear, there is fair evidence to suggest that perioperative active warming may reduce the risk of postoperative cardiac events, bleeding, and SSIs. As such, proactive efforts by surgical teams to prevent PH are warranted and have become the standard of care at many institutions. Continued intraoperative monitoring of core temperature (ideally using esophageal probes) is recommended in all cases lasting more than 30 minutes, both to detect malignant hyperthermia and to maintain normothermia. Preoperative and/or intraoperative use of warmed forced-air devices is an effective way to minimize redistribution hypothermia following induction, whereas intraoperative use of warmed i.v. fluids helps reduce the potential for fluid-induced hypothermia and, in turn, optimizes rates of perioperative normothermia.

  1. Quality and Patient Safety Teams in the Perioperative Setting.

    PubMed

    Serino, Michele Fusco

    2015-12-01

    Quality and patient safety teams in the perioperative setting can provide perioperative personnel with a safety net to prevent avoidable errors, which is a necessity in today's complex surgical world. The primary goal of the quality and patient safety team should be to develop and implement a perioperative quality and patient safety strategic plan. The mission of the plan can be developed by surveying facility employees, choosing a quality methodology, and using an evidence-based approach to develop and implement quality programs and processes. To create and sustain a quality and patient safety team, it is important to select a heterogeneous group; define team roles; identify day-to-day, weekly, and monthly team responsibilities; actively participate in facility committees, meetings, and new employee orientation; conduct audits; and schedule project time.

  2. Implementing a Perioperative RN Training Program for Recent Graduates.

    PubMed

    Byrd, Debra; Mullen, Linda; Renfro, David; Harris, Theodore A

    2015-09-01

    In 2010, nurse educators at one health care facility implemented a new program that emphasized placing new graduates in specialty areas, including the hemodialysis unit, the gastroenterology unit, and the OR. Managers in the OR faced staffing challenges because of the difficulty in recruiting and retaining experienced perioperative nurses and the expected retirement of a significant number of staff members. Surgical services managers agreed to participate in the new graduate program and decided to use AORN's Periop 101™ course and a series of monthly simulation training sessions to supplement the program and provide recently graduated nurses with a strong perioperative nursing foundation. In three years, a total of nine newly graduated RNs successfully completed the program. The three-year retention rate was 78%.

  3. Why is perioperative chemotherapy for bladder cancer underutilized?

    PubMed

    Patafio, Francis M; Mackillop, William J; Feldman-Stewart, Deb; Siemens, David Robert; Booth, Christopher M

    2014-05-01

    Despite clinical evidence and recommendations from international treatment guidelines, the use of perioperative chemotherapy for muscle-invasive bladder cancer in routine practice remains low. Although multiple studies have described underutilization, there is an urgent need to better understand the elements contributing to the observed gaps in care. In this commentary, we explore what is known about the factors contributing to underutilization of perioperative chemotherapy for muscle-invasive bladder cancer. We also propose a framework to guide future knowledge translation activities in an effort to improve the care and outcomes of patients with this disease.

  4. Pleiotropic Effects of Statins in the Perioperative Setting

    PubMed Central

    Galyfos, George; Sianou, Argyri; Filis, Konstantinos

    2017-01-01

    Statins belong to a specific group of drugs that have been described for their ability to control hyperlipidemia as well as for other pleiotropic effects such as improving vascular endothelial function, inhibition of oxidative stress pathways, and anti-inflammatory actions. Accumulating clinical evidence strongly suggests that statins also have a beneficial effect on perioperative morbidity and mortality. Therefore, this review aims to present all recent and pooled data on statin treatment in the perioperative setting as well as to highlight considerations regarding their indications and therapeutic application. PMID:28074822

  5. Transdermal rotigotine for the perioperative management of restless legs syndrome

    PubMed Central

    2012-01-01

    Background Immobilisation, blood loss, sleep deficiency, and (concomitant) medications during perioperative periods might lead to acute exacerbation of symptoms in patients with the restless legs syndrome (RLS). Continuous transdermal delivery of the dopamine agonist rotigotine provides stable plasma levels over 24 h and may provide RLS patients with a feasible treatment option for perioperative situations. To assess the feasibility of use of rotigotine transdermal patch for the perioperative management of moderate to severe RLS, long-term data of an open-label extension of a rotigotine dose-finding study were retrospectively reviewed. Methods The data of all 295 patients who had entered the 5-year study were screened independently by two reviewers for the occurrence of surgical interventions during the study period. The following data were included in this post-hoc analysis: patient age, sex, surgical intervention and outcome, duration of hospital stay, rotigotine maintenance dose at the time of surgery, rotigotine dose adjustment, and continuation/discontinuation of rotigotine treatment. All parameters were analysed descriptively. No pre-specified efficacy assessments (e.g. IRLS scores) were available for the perioperative period. Results During the study period, 61 surgical interventions were reported for 52 patients (median age, 63 years; 67% female); the majority of patients (85%) had one surgical intervention. The mean rotigotine maintenance dose at time of surgery was 3.1 ± 1.1 mg/24 h. For most interventions (95%), rotigotine dosing regimens were maintained during the perioperative period. Administration was temporarily suspended in one patient and permanently discontinued in another two. The majority (96%) of the patients undergoing surgery remained in the study following the perioperative period and 30 of these patients (61%) completed the 5-year study. Conclusions Although the data were obtained from a study which was not designed to assess

  6. Ultrasound and its evolution in perioperative regional anesthesia and analgesia.

    PubMed

    Mariano, Edward R; Marshall, Zwade J; Urman, Richard D; Kaye, Alan David

    2014-03-01

    Perioperative regional anesthetic and analgesic techniques have evolved considerably over the past four decades. Perhaps, the most impressive development in recent years has been the rapid adoption and widespread utilization of ultrasound (US) guidance to perform targeted delivery of local anesthetics and catheters in a consistent manner for postoperative pain control. This article briefly reviews the history of US in regional anesthesia and perioperative analgesia, the evidence basis for this practice, the clinical application of novel techniques and imaging modalities, and possible future technology and research directions.

  7. Batch testing for noroviruses in frozen raspberries.

    PubMed

    De Keuckelaere, Ann; Li, Dan; Deliens, Bart; Stals, Ambroos; Uyttendaele, Mieke

    2015-01-02

    Berries, in particular raspberries, have been associated with multiple recalls due to norovirus contamination and were linked to a number of norovirus (NoV) outbreaks. In the present study a total of 130 samples of frozen raspberries were collected from 26 batches in four different raspberry processing companies. In two companies the samples consisted of bulk frozen raspberries serving as raw material for the production of raspberry puree (an intermediate food product in a business to business setting). In two other companies, the samples consisted of bulk individually quick frozen (IQF) raspberries serving as raw material for the production of frozen fruit mixes (as a final food product for consumer). Enumeration of Escherichia coli and coliforms was performed as well as real-time reverse transcription PCR (RT-qPCR) detection of GI and GII NoV (in 2 × 10 g). In addition, in cases where positive NoV GI or GII RT-qPCR signals were obtained, an attempt to sequence the amplicons was undertaken. Six out of 70 samples taken from the 14 batches of frozen raspberries serving raspberry puree production provided a NoV RT-qPCR signal confirmed by sequencing. Four of these six positive samples clustered in one batch whereas the other two positive samples clustered in another batch from the same company. All six positive samples showed NoV RT-qPCR signals above the limit of quantification of the RT-qPCR assay. These two positive batches of frozen raspberries can be classified as being of insufficient sanitary quality. The mean NoV level in 20 g of these raspberry samples was 4.3 log genomic copies NoV GI/20 g. The concern for public health is uncertain as NoV RT-qPCR detection is unable to discriminate between infectious and non-infectious virus particles. For the IQF raspberries, one batch out of 12 tested NoV positive, but only 1 out of the 5 samples analyzed in this batch showed a positive RT-qPCR GI NoV signal confirmed by sequencing. The RT-qPCR signal was below the

  8. The Jefferson Lab frozen spin target

    NASA Astrophysics Data System (ADS)

    Keith, C. D.; Brock, J.; Carlin, C.; Comer, S. A.; Kashy, D.; McAndrew, J.; Meekins, D. G.; Pasyuk, E.; Pierce, J. J.; Seely, M. L.

    2012-08-01

    A frozen spin polarized target, constructed at Jefferson Lab for use inside a large acceptance spectrometer, is described. The target has been utilized for photoproduction measurements with polarized tagged photons of both longitudinal and circular polarization. Protons in TEMPO-doped butanol were dynamically polarized to approximately 90% outside the spectrometer at 5 T and 200-300 mK. Photoproduction data were acquired with the target inside the spectrometer at a frozen-spin temperature of approximately 30 mK with the polarization maintained by a thin, superconducting coil installed inside the target cryostat. A 0.56 T solenoid was used for longitudinal target polarization and a 0.50 T dipole for transverse polarization. Spin-lattice relaxation times as high as 4000 h were observed. We also report polarization results for deuterated propanediol doped with the trityl radical OX063.

  9. The Jefferson Lab Frozen Spin Target

    SciTech Connect

    Christopher Keith, James Brock, Christopher Carlin, Sara Comer, David Kashy, Josephine McAndrew, David Meekins, Eugene Pasyuk, Joshua Pierce, Mikell Seely

    2012-08-01

    A frozen spin polarized target, constructed at Jefferson Lab for use inside a large acceptance spectrometer, is described. The target has been utilized for photoproduction measurements with polarized tagged photons of both longitudinal and circular polarization. Protons in TEMPO-doped butanol were dynamically polarized to approximately 90% outside the spectrometer at 5 T and 200-300 mK. Photoproduction data were acquired with the target inside the spectrometer at a frozen-spin temperature of approximately 30 mK with the polarization maintained by a thin, superconducting coil installed inside the target cryostat. A 0.56 T solenoid was used for longitudinal target polarization and a 0.50 T dipole for transverse polarization. Spin relaxation times as high as 4000 hours were observed. We also report polarization results for deuterated propanediol doped with the trityl radical OX063.

  10. Drug response in organoids generated from frozen primary tumor tissues

    PubMed Central

    Walsh, Alex J.; Cook, Rebecca S.; Sanders, Melinda E.; Arteaga, Carlos L.; Skala, Melissa C.

    2016-01-01

    Primary tumor organoids grown in three-dimensional culture provide an excellent platform for studying tumor progression, invasion, and drug response. However, organoid generation protocols require fresh tumor tissue, which limits organoid research and clinical use. This study investigates cellular morphology, viability, and drug response of organoids derived from frozen tissues. The results demonstrate that viable organoids can be grown from flash-frozen and thawed tissue and from bulk tissues slowly frozen in DMSO supplemented media. While the freezing process affects the basal metabolic rate of the cells, the optical metabolic imaging index correlates between organoids derived from fresh and frozen tissue and can be used to detect drug response of organoids grown from frozen tissues. The slow, DMSO frozen tissue yielded organoids with more accurate drug response than the flash frozen tissues, and thus bulk tissue should be preserved for subsequent organoid generation by slow freezing in DMSO supplemented media. PMID:26738962

  11. Drug response in organoids generated from frozen primary tumor tissues.

    PubMed

    Walsh, Alex J; Cook, Rebecca S; Sanders, Melinda E; Arteaga, Carlos L; Skala, Melissa C

    2016-01-07

    Primary tumor organoids grown in three-dimensional culture provide an excellent platform for studying tumor progression, invasion, and drug response. However, organoid generation protocols require fresh tumor tissue, which limits organoid research and clinical use. This study investigates cellular morphology, viability, and drug response of organoids derived from frozen tissues. The results demonstrate that viable organoids can be grown from flash-frozen and thawed tissue and from bulk tissues slowly frozen in DMSO supplemented media. While the freezing process affects the basal metabolic rate of the cells, the optical metabolic imaging index correlates between organoids derived from fresh and frozen tissue and can be used to detect drug response of organoids grown from frozen tissues. The slow, DMSO frozen tissue yielded organoids with more accurate drug response than the flash frozen tissues, and thus bulk tissue should be preserved for subsequent organoid generation by slow freezing in DMSO supplemented media.

  12. Frozen soil barriers for hazardous waste confinement

    SciTech Connect

    Dash, J.G.; Leger, R.; Fu, H.Y.

    1997-12-31

    Laboratory and full field measurements have demonstrated the effectiveness of artificial ground freezing for the containment of subsurface hazardous and radioactive wastes. Bench tests and a field demonstration have shown that cryogenic barriers are impenetrable to aqueous and non aqueous liquids. As a result of the successful tests the US Department of Energy has designated frozen ground barriers as one of its top ten remediation technologies.

  13. Demonstration of an Artificial Frozen Barrier

    DTIC Science & Technology

    2012-11-01

    used for deep excavation, tunneling, and underground construction ( Hass and Schäfers 2006). Frozen barriers can be created us- ing artificial...adjacent are soil, rock, or other solids. These mate- rials usually cause problems when more traditional techniques, such as grouting, are used ( Hass ...H. M. 2007. The periglacial environment. Chichester: J. Wiley. Hass , H., and P. Schäfers. 2006. Application of ground freezing for underground

  14. A Comparison of Raman Spectral Features of Frozen and Deparaffinized Tissues in Neuroblastoma and Ganglioneuroma

    NASA Astrophysics Data System (ADS)

    Devpura, Suneetha; Thakur, Jagdish S.; Poulik, Janet M.; Rabah, Raja; Naik, Vaman M.; Naik, Ratna

    2012-02-01

    We have investigated the cellular regions in neuroblastoma and ganglioneuroma using Raman spectroscopy and compared their spectral characteristics with those of normal adrenal gland. Thin sections from both frozen and deparaffinized tissues, obtained from the same tissue specimen, were studied in conjunction with the pathological examination of the tissues. We found a significant difference in the spectral features of frozen sections of normal adrenal gland, neuroblastoma, and ganglioneuroma when compared to deparaffinized tissues. The quantitative analysis of the Raman data using chemometric methods of principal component analysis and discriminant function analysis obtained from the frozen tissues show a sensitivity and specificity of 100% each. The biochemical identification based on the spectral differences shows that the normal adrenal gland tissues have higher levels of carotenoids, lipids, and cholesterol compared to the neuroblastoma and ganglioneuroma frozen tissues. However, deparaffinized tissues show complete removal of these biochemicals in adrenal tissues. This study demonstrates that Raman spectroscopy combined with chemometric methods can successfully distinguish neuroblastoma and ganglioneuroma at cellular level.

  15. Existence of frozen-in coordinate systems

    NASA Technical Reports Server (NTRS)

    Chertkov, A. D.

    1995-01-01

    The 'frozen-in' coordinate systems were first introduced in the works on 'reconnection' and 'magnetic barrier' theories (see review by M.l.Pudovkin and V.S.Semenov, Space Sci. Rev. 41,1 1985). The idea was to utilize the mathematical apparatus developed for 'general relativity' theory to simplify obtaining solutions to the ideal MHD equations set. Magnetic field (B), plasma velocity (v), and their vector product were used as coordinate vectors. But there exist no stationary solutions of ideal MHD set that satisfies the required boundary conditions at infinity (A.D.Chertkov, Solar Wind Seven Conf.,Pergamon Press,1992,165) having non-zero vector product of v and B where v and B originate from the same sphere. The existence of a solution is the hidden mine of the mentioned theories. The solution is constructed in the coordinate system, which is unknown and indeterminate before obtaining this solution. A substitution of the final solution must be done directly into the initial MHD set in order to check the method. One can demonstrate that 'solutions' of Petschek's problem, obtained by 'frozen-in' coordinate systems, does not satisfy just the 'frozen-in' equation, i.e. induction equation. It stems from the fact that Petschek's 're-connection' model, treated as a boundary problem, is over determined. This problem was incorrectly formulated.

  16. Nuclear protein extraction from frozen porcine myocardium.

    PubMed

    Kuster, Diederik W D; Merkus, Daphne; Jorna, Huub J J; Dekkers, Dick H W; Duncker, Dirk J; Verhoeven, Adrie J M

    2011-06-01

    Protocols for the extraction of nuclear proteins have been developed for cultured cells and fresh tissue, but sometimes only frozen tissue is available. We have optimized the homogenization procedure and subsequent fractionation protocol for the preparation of nuclear protein extracts from frozen porcine left ventricular (LV) tissue. This method gave a highly reproducible protein yield (6.5±0.7% of total protein; mean±SE, n=9) and a 6-fold enrichment of the nuclear marker protein B23. The nuclear protein extracts were essentially devoid of cytosolic, myofilament, and histone proteins. Compared to nuclear extracts from fresh LV tissue, some loss of nuclear proteins to the cytosolic fraction was observed. Using this method, we studied the distribution of tyrosine phosphorylated signal transducer and activator of transcription 3 (PY-STAT3) in LV tissue of animals treated with the β-agonist dobutamine. Upon treatment, PY-STAT3 increased 30.2±8.5-fold in total homogenates, but only 6.9±2.1-fold (n=4, P=0.03) in nuclear protein extracts. Of all PY-STAT3 formed, only a minor fraction appeared in the nuclear fraction. This simple and reproducible protocol yielded nuclear protein extracts that were highly enriched in nuclear proteins with almost complete removal of cytosolic and myofilament proteins. This nuclear protein extraction protocol is therefore well-suited for nuclear proteome analysis of frozen heart tissue collected in biobanks.

  17. Rapid detection of irradiated frozen hamburgers

    NASA Astrophysics Data System (ADS)

    Delincée, Henry

    2002-03-01

    DNA comet assay can be employed as a rapid and inexpensive screening test to check whether frozen ground beef patties (hamburgers) have been irradiated as a means to increase their safety by eliminating pathogenic bacteria, e.g. E. coli O157:H7. Such a detection procedure will provide an additional check on compliance with existing regulations, e.g. enforcement of labelling and rules in international trade. Frozen ready prepared hamburgers from the market place were `electron irradiated' with doses of 0, 1.3, 2.7, 4.5 and 7.2kGy covering the range of potential commercial irradiation. DNA fragmentation in the hamburgers was made visible within a few hours using the comet assay, and non-irradiated hamburgers could be easily discerned from the irradiated ones. Even after 9 months of frozen storage, irradiated hamburgers could be identified. Since DNA fragmentation may also occur with other food processes (e.g. temperature abuse), positive screening tests shall be confirmed using a validated method to specifically prove an irradiation treatment, e.g. EN 1784 or EN 1785.

  18. Perioperative Management of Direct Oral Anticoagulants (DOACs): A Systemic Review

    PubMed Central

    Sunkara, Tagore; Ofori, Emmanuel; Zarubin, Vadim; Caughey, Megan E.; Gaduputi, Vinaya; Reddy, Madhavi

    2016-01-01

    Direct oral anticoagulants (DOACs) are in wide use among patients requiring both short- and long-term anticoagulation, mainly due to their ease of use and the lack of monitoring requirements. With growing use of DOACs, it is imperative that physicians be able to manage patients on these medications, especially in the perioperative period. We aim to provide guidance on the management of DOACs in the perioperative period. In this review, we performed an extensive literature search summarizing the management of patients on direct-acting anticoagulants in the perioperative period. A total of four direct-acting oral anticoagulants were considered appropriate for inclusion in this review. The drugs were dabigatran etexilate mesylate (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis), and edoxaban (Savaysa). Management of patients on DOACs in the perioperative period involves an assessment of thromboembolic event risk while off anticoagulation compared to the relative risk of bleeding if such drug is continued. DOACs may not need to be discontinued in minor surgeries or procedures, and in major surgeries, they may be discontinued hours prior depending on drug pharmacokinetics and renal function of the patients. PMID:28008269

  19. Registered nurse peer evaluation in the perioperative setting.

    PubMed

    Gentry, Melanie B

    2006-09-01

    ANNUAL PERFORMANCE evaluations can be difficult to prepare and may rely, in part, on anecdotal information. PERIOPERATIVE RNs at CHRISTUS St Patrick Hospital, Lake Charles, La, developed and implemented a peer evaluation as part of nurses' annual performance evaluations. THE EVALUATION FORMS created were considered to be useful and fair by both staff members and managers.

  20. Reflections on a perioperative career: 1970-2008.

    PubMed

    Williams, Marilyn

    2009-03-01

    This paper is a personal journey through nurse training and perioperative practice. Nurse education is also explored alongside some of the social, academic and political changes that have influenced healthcare in the United Kingdom between 1966 and 2008. The views expressed are those of the author only, and the anecdotal descriptions are anonymous.

  1. Perioperative considerations in the patient with Angelman syndrome.

    PubMed

    Bevinetto, Cara M; Kaye, Alan D

    2014-02-01

    Angelman syndrome arises by one of 4 genetic mechanisms. Patients often have craniofacial abnormalities, vagal hypertonia, skeletal muscle atrophy or underdevelopment, a history of seizure disorders, and pharmacodynamic unpredictability. Its pathogenesis, clinical manifestations, diagnosis and treatment options, and perioperative anesthetic considerations are presented.

  2. Effects of perioperative hypothermia and warming in surgical practice.

    PubMed

    Kumar, Senthil; Wong, Peng Foo; Melling, Andrew Christian; Leaper, David John

    2005-09-01

    Perioperative hypothermia is common and adversely affects clinical outcomes due to its effect on a range of homeostatic functions. Many of these adverse consequences are preventable by the use of warming techniques. A literature search was conducted to identify relevant published articles on perioperative hypothermia and warming. The databases searched include MEDLINE (1966 to February 2005), EMBASE (1974 to February 2005), CINAHL, the Cochrane library and the health technology assessment database. Reference lists of key articles were also searched. The primary beneficial effects of warming are mediated through increased blood flow and oxygen tension at tissue level. Reduction in wound infection, blood loss and perioperative pain with warming is promising. However, more evidence from good-quality prospective randomised controlled trials is needed to evaluate the role of warming in improving overall morbidity, mortality and hospital stay as well as to clarify its role as an adjunct to resuscitation and during the pre-hospital transport phase of critically ill patients. Awareness of the risks of perioperative hypothermia is the key to prevention. Achieving normothermia throughout the patient's journey is a worthwhile goal in surgical patients.

  3. Perioperative Diabetic Consultation: A Plea for Improved Training

    ERIC Educational Resources Information Center

    Rudd, Peter; And Others

    1978-01-01

    To determine the clinical and educational impact of an academic general internal medicine consultation service, the perioperative management of diabetes mellitus was examined. The findings indicate that consultative skills must be taught more effectively if medical consultations are to have maximal impact. (Author/LBH)

  4. Medical robotics: the impact on perioperative nursing practice.

    PubMed

    Francis, Paula; Winfield, Howard N

    2006-04-01

    Robotic technology and the increased use of minimally invasive surgery approaches is altering the environment in which operating room personnel work and affecting how nurses must care for patients. An understanding of the history of robotics, current applications of the technology, and perioperative nursing responsibilities is needed to assure quality patient care in the wake of continued advances in technology.

  5. Combination Treatment of Perioperative Rehabilitation and Psychoeducation Undergoing Thoracic Surgery

    PubMed Central

    Inoue, Takayuki; Nagaya, Motoki; Ito, Satoru; Nakajima, Hiroki; Hattori, Keiko; Kadono, Izumi; Yokoi, Kohei; Nishida, Yoshihiro

    2017-01-01

    Postoperative pulmonary complications are a risk associated with thoracic surgery. However, there have been few reports on cases at high risk of postoperative complications. Cancer patients often have negative automatic thoughts about illness, and these negative automatic thoughts are associated with reduced health behavior and physical activity. This case series demonstrates the successful combination treatment of perioperative rehabilitation and psychoeducation for negative automatic thoughts in two cancer patients who underwent thoracic surgery. One patient underwent pneumonectomy with laryngeal recurrent nerve paralysis; the other patient, who had a history of recurrent hepatic encephalopathy and dialysis, underwent S6 segmentectomy. Both patients had negative automatic thoughts about cancer-related stress and postoperative pain. The physical therapists conducted a perioperative rehabilitation program in which the patients were educated to replace their maladaptive thoughts with more adaptive thoughts. After rehabilitation, the patients had improved adaptive thoughts, increased physical activity, and favorable recovery without pulmonary complications. This indicates that the combination treatment of perioperative rehabilitation and psychoeducation was useful in two thoracic cancer surgery patients. The psychoeducational approach should be expanded to perioperative rehabilitation of patients with cancer. PMID:28280511

  6. Clinical effectiveness of fresh frozen plasma compared with fibrinogen concentrate: a systematic review

    PubMed Central

    2011-01-01

    Introduction Haemostatic therapy in surgical and/or massive trauma patients typically involves transfusion of fresh frozen plasma (FFP). Purified human fibrinogen concentrate may offer an alternative to FFP in some instances. In this systematic review, we investigated the current evidence for the use of FFP and fibrinogen concentrate in the perioperative or massive trauma setting. Methods Studies reporting the outcome (blood loss, transfusion requirement, length of stay, survival and plasma fibrinogen level) of FFP or fibrinogen concentrate administration to patients in a perioperative or massive trauma setting were identified in electronic databases (1995 to 2010). Studies were included regardless of type, patient age, sample size or duration of patient follow-up. Studies of patients with congenital clotting factor deficiencies or other haematological disorders were excluded. Studies were assessed for eligibility, and data were extracted and tabulated. Results Ninety-one eligible studies (70 FFP and 21 fibrinogen concentrate) reported outcomes of interest. Few were high-quality prospective studies. Evidence for the efficacy of FFP was inconsistent across all assessed outcomes. Overall, FFP showed a positive effect for 28% of outcomes and a negative effect for 22% of outcomes. There was limited evidence that FFP reduced mortality: 50% of outcomes associated FFP with reduced mortality (typically trauma and/or massive bleeding), and 20% were associated with increased mortality (typically surgical and/or nonmassive bleeding). Five studies reported the outcome of fibrinogen concentrate versus a comparator. The evidence was consistently positive (70% of all outcomes), with no negative effects reported (0% of all outcomes). Fibrinogen concentrate was compared directly with FFP in three high-quality studies and was found to be superior for > 50% of outcomes in terms of reducing blood loss, allogeneic transfusion requirements, length of intensive care unit and hospital

  7. A healthy patient with bilateral frozen hips preceding bilateral frozen shoulders: a cautionary tale.

    PubMed

    Miller, Abigail R; Arnot, Dean; Wake, Melissa

    2015-11-12

    Adhesive capsulitis of the shoulder (frozen shoulder) is a common disease characterised by spontaneous onset of pain and restriction of movement, followed by 'thawing', with complete or near-complete resolution. Adhesive capsulitis of the hip has been reported in around a dozen patients. This report describes an otherwise-healthy middle-aged woman with apparent sequential resolving adhesive capsulitis of all four ball-and-socket joints over a 9-year period, initially affecting each hip and then each shoulder sequentially. The likely hip diagnosis became clear only retrospectively with development of the second frozen shoulder, 5 years after the first pain. All joints subsequently resolved within the expected timeframe and the patient remains healthy, other than having mild hypertension. This case illustrates that, when hip precedes shoulder involvement, there is the potential for the frozen hip to receive alternate diagnoses for which invasive open hip surgery could unnecessarily be recommended.

  8. Bacteriological profile of raw, frozen chicken nuggets.

    PubMed

    Eglezos, Sofroni; Dykes, Gary A; Huang, Bixing; Fegan, Narelle; Stuttard, Ed

    2008-03-01

    The bacteriological profile of raw, frozen chicken nuggets manufactured at a chicken processing facility in Queensland, Australia, was determined. Chicken nuggets are manufactured by grinding poultry, adding premixes to incorporate spices, forming the meat to the desired size and shape, applying a batter and breading, freezing, and packaging. A total of 300 frozen batches were analyzed for aerobic plate count, Escherichia coli, and Salmonella over a period of 4 years. The mean of the aerobic plate count was 5.4 log CFU/g, and counts at the 90th, 95th, and 99th percentiles were 5.7, 5.9, and 6.5 log CFU/g, respectively. The maximum number of bacteria detected was 6.6 log CFU/g. E. coli prevalence was 47%, and of the positive samples, the mean was 1.9 log CFU/g; counts at the 90th, 95th, and 99th percentiles were 2.3, 2.4, and 2.8 log CFU/g, respectively. The maximum number of E. coli was 2.9 log CFU/g. The Salmonella prevalence was 8.7%, and 57.7% of these isolates were typed as Salmonella subspecies II 4,12,[27]:b:[e,n,x] (Sofia), a low-virulence serotype well adapted to Australian poultry flocks. There was a significant relationship (P < 0.05) between season and both aerobic plate counts and E. coli counts, and no correlation between E. coli counts and Salmonella prevalence. This study provides valuable data on the bacteriological quality of raw, frozen chicken nuggets.

  9. Perioperative Considerations and Management of Patients Receiving Anticoagulants

    PubMed Central

    Shaikh, Safiya Imtiaz; Kumari, R. Vasantha; Hegade, Ganapati; Marutheesh, M.

    2017-01-01

    Anticoagulants remain the primary strategy for the prevention and treatment of thrombosis. Unfractionated heparin, low molecular weight heparin (LMWH), fondaparinux, and warfarin have been studied and employed extensively with direct thrombin inhibitors typically reserved for patients with complications or those requiring interventions. Novel oral anticoagulants have emerged from clinical development and are expected to replace older agents with their ease to use and more favorable pharmacodynamic profiles. Increasingly, anesthesiologists are being requested to anesthetize patients who are on some form of anticoagulants and hence it is important to have sound understanding of pharmacology, dosing, monitoring, and toxicity of anticoagulants. We searched the online databases including PubMed Central, Cochrane, and Google Scholar using anticoagulants, perioperative management, anesthetic considerations, and LMWH as keywords for the articles published between 1994 and 2015 while writing this review. In this article, we will review the different classes of anticoagulants and how to manage them in the perioperative settings. PMID:28298749

  10. Emerging Risk Factors and Prevention of Perioperative Pulmonary Complications

    PubMed Central

    2014-01-01

    Modern surgery is faced with the emergence of newer “risk factors” and the challenges associated with identifying and managing these risks in the perioperative period. Obstructive sleep apnea and obesity hypoventilation syndrome pose unique challenges in the perioperative setting. Recent studies have identified some of the specific risks arising from caring for such patients in the surgical setting. While all possible postoperative complications are not yet fully established or understood, the prevention and management of these complications pose even greater challenges. Pulmonary hypertension with its changing epidemiology and novel management strategies is another new disease for the surgeon and the anesthesiologist in the noncardiac surgical setting. Traditionally most such patients were not considered surgical candidates for any required elective surgery. Our review discusses these disease entities which are often undiagnosed before elective noncardiac surgery. PMID:24578647

  11. Using YouTube in perioperative nursing education.

    PubMed

    Logan, Rebecca

    2012-04-01

    Educators today need innovative teaching strategies to meet the learning needs of the multigenerational population of perioperative nurses. Emerging technologies, such as YouTube, the world's largest video-sharing web site, can be used as a component of an active learning strategy that can appeal to a broad group of nurses along the novice-to-expert proficiency continuum. Using video clips can be a useful method to engage learners and promote critical thinking, decision making, and creativity. YouTube videos can be used to teach skills or as a platform for discussion. Learners also can create and upload their own videos to educate others. Increased engagement and active learning can lead the perioperative nurse to a deeper understanding of the educational material.

  12. Evaluating Enhancements to a Perioperative Nurse Liaison Program

    PubMed Central

    Hanson-Heath, Cathy Ann; Muller, Linda M.; Cunningham, Maureen F.

    2016-01-01

    The impetus for the Perioperative Nurse Liaison (PNL) program at our cancer center was to reduce anxiety for family members of patients undergoing surgery by improving communication between the family and the perioperative team. The purpose of our quality improvement project was to increase contact with family members during the patient’s surgery and to support families and surgeons during the postoperative family consult when findings were unexpected. After implementing process changes, the PNLs evaluated the program using a short survey given to families after the postoperative consult. Families reported a reduction in stress and anxiety when receiving intraoperative updates either in person or by telephone. In addition, when the PNL accompanied family members to the consult, the family felt supported when receiving unexpected findings. Further, family contact increased from 82% to 98% and consults with surgeons that included the PNL rose from an average of 254 to 500 per year. PMID:27004504

  13. Inhaled therapy for the management of perioperative pulmonary hypertension

    PubMed Central

    Thunberg, C. A.; Morozowich, S. T.; Ramakrishna, Harish

    2015-01-01

    Patients with pulmonary hypertension (PH) are at high risk for complications in the perioperative setting and often receive vasodilators to control elevated pulmonary artery pressure (PAP). Administration of vasodilators via inhalation is an effective strategy for reducing PAP while avoiding systemic side effects, chiefly hypotension. The prototypical inhaled pulmonary-specific vasodilator, nitric oxide (NO), has a proven track record but is expensive and cumbersome to implement. Alternatives to NO, including prostanoids (such as epoprostenol, iloprost, and treprostinil), NO-donating drugs (sodium nitroprusside, nitroglycerin, and nitrite), and phosphodiesterase inhibitors (milrinone, sildenafil) may be given via inhalation for the purpose of treating elevated PAP. This review will focus on the perioperative therapy of PH using inhaled vasodilators. PMID:26139748

  14. Discontinuation of perioperative antiplatelet and anticoagulant therapy in stroke patients.

    PubMed

    Armstrong, Melissa J; Schneck, Michael J; Biller, José

    2006-11-01

    Growing evidence suggests that perioperative withdrawal of ASA for secondary stroke prevention increases thromboembolic risk without the associated benefit of decreased bleeding complications. ASA maintenance is acceptable in many procedures, including invasive ones. Many procedures, in particular ophthalmologic, dermatologic, and dental surgeries, also are safe while continuing oral AC. Warfarin has been continued successfully even in some surgeries that have high bleeding risk. When the risk is too high, temporary bridging therapy with LWMH is safe in many populations. Although the exact thromboembolic risks associated with temporary cessation of AP and AC are unknown and likely low, morbidity and mortality associated with thromboembolism are high. Further studies investigating the risks and benefits of maintaining AP and AC during procedures, particularly invasive ones, are needed. Meanwhile, it is critical that physicians understand the risks and benefits of perioperative AP and AC and the variety of procedures in which these agents can be safely continued.

  15. Intravenous sub-anesthetic ketamine for perioperative analgesia.

    PubMed

    Gorlin, Andrew W; Rosenfeld, David M; Ramakrishna, Harish

    2016-01-01

    Ketamine, an N-methyl-d-aspartate antagonist, blunts central pain sensitization at sub-anesthetic doses (0.3 mg/kg or less) and has been studied extensively as an adjunct for perioperative analgesia. At sub-anesthetic doses, ketamine has a minimal physiologic impact though it is associated with a low incidence of mild psychomimetic symptoms as well as nystagmus and double vision. Contraindications to its use do exist and due to ketamine's metabolism, caution should be exercised in patients with renal or hepatic dysfunction. Sub-anesthetic ketamine improves pain scores and reduces perioperative opioid consumption in a broad range of surgical procedures. In addition, there is evidence that ketamine may be useful in patients with opioid tolerance and for preventing chronic postsurgical pain.

  16. Acupuncture and related techniques during perioperative period: A literature review.

    PubMed

    Acar, H Volkan

    2016-12-01

    Acupuncture has been used in the Far East for more than 2000 years. Since the early 1970s, this technique has been gaining popularity among Western medical community. A number of studies suggest that its mechanism of effect can be explained in biomedical terms. In this context, a number of transmitters and modulators including beta-endorphin, serotonin, substance P, interleukins, and calcitonin gene-related peptide are released. For that reason, acupuncture can be used in a wide variety of clinical conditions. Studies showed that acupuncture may have beneficial effect in perioperative period. It relieves preoperative anxiety, decreases postoperative analgesic requirements, and decreases the incidence of postoperative nausea and vomiting. In this review article, we examine perioperative use of acupuncture for a variety of conditions.

  17. Novel Anticoagulants in Atrial Fibrillation: Monitoring, Reversal and Perioperative Management

    PubMed Central

    Shamoun, Fadi; Obeid, Hiba; Ramakrishna, Harish

    2015-01-01

    Atrial fibrillation continues to be a significant source of morbidity and mortality worldwide. Effective anticoagulation remains the cornerstone of outpatient and inpatient treatment. The use of the new generation of anticoagulants (NOACs) continues to grow. Recently published data indicate their cost-effectiveness and overall safety in stroke prevention; compared to vitamin K antagonists, they can be prescribed in fixed doses for long-term therapy without the need for coagulation monitoring. Both United States and European Guidelines recommend NOACs for stroke prevention in patients with atrial fibrillation. This review discusses each of the NOACs, along with their efficacy and safety data. It explores the most recent guidelines regarding their perioperative use in atrial fibrillation patients. It also discusses bleeding complications, perioperative management, and reversal agents. PMID:26221593

  18. Perioperative management of special populations: the geriatric patient.

    PubMed

    Loran, David B; Hyde, Brannon R; Zwischenberger, Joseph B

    2005-12-01

    Americans over age 65 represent the fastest growing segment of the United States population. As a result, the demographic landscape of America is changing. Knowledge of aged physiology is necessary to construct a risk-benefit analysis tailored for each patient to improve perioperative outcomes and lower the morbidity and mortality rates among the elderly. Benefit estimates should account for a patient's life expectancy and quality of life before and after surgery. With aging, baseline functions of almost every organ system undergo progressive decline resulting in a decreased physiologic reserve and ability to compensate for stress. Pain control, postoperative cognitive dysfunction, end-of-life issues, and realistic expectations after surgery are paramount issues throughout the perioperative period.

  19. The maintenance and monitoring of perioperative blood volume

    PubMed Central

    2013-01-01

    The assessment and maintenance of perioperative blood volume is important because fluid therapy is a routine part of intraoperative care. In the past, patients undergoing major surgery were given large amounts of fluids because health-care providers were concerned about preoperative dehydration and intraoperative losses to a third space. In the last decade it has become clear that fluid therapy has to be more individualized. Because the exact determination of blood volume is not clinically possible at every timepoint, there have been different approaches to assess fluid requirements, such as goal-directed protocols guided by invasive and less invasive devices. This article focuses on laboratory volume determination, capillary dynamics, aspects of different fluids and how to clinically assess and monitor perioperative blood volume. PMID:24472160

  20. Perioperative Management of Multiple Noncardiac Implantable Electronic Devices.

    PubMed

    Ramos, Juan A; Brull, Sorin J

    2015-12-01

    The number of patients with noncardiac implantable electronic devices is increasing, and the absence of perioperative management standards, guidelines, practice parameters, or expert consensus statements presents clinical challenges. A 69-year-old woman presented for latissimus dorsi breast reconstruction. The patient had previously undergone implantation of a spinal cord stimulator, a gastric pacemaker, a sacral nerve stimulator, and an intrathecal morphine pump. After consultation with device manufacturers, the devices with patient programmability were switched off. Bipolar cautery was used intraoperatively. Postoperatively, all devices were interrogated to ensure appropriate functioning before home discharge. Perioperative goals include complete preoperative radiologic documentation of device component location, minimizing electromagnetic interference, and avoiding mechanical damage to implanted device components.

  1. Amyand's hernia in elderly patients: diagnostic, anesthetic, and perioperative considerations.

    PubMed

    Yang, Weiping; Tao, Zongyuan; Chen, Hao; Li, Qinyu; Chu, Peiguo G; Yen, Yun; Qiu, Weihua

    2009-01-01

    The presence of a vermiform appendix in an inguinal hernia sac is termed as Amyand's hernia. Although rare, mistakes in diagnosis and treatment can cause catastrophic results. Charts of patients with inguinal hernia were reviewed, and four cases of Amyand's hernia were confirmed. The clinical presentation, anesthetic, and perioperative management of Amyand's hernia were further analyzed. The mean age of patients was over 70 years, and all were males. None of the patients were diagnosed preoperatively. All the patients had little abdominal complaint only with a right inguinal mass and dragging sensation for several hours. Due to the short time after incarceration and significant cardiovascular and pulmonary comorbidities, manual reduction was attempted first in three patients. With complete preoperative evaluation and careful perioperative support, all patients underwent appendectomy and Bassini's hernia repair through a groin incision. Based on age-related organ failure and associated chronic medical illnesses of geriatric patients, the difficulties in the diagnosis and treatment are also summarized and analyzed.

  2. Primary Frozen Shoulder Syndrome: Arthroscopic Capsular Release

    PubMed Central

    Arce, Guillermo

    2015-01-01

    Idiopathic adhesive capsulitis, or primary frozen shoulder syndrome, is a fairly common orthopaedic problem characterized by shoulder pain and loss of motion. In most cases, conservative treatment (6-month physical therapy program and intra-articular steroid injections) improves symptoms and restores shoulder motion. In refractory cases, arthroscopic capsular release is indicated. This surgical procedure carries several advantages over other treatment modalities. First, it provides precise and controlled release of the capsule and ligaments, reducing the risk of traumatic complications observed after forceful shoulder manipulation. Second, release of the capsule and the involved structures with a radiofrequency device delays healing, which prevents adhesion formation. Third, the technique is straightforward, and an oral postoperative steroid program decreases pain and allows for a pleasant early rehabilitation program. Fourth, the procedure is performed with the patient fully awake under an interscalene block, which boosts the patient's confidence and adherence to the physical therapy protocol. In patients with refractory primary frozen shoulder syndrome, arthroscopic capsular release emerges as a suitable option that leads to a faster and long-lasting recovery. PMID:26870652

  3. Frozen Chemistry Effects on Nozzle Performance Simulations

    NASA Technical Reports Server (NTRS)

    Yoder, Dennis A.; Georgiadis, Nicholas J.; O'Gara, Michael R.

    2009-01-01

    Simulations of exhaust nozzle flows are typically conducted assuming the gas is calorically perfect, and typically modeled as air. However the gas inside a real nozzle is generally composed of combustion products whose thermodynamic properties may differ. In this study, the effect of gas model assumption on exhaust nozzle simulations is examined. The three methods considered model the nozzle exhaust gas as calorically perfect air, a calorically perfect exhaust gas mixture, and a frozen exhaust gas mixture. In the latter case the individual non-reacting species are tracked and modeled as a gas which is only thermally perfect. Performance parameters such as mass flow rate, gross thrust, and thrust coefficient are compared as are mean flow and turbulence profiles in the jet plume region. Nozzles which operate at low temperatures or have low subsonic exit Mach numbers experience relatively minor temperature variations inside the nozzle, and may be modeled as a calorically perfect gas. In those which operate at the opposite extreme conditions, variations in the thermodynamic properties can lead to different expansion behavior within the nozzle. Modeling these cases as a perfect exhaust gas flow rather than air captures much of the flow features of the frozen chemistry simulations. Use of the exhaust gas reduces the nozzle mass flow rate, but has little effect on the gross thrust. When reporting nozzle thrust coefficient results, however, it is important to use the appropriate gas model assumptions to compute the ideal exit velocity. Otherwise the values obtained may be an overly optimistic estimate of nozzle performance.

  4. Modelling infiltration processes in frozen soils

    NASA Astrophysics Data System (ADS)

    Ireson, A. M.; Barbour, L. S.

    2014-12-01

    Understanding the hydrological processes in soils subject to significant freeze-thaw is fraught by "experimental vagaries and theoretical imponderables" (Miller 1980, Applications of soil physics). The infiltration of snowmelt water and the subsequent transmission of unfrozen water during thawing, is governed by hydraulic conductivity values which are changing with both ice and unfrozen water content. Water held within pores is subject to capillary forces, which results in a freezing point depression (i.e. water remains in the liquid state slightly below 0°C). As the temperature drops below zero, water freezes first in the larger pores, and then in progressively smaller pores. Since the larger pores also are the first to empty by drainage, these pores may be air filled during freezing, while smaller water filled pores freeze. This explains why an unsaturated, frozen soil may still have a considerable infiltration capacity. Infiltration into frozen soil is a critical phenomena related to the risk of flooding in the Canadian prairies, controlling the partitioning of snowmelt into either infiltration or runoff. We propose a new model, based on conceptualizing the pore space as a bundle of capillary tubes (with significant differences to the capillary bundle model of Wannatabe and Flury, 2008, WRR, doi:10.1029/2008WR007102) which allows any air-filled macropores to contribute to the potential infiltration capacity of the soil. The patterns of infiltration and water movement during freeze-thaw from the model are compared to field observations from the Canadian prairies and Boreal Plains.

  5. Stability of Frozen Orbits Around Europa

    NASA Astrophysics Data System (ADS)

    Cardoso Dos Santos, Josué; Vilhena de Moraes, R.; Carvalho, J. S.

    2013-05-01

    Abstract (2,250 Maximum Characters): A planetary satellite of interest at the present moment for the scientific community is Europa, one of the four largest moons of Jupiter. There are some missions planned to visit Europa in the next years, for example, Jupiter Europa Orbiter (JEO, NASA) and Jupiter IcyMoon Explorer (JUICE, ESA). In this work we are formulating theories and constructing computer programs to be used in the design of aerospace tasks as regards the stability of artificial satellite orbits around planetary satellites. The studies are related to translational motion of orbits around planetary satellites considering polygenic perturbations due to forces, such as the nonspherical shape of the central body and the perturbation of the third body. The equations of motion will be developed in closed form to avoid expansions in eccentricity and inclination. For a description of canonical formalism are used the Delaunay canonical variables. The canonical set of equations, which are nonlinear differential equations, will be used to study the stability of orbits around Europa. We will use a simplified dynamic model, which considers the effects caused by non-uniform distribution of mass of Europa (J2, J3 and C22) and the gravitational attraction of Jupiter. Emphasis will be given to the case of frozen orbits, defined as having almost constant values of eccentricity, inclination, and argument of pericentre. An approach will be used to search for frozen orbits around planetary satellites and study their stability by applying a process of normalization of Hamiltonian. Acknowledges: FAPESP

  6. Perioperative Outcome of Dyssomnia Patients on Chronic Methylphenidate Use

    PubMed Central

    Ellis, Thomas; Moran, Kenneth; Ackermann, Wiebke; Wilson, Thomas; Quevedo, Eduardo; Bergese, Sergio

    2014-01-01

    Methylphenidate is frequently prescribed for attention deficit hyperactivity disorder, narcolepsy, and other sleep disorders requiring psychostimulants. Our report is based on 2 different clinical experiences of patients with chronic methylphenidate use, undergoing general anesthesia. These cases contrast different strategies of taking versus withholding the drug treatment on the day of surgery. From the standpoint of anesthetic management and patient safety, the concerns for perioperative methylphenidate use are mainly related to cardiovascular stability and possible counteraction of sedatives and anesthetics. PMID:26425593

  7. Perioperative Management of the Ambulatory Anorectal Surgery Patient

    PubMed Central

    Shaw, Darcy; Ternent, Charles A.

    2016-01-01

    Ambulatory surgery is appropriate for most anorectal pathology. Ambulatory anorectal surgery can be performed at reduced cost compared with inpatient procedures with excellent safety, improved efficiency, and high levels of patient satisfaction. Several perioperative strategies are employed to control pain and avoid urinary retention, including the use of a multimodal pain regimen and restriction of intravenous fluids. Ambulatory anorectal surgery often utilizes standardized order sets and discharge instructions. PMID:26929746

  8. Anesthesia for opioid addict: Challenges for perioperative physician.

    PubMed

    Goyal, Rohit; Khurana, Gurjeet; Jindal, Parul; Sharma, J P

    2013-07-01

    Opioid addiction is on a rise globally. Such a patient presents to an anesthesiologist as well as to the surgeon with an array of challenges. We present the case of an opioid addict (pentazocine) who presented for debridement and grafting of eschars and old healed scars. Initially he was medically managed for opioid addiction followed by a planned anesthesia. We hereby discuss the challenges faced during perioperative period.

  9. Perioperative Management of Patients with Connective Tissue Disease

    PubMed Central

    Goodman, Susan M.; Figgie, Mark P.

    2010-01-01

    Diseases of the connective tissue are a varied group of disorders with major musculoskeletal manifestations such as joint pain and loss of function. As a consequence of the accompanying inflammatory joint disease, such patients often require surgery. Due to the protean organ-related consequences of these conditions, patients who suffer from chronic connective tissue disease are a highly challenging population in the perioperative context. This paper reviews the management of such patients in this clinical setting. PMID:22294961

  10. [Perioperative treatment of a pregnant woman with recent cerebral infarction secondary to noncompaction cardiomyopathy].

    PubMed

    Fernández Sánchez, L J; Pérez González, R; Guasch Arévalo, E; Martín Reyes, R; Gilsanz Rodríguez, F

    2006-12-01

    Recent-onset noncompaction of the myocardium is a rare but serious entity with uncertain prognosis. Cerebral infarction is among the forms of presentation, and pregnancy and hypercoagulability increase risk. We report the case of a pregnant woman brought to the emergency department with ischemic cerebral infarction. Investigation demonstrated the cause to be cardiac embolism, and noncompaction of the myocardium was diagnosed. She was stabilized and a few days later underwent elective cesarean section under general anesthesia. Surgery and postoperative recovery were uneventful, and she was transferred for rehabilitation. Myocardial injury and progression to cerebrovascular accident must be prevented in such cases; the patient must be stabilized and antiplatelet and/or anticoagulant therapy initiated before surgery. Hemodynamic stability must be maintained throughout the perioperative period and neonatal depression avoided after delivery. Various approaches are available to be adapted to the patient's situation.

  11. Development of perioperative glycemic control using an artificial endocrine pancreas.

    PubMed

    Hanazaki, Kazuhiro; Namikawa, Tsutomu

    2013-01-01

    It is well known that tight glycemic control (TGC) in patients with diabetes mellitus is the most important to reduce complications, such as nephropathy, neuropathy, and retinopathy. Also, surgical stress induced hyperglycemia leading to glucose toxicity is the main cause of infectious complications after surgery. Recently perioperative TGC has been proven an effective method to reduce postoperative infectious complications and accelerate enhanced recovery after surgery (ERAS), with the main purpose of short staying hospital. However, conventional TGC with open-loop glycemic control system is likely to induce not only occurrence of hypoglycemia but also unstable glycemic control. To solve these problems, we have involved introduction of novel glycemic control using an artificial pancreas (AP) with closed-loop glycemic control system since 2006. To date, this novel perioperative glycemic control was performed in more than 400 surgical patients. As a result, we established stable and safe TGC using an AP to improve surgical outcomes without hypoglycemia. In this paper, we report current scientific evidence focusing on perioperative glycemic control using an AP.

  12. A Systematic Approach to Creation of a Perioperative Data Warehouse.

    PubMed

    Hofer, Ira S; Gabel, Eilon; Pfeffer, Michael; Mahbouba, Mohammed; Mahajan, Aman

    2016-06-01

    Extraction of data from the electronic medical record is becoming increasingly important for quality improvement initiatives such as the American Society of Anesthesiologists Perioperative Surgical Home. To meet this need, the authors have built a robust and scalable data mart based on their implementation of EPIC containing data from across the perioperative period. The data mart is structured in such a way so as to first simplify the overall EPIC reporting structure into a series of Base Tables and then create several Reporting Schemas each around a specific concept (operating room cases, obstetrics, hospital admission, etc.), which contain all of the data required for reporting on various metrics. This structure allows centralized definitions with simplified reporting by a large number of individuals who access only the Reporting Schemas. In creating the database, the authors were able to significantly reduce the number of required table identifiers from >10 to 3, as well as to correct errors in linkages affecting up to 18.4% of cases. In addition, the data mart greatly simplified the code required to extract data, making the data accessible to individuals who lacked a strong coding background. Overall, this infrastructure represents a scalable way to successfully report on perioperative EPIC data while standardizing the definitions and improving access for end users.

  13. Perioperative care in colorectal surgery: current practice patterns and opinions.

    PubMed

    Roig, J V; García-Fadrique, A; Redondo, C; Villalba, F L; Salvador, A; García-Armengol, J

    2009-11-01

    Objective Evidence regarding perioperative care in colorectal surgery has recently increased, leading to changes in classical clinical procedures that make the perioperative period safer and shorter. This survey aimed to evaluate the opinions of Spanish colorectal surgeons on the perioperative management of their patients. Method Emailed surveys submitted to the members of Spanish Coloproctological Associations. Results One hundred and thirty-one (31.7%) of the 413 members participated in the study and responded thus: 21% use clinical pathways and 8% use fast track (FT); 36% use epidural analgesia in colonic surgery and 57% in rectal; 40% use warm air and 23% warm fluids to maintain intraoperative normothermia; 53% prescribe >/= 3000 ml. of iv fluids on the first postoperative day and 6.2%

  14. [Perioperative management of a child with congenital nephrogenic diabetes insipidus].

    PubMed

    Mizushima, T; Kitamura, S; Kinouchi, K; Taniguchi, A; Fukumitsu, K

    2001-03-01

    The key point in perioperative management of a patient with congenital nephrogenic diabetes insipidus is fluid and electrolytes management. Since the urine of these patients consists mainly of solute free water, replacement fluids should be fluids which provide free water. A 2-year-old girl with congenital nephrogenic diabetes insipidus was scheduled for dental extraction. Her daily fluid intake was 10 liter. She had a history of recurrent fever, polyuria and polydipsia since 2 months of age. Her previous perioperative course for gastric volvulus at another hospital was complicated with postoperative hyponatremia and convulsion. A venous line was secured the day before surgery and 5% dextrose in water was infused at a rate of 12 ml.kg-1.hr-1. Intraoperative infusion was mainly with 5% dextrose in water combined with maintenance fluid. Five hours after surgery oral intake was started. Her intraoperative electrolytes levels were low (Na 133 mEq.l-1, K 2.8 mEq.l-1), but otherwise her perioperative course was uneventful.

  15. Update on perioperative management of the child with asthma

    PubMed Central

    Dones, Francesco; Foresta, Grazia; Russotto, Vincenzo

    2012-01-01

    Asthma represents the leading cause of morbidity from a chronic disease among children. Dealing with this disease during the perioperative period of pediatric surgical procedures is, therefore, quite common for the anesthesiologist and other professionalities involved. Preoperative assessment has a key role in detecting children at increased risk of perioperative respiratory complications. For children without an optimal control of symptoms or with a recent respiratory tract infection elective surgery should be postponed, if possible, after the optimization of therapy. According to clinical setting, loco-regional anesthesia represents the desirable option since it allows to avoid airway instrumentation. Airway management goals are preventing the increase of airflow resistance during general anesthesia along with avoiding triggers of bronchospasm. When their use is possible, face mask ventilation and laringeal mask are considered more reliable than tracheal intubation for children with asthma. Sevoflurane is the most commonly used anesthetic for induction and manteinance. Salbutamol seems to be useful in preventing airflow resistance rise after endotracheal intubation. Mechanical ventilation should be tailored according to pathophysiology of asthma: an adequate expiratory time should be setted in order to avoid a positive end-expiratory pressure due to expiratory airflow obstruction. Pain should be prevented and promptly controlled with a loco-regional anesthesia technique when it is possible. Potential allergic reactions to drugs or latex should always be considered during the whole perioperative period. Creating a serene atmosphere should be adopted as an important component of interventions in order to guarantee the best care to the asthmatic child. PMID:22802997

  16. Non-opioid analgesics: Novel approaches to perioperative analgesia for major spine surgery.

    PubMed

    Dunn, Lauren K; Durieux, Marcel E; Nemergut, Edward C

    2016-03-01

    Perioperative pain management is a significant challenge following major spine surgery. Many pathways contribute to perioperative pain, including nociceptive, inflammatory, and neuropathic sources. Although opioids have long been a mainstay for perioperative analgesia, other non-opioid therapies have been increasingly used as part of a multimodal analgesic regimen to provide improved pain control while minimizing opioid-related side effects. Here we review the evidence supporting the use of novel analgesic approaches as an alternative to intravenous opioids for major spine surgery.

  17. 21 CFR 146.126 - Frozen concentrate for colored lemonade.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... (CONTINUED) FOOD FOR HUMAN CONSUMPTION CANNED FRUIT JUICES Requirements for Specific Standardized Canned Fruit Juices and Beverages § 146.126 Frozen concentrate for colored lemonade. (a) Frozen concentrate for... lemonade by § 146.120, except that it is colored with a safe and suitable fruit juice, vegetable juice,...

  18. A Possible Small Frozen Lake in Utopia Planitia, Mars

    NASA Astrophysics Data System (ADS)

    de Pablo, M. A.; Pacifici, A.; Komatsu, G.

    2008-03-01

    We describe the geomorphological features observed on a MOC-na image (E0402007) that reveal the existence of a possible small frozen lake on the surface of Utopia Planitia. Some of its characteristics are similar to some frozen lakes on the Earth.

  19. Title: Characterizing a Frozen Extrasolar World

    NASA Technical Reports Server (NTRS)

    Skemer, Andrew J.; Morley, Caroline V.; Allers, Katelyn N.; Geballe, Thomas R.; Marley, Mark S.; Fortney, Jonathan J.; Faherty, Jacqueline K.; Bjoraker, Gordon L.

    2016-01-01

    The recently discovered brown dwarf WISE 0855 presents our first opportunity to study an object outside the Solar System that is nearly as cold as our own gas giant planets. However the traditional methodology for characterizing brown dwarfs-near infrared spectroscopy-is not currently feasible as WISE 0855 is too cold and faint. To characterize this frozen extrasolar world we obtained a 4.5-5.2 micrometers spectrum, the same bandpass long used to study Jupiter's deep thermal emission. Our spectrum reveals the presence of atmospheric water vapor and clouds, with an absorption profile that is strikingly similar to Jupiter. The spectrum is high enough quality to allow the investigation of dynamical and chemical processes that have long been studied in Jupiter's atmosphere, but this time on an extrasolar world.

  20. 76 FR 6603 - Certain Frozen Warmwater Shrimp from Thailand; Notice of Amended Final Results of Antidumping...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-07

    ... From the Federal Register Online via the Government Publishing Office ] DEPARTMENT OF COMMERCE International Trade Administration Certain Frozen Warmwater Shrimp from Thailand; Notice of Amended Final... antidumping duty order on certain frozen warmwater shrimp (shrimp) from Thailand. See Certain Frozen...

  1. Cool-down and frozen start-up behavior of a grooved water heat pipe

    NASA Technical Reports Server (NTRS)

    Jang, Jong Hoon

    1990-01-01

    A grooved water heat pipe was tested to study its characteristics during the cool-down and start-up periods. The water heat pipe was cooled down from the ambient temperature to below the freezing temperature of water. During the cool-down, isothermal conditions were maintained at the evaporator and adiabatic sections until the working fluid was frozen. When water was frozen along the entire heat pipe, the heat pipe was rendered inactive. The start-up of the heat pipe from this state was studied under several different operating conditions. The results show the existence of large temperature gradients between the evaporator and the condenser, and the moving of the melting front of the working fluid along the heat pipe. Successful start-up was achieved for some test cases using partial gravity assist. The start-up behavior depended largely on the operating conditions.

  2. Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology.

    PubMed

    Kozek-Langenecker, Sibylle A; Afshari, Arash; Albaladejo, Pierre; Santullano, Cesar Aldecoa Alvarez; De Robertis, Edoardo; Filipescu, Daniela C; Fries, Dietmar; Görlinger, Klaus; Haas, Thorsten; Imberger, Georgina; Jacob, Matthias; Lancé, Marcus; Llau, Juan; Mallett, Sue; Meier, Jens; Rahe-Meyer, Niels; Samama, Charles Marc; Smith, Andrew; Solomon, Cristina; Van der Linden, Philippe; Wikkelsø, Anne Juul; Wouters, Patrick; Wyffels, Piet

    2013-06-01

    The aims of severe perioperative bleeding management are three-fold. First, preoperative identification by anamesis and laboratory testing of those patients for whom the perioperative bleeding risk may be increased. Second, implementation of strategies for correcting preoperative anaemia and stabilisation of the macro- and microcirculations in order to optimise the patient's tolerance to bleeding. Third, targeted procoagulant interventions to reduce the amount of bleeding, morbidity, mortality and costs. The purpose of these guidelines is to provide an overview of current knowledge on the subject with an assessment of the quality of the evidence in order to allow anaesthetists throughout Europe to integrate this knowledge into daily patient care wherever possible. The Guidelines Committee of the European Society of Anaesthesiology (ESA) formed a task force with members of scientific subcommittees and individual expert members of the ESA. Electronic databases were searched without language restrictions from the year 2000 until 2012. These searches produced 20 664 abstracts. Relevant systematic reviews with meta-analyses, randomised controlled trials, cohort studies, case-control studies and cross-sectional surveys were selected. At the suggestion of the ESA Guideline Committee, the Scottish Intercollegiate Guidelines Network (SIGN) grading system was initially used to assess the level of evidence and to grade recommendations. During the process of guideline development, the official position of the ESA changed to favour the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. This report includes general recommendations as well as specific recommendations in various fields of surgical interventions. The final draft guideline was posted on the ESA website for four weeks and the link was sent to all ESA members. Comments were collated and the guidelines amended as appropriate. When the final draft was complete, the Guidelines Committee and

  3. Radiation inactivation of foodborne pathogens on frozen seafood products.

    PubMed

    Sommers, Christopher H; Rajkowski, Kathleen T

    2011-04-01

    Foodborne illness due to consumption of contaminated seafood is, unfortunately, a regular occurrence in the United States. Ionizing (gamma) radiation can effectively inactivate microorganisms and extend the shelf life of seafood. In this study, the ability of gamma irradiation to inactivate foodborne pathogens surface inoculated onto frozen seafood (scallops, lobster meat, blue crab, swordfish, octopus, and squid) was investigated. The radiation D(10)-values (the radiation dose needed to inactivate 1 log unit of a microorganism) for Listeria monocytogenes, Staphylococcus aureus, and Salmonella inoculated onto seafood samples that were then frozen and irradiated in the frozen state (-20°C) were 0.43 to 0.66, 0.48 to 0.71, and 0.47 to 0.70 kGy, respectively. In contrast, the radiation D(10)-value for the same pathogens suspended on frozen pork were 1.26, 0.98, and 1.18 kGy for L. monocytogenes, S. aureus, and Salmonella, respectively. The radiation dose needed to inactivate these foodborne pathogens on frozen seafood is significantly lower than that for frozen meat or frozen vegetables.

  4. Evaluation of Perioperative Medication Errors and Adverse Drug Events

    PubMed Central

    Nanji, Karen C.; Patel, Amit; Shaikh, Sofia; Seger, Diane L.; Bates, David W.

    2015-01-01

    Background The purpose of this study is to assess the rates of perioperative medication errors (MEs) and adverse drug events (ADEs) as percentages of medication administrations, evaluate their root causes, and formulate targeted solutions to prevent them. Methods In this prospective observational study, anesthesia-trained study staff (anesthesiologists/nurse anesthetists) observed randomly selected operations at a 1,046 bed tertiary care academic medical center to identify MEs and ADEs over eight months. Retrospective chart abstraction was performed to flag events that were missed by observation. All events subsequently underwent review by two independent reviewers. Primary outcomes were the incidence of MEs and ADEs. Results A total of 277 operations were observed with 3,671 medication administrations of which 193 (5.3%, 95% CI 4.5 to 6.0) involved a ME and/or ADE. Of these, 153 (79.3%) were preventable and 40 (20.7%) were non-preventable. The events included 153 (79.3%) errors and 91 (47.2%) ADEs. While 32 (20.9%) of the errors had little potential for harm, 51 (33.3%) led to an observed ADE and an additional 70 (45.8%) had the potential for patient harm. Of the 153 errors, 99 (64.7%) were serious, 51 (33.3%) were significant and 3 (2.0%) were life-threatening. Conclusions One in twenty perioperative medication administrations included an ME and/or ADE. More than one third of the MEs led to observed ADEs, and the remaining two thirds had the potential for harm. These rates are markedly higher than those reported by retrospective surveys. Specific solutions exist which have the potential to decrease the incidence of perioperative MEs. PMID:26501385

  5. Perioperative physiotherapy in patients undergoing lung cancer resection.

    PubMed

    Rodriguez-Larrad, Ana; Lascurain-Aguirrebena, Ion; Abecia-Inchaurregui, Luis Carlos; Seco, Jesús

    2014-08-01

    Physiotherapy is considered an important component of the perioperative period of lung resection surgery. A systematic review was conducted to assess evidence for the effectiveness of different physiotherapy interventions in patients undergoing lung cancer resection surgery. Online literature databases [Medline, the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, SCOPUS, PEDro and CINAHL] were searched up until June 2013. Studies were included if they were randomized controlled trials, compared 2 or more perioperative physiotherapy interventions or compared one intervention with no intervention, included only patients undergoing pulmonary resection for lung cancer and assessed at least 2 or more of the following variables: functional capacity parameters, postoperative pulmonary complications or length of hospital stay. Reviews and meta-analyses were excluded. Eight studies were selected for inclusion in this review. They included a total of 599 patients. Seven of the studies were identified as having a low risk of bias. Two studies assessed preoperative interventions, 4 postoperative interventions and the remaining 2 investigated the efficacy of interventions that were started preoperatively and then continued after surgery. The substantial heterogeneity in the interventions across the studies meant that it was not possible to conduct a meta-analysis. The most important finding of this systematic review is that presurgical interventions based on moderate-intense aerobic exercise in patients undergoing lung resection for lung cancer improve functional capacity and reduce postoperative morbidity, whereas interventions performed only during the postoperative period do not seem to reduce postoperative pulmonary complications or length of hospital stay. Nevertheless, no firm conclusions can be drawn because of the heterogeneity of the studies included. Further research into the efficacy and effectiveness of perioperative respiratory physiotherapy in

  6. A novel experiment for measuring infiltration into seasonal frozen soil

    NASA Astrophysics Data System (ADS)

    Demand, Dominic; Weiler, Markus

    2016-04-01

    Large parts of the northern hemisphere have at least seasonal frozen soils. Depending on the initial soil water content infiltration capacity can be reduced through pore blockage of ice. Many studies dealing with this topic used numerical modelling for estimating the effect of frozen soils on infiltration. Only a few studies investigated the influences of seasonal frozen soils on infiltration and runoff generation in field experiments. Some authors point out that preferential flow can be an important factor under frozen conditions, but only qualitative information are available so far. A missing methodology makes it hard to measure and quantify infiltration into frozen soils, especially the role of preferential flow. Therefore, a novel multi-method approach for measuring the influences of seasonal frozen soil on infiltration is presented. Sprinkling experiments with a rate of 50 mm/h were performed at frozen soil plots under wet and dry initial conditions in a grassland field site in the Black Forest, Germany. Additionally, two different water temperatures were used for the sprinkling experiments (~2°C and ~10°C). Thermal infrared imagery was tested for continuous, in-situ monitoring of the spatiotemporal soil thermal state during infiltration and the possibility to derive information on water flow. A dye tracer (Brilliant Blue FCF) was added to the infiltrating water and analyzed by image analysis for flow patterns and depth distribution. Thermal infrared imagery and dye tracer were used for the first time in field experiments in frozen soils and were tested for their potential to show the effect of preferential flow under frozen conditions. These information were related to observed soil moisture and temperature profiles measured with capacitance probes in five depths. Furthermore timing and amount of surface runoff was examined for all plots. Brilliant Blue flow patterns and surface runoff were compared against unfrozen soils with similar initial conditions

  7. [Prevention of venous perioperative thromboembolism in ENT and maxillofacial surgery].

    PubMed

    Lestienne, B; Vergnes, M-C; Audibert, G; Faillot, T; Bosson, J-L; Payen, J-F; Bruder, N

    2005-08-01

    There are few studies of poor methodological quality on the risk of thromboembolism in head and neck surgery. The incidence of symptomatic deep vein thrombosis is estimated between, 0.1% and 0.6%. The patient's risk factors (cancer, alcoholism, smoking, malnutrition) determine for the assessment of the potential benefit of thromboembolism prophylaxis. No method can be recommended based on the literature. In patients receiving anticoagulant therapy undergoing superficial head and neck surgery or dental extraction, the literature suggest to continue anticoagulation throughout the perioperative period.

  8. Educating perioperative managers about materials and financial management.

    PubMed

    Davis, Eric

    2005-04-01

    One of the most resource intensive areas in many hospitals is the OR, which often accounts for more than 50% of a hospital's materials management budget. Surgical services managers often have no formal training in materials and financial management, but they are held accountable for one of the most costly clinical areas in the hospital. A program proposed for Navy perioperative nurse managers is a five-day course that covers the basics of Navy medical materials and financial management as they apply to the OR. Application strategies for the civilian sector also are discussed.

  9. Transient perioperative brainstem paralysis secondary to a local anesthetic.

    PubMed

    Joannides, Alexis J; Santarius, Thomas; Fernandes, Helen M; Laing, Rodney J C; Trivedi, Rikin A

    2012-07-01

    Local anesthesia is widely used, in isolation or in conjunction with general anesthesia. The authors describe 2 adolescent patients presenting with absent brainstem reflexes and delayed awakening following elective foramen magnum decompression for Chiari Type I malformation. In both cases, neurological deficits were closely associated with the administration of a levobupivacaine field block following wound closure. In the absence of any structural or biochemical abnormalities, and with spontaneous recovery approximating the anesthetic half-life, the authors' observations are consistent with transient brainstem paralysis caused by perioperative local anesthetic infiltration.

  10. Perioperative Anaphylactic Risk Score For Risk-Oriented Premedication

    PubMed Central

    Manfredi, Giacomo; Pezzuto, F.; Balestrini, A.; Lo Schiavo, M.; Montera, M.C.; Pio, A.; Iannelli, M.; Gargano, D.; Bianchi, M.J.; Casale, G.; Galimberti, M.; Triggiani, M.; Piazza, O.

    Basing on the current knowledge, this paper is aimed to review the core characteristics of the most relevant therapeutic agents (steroids and antihistamines), administered to prevent perioperative anaphylaxis. Moreover, the Authors propose the validation of a Global Anaphylactic Risk Score, built up by recording the individual scores related to the most relevant anaphylaxis parameters (i.e. medical history, symptoms and medication for asthma, rhinitis and urticaria etc) and by adding them on all together; the score could be used in the preoperative phase to evaluate the global anaphylactic risk and to prescribe risk-oriented premedication protocols. PMID:24251246

  11. Severe antiphospholipid syndrome and cardiac surgery: Perioperative management.

    PubMed

    Mishra, Pankaj Kumar; Khazi, Fayaz Mohammed; Yiu, Patrick; Billing, John Stephen

    2016-06-01

    Antiphospholipid syndrome is an antiphospholipid antibody-mediated prothrombotic state leading to arterial and venous thrombosis. This condition alters routine in-vitro coagulation tests, making results unreliable. Antiphospholipid syndrome patients requiring cardiac surgery with cardiopulmonary bypass present a unique challenge in perioperative anticoagulation management. We describe 3 patients with antiphospholipid syndrome who had successful heart valve surgery at our institution. We have devised an institutional protocol for antiphospholipid syndrome patients, and all 3 patients were managed according to this protocol. An algorithm-based approach is recommended because it improves team work, optimizes treatment, and improves patient outcome.

  12. Perioperative hemodynamic instability in patients undergoing laparoscopic adrenalectomy for pheochromocytoma

    PubMed Central

    Pisarska, Magdalena; Budzyński, Andrzej

    2016-01-01

    Perioperative hemodynamic instability still remains the biggest surgical and anesthetic challenge in surgery for pheochromocytoma. The aim of this review was to discuss pre-, intra- and postoperative factors that may impact on hemodynamic condition of a patient. It describes patients’ preparation with appropriate medication, principles of surgical technique as well as risk factors for development of hemodynamic instability in postoperative period. Currently the gold standard in the treatment of pheochromocytoma is preoperative use of alpha-blockers and laparoscopic surgery. This approach allowed improving outcomes by lowering both mortality and morbidity. PMID:27867865

  13. Safe handling of chemotherapy in the perioperative setting.

    PubMed

    Mellinger, Ellice; Skinker, Linda; Sears, Diane; Gardner, Diane; Shult, Piya

    2010-04-01

    Safe handling of chemotherapeutic agents during administration and disposal is critical. Most antineoplastic agents are toxic compounds that are carcinogenic, mutagenic, or teratogenic. Direct contact may cause irritation of the skin, eyes, and mucous membranes. Perioperative personnel should know how to handle hazardous materials safely to protect the patient, other staff members, and themselves. These safety precautions include appropriately identifying the patient; correctly preparing, verifying, and documenting the chemotherapeutic agents being administered; consistently wearing personal protective equipment; transporting the chemotherapeutic agent in a puncture-resistant container labeled "chemotherapy"; properly disposing of the chemotherapeutic agent and supplies; and handling a spill if one occurs.

  14. Perioperative Management of Severe Hypertension during Laparoscopic Surgery for Pheochromocytoma

    PubMed Central

    Erdoğan, Mehmet Ali; Uçar, Muharrem; Özkan, Ahmet Selim; Özgül, Ülkü; Durmuş, Mahmut

    2016-01-01

    Phaeochromocytoma is a catecholamine-secreting vascular tumour that is derived from chromaffin cell. Lethal cardiovascular complications, such as serious hypertension, myocardial infarction and aortic dissection, may occur because of uncontrolled catecholamine release. Each stage of anaesthesia management has vital importance because of this destructive catecholamine secretion that may occur during induction, perioperative stage and surgical manipulation. In this study, we report regarding the preoperative preparation and severe, persistent hypertension attack management with a combination of α-adrenergic blockade, β-adrenergic blockade, sodium nitroprusside and remifentanil in a patient who underwent laparoscopic surgery for phaeochromocytoma. PMID:27366556

  15. Perioperative management of patients with cardiac implantable electronic devices.

    PubMed

    Poveda-Jaramillo, R; Castro-Arias, H D; Vallejo-Zarate, C; Ramos-Hurtado, L F

    2017-05-01

    The use of implantable cardiac devices in people of all ages is increasing, especially in the elderly population: patients with pacemakers, cardioverter-defibrillators or cardiac resynchronization therapy devices regularly present for surgery for non-cardiac causes. This review was made in order to collect and analyze the latest evidence for the proper management of implantable cardiac devices in the perioperative period. Through a detailed exploration of PubMed, Academic Search Complete (EBSCO), ClinicalKey, Cochrane (Ovid), the search software UpToDate, textbooks and patents freely available to the public on Google, we selected 33 monographs, which matched the objectives of this publication.

  16. Perioperative management of hemostasis in children and adolescents.

    PubMed

    Bidlingmaier, Christoph; Olivieri, Martin; Hütker, Sebastian; Dietl, Sabrina; Kurnik, Karin

    2017-01-16

    Invasive procedures in children are in most cases elective and are carried out in otherwise healthy children. While many surgeries are still performed in a hospital, more and more procedures are defined as "outpatient procedures," leading to increased discussion about safety and risks. This review will examine common practices, review the sparse literature and provide recommendations regarding the identification of children with increased bleeding risk, planning for children with known bleeding disorders and strategies for perioperative management. In conclusion, after careful planning, surgeries can be performed safely even in children with known bleeding disorders.

  17. Perioperative management of pediatric patients on mechanical cardiac support.

    PubMed

    Mossad, Emad B; Motta, Pablo; Rossano, Joseph; Hale, Brittani; Morales, David L

    2011-05-01

    The population of children with end-stage heart failure requiring mechanical circulatory support is growing. These children present for diagnostic imaging studies, various interventions and noncardiac surgical procedures that require anesthetic care. This article is a review of the population demographics of children on mechanical cardiac support, the alternative devices available, and the important concepts for safe perioperative management of these patients. The discussion will be limited to devices for short- and long-term cardiac support, excluding extracorporeal membrane oxygenation (ECMO) for respiratory support.

  18. Hot Climate and Perioperative Outcome in Trauma Patients

    PubMed Central

    Gupta, Bhawna; Katyal, Sunil; Gautam, Nikhil

    2016-01-01

    Introduction Extreme hot climatic conditions constitute a major public health threat. Recent studies have shown higher rate of perioperative complications during hot weather. Although a lot of researches have been carried out to evaluate effect of hot climatic conditions and its correlation with other medical conditions, but very little has been studied in trauma patients. Aim To evaluate the impact of hot climatic conditions on perioperative morbidity in trauma patients. Materials and Methods We enrolled 100 trauma patients scheduled for surgery after approval by the Hospital and University Ethical Committee. Patients were grouped as Control Group (C) when outdoor temperature ranged in comfortable zone i.e., 20-290C and Study Group (S) when outdoor temperature ranged 400C or more. Patients living in regular air conditioned atmosphere (more than 18 hours per day) and with co-morbid conditions or on drugs interfering with temperature regulation were excluded. Student’s t-test, z-test and chi-square tests were used for statistical analysis. Results Both groups were comparable in terms of demographics, age (control group C=38.2±12.93 years and in group S= 40.14 ± 15.98 years), sex, socioeconomic status and type of surgery. Mean Trauma Index Score (TIS) were 6.20±1.56 and 5.80±1.31 respectively. All patients were of low risk as per Shoe Maker’s risk criteria. Post Anaesthesia Care Unit (PACU) stay was similar. Mean duration of hospital stay was 12.16 ± 8.50 days in group C and 10.98 ± 6.90 days in group S (p-value 0.21). 20% patients in group C whereas 54% in group S had complications (p= 0.009). There was a higher incidence of infections as well as respiratory distress in group S. On multiple logistic regression analysis peak environmental temperature was found to be the single independent risk factor for predicting perioperative morbidity. Conclusion High ambient temperature adversely affects the outcome of surgery even in low risk young trauma patients

  19. Atypical Presentation of a Pulmonary Embolism in the Perioperative Setting.

    PubMed

    Viswanath, Omar; Simpao, Allan F; Santhosh, Sushmitha

    2015-08-15

    We present the case of an asymptomatic 82-year-old patient with no coronary artery disease and a negative cardiac workup who presented to the hospital for an elective total knee replacement. The patient had stable vital signs in the preanesthesia holding unit, yet the anesthesiologist recognized new-onset atrial fibrillation on the patient's monitor. The dysrhythmia was confirmed with a 12-lead electrocardiogram. The procedure was canceled, and the patient was sent for additional evaluation. An echocardiogram revealed a pulmonary embolism. This case report illustrates the need for a questioning attitude and diligent monitoring in all phases of perioperative care.

  20. Perioperative Outcomes in Patients Undergoing the Transglabellar/Subcranial Approach to the Anterior Skull Base

    PubMed Central

    Pepper, Jon-Paul; Ward, P. Daniel; Lin, Erin M.; Sullivan, Stephen E.; Hecht, Sarah L.; Marentette, Lawrence J.

    2011-01-01

    We analyzed the effect of predefined patient demographic, disease, and perioperative variables on the rate of complications in the perioperative period following subcranial surgery for anterior skull base lesion. A secondary goal of this study was to provide a benchmark rate of perioperative mortality and morbidity through comprehensive analysis of complications. Retrospective review of a consecutive series of patients (n = 164) who underwent the transglabellar/subcranial approach to lesions of the anterior skull base between December 1995 and November 2009 in a tertiary referral center. Main outcome measures were perioperative morbidity and mortality. No perioperative mortalities were observed over the period of consecutive review. The overall complication rate was 28.7%, with 30 (18%) patients experiencing major complication. Multivariate analysis revealed that the following variables were independent predictors of perioperative complication of any type: positive margins on final pathology, perioperative lumbar drain placement, and dural invasion. The subcranial approach provides excellent access to the anterior skull base with zero mortality and acceptable morbidity in comparison with other contemporary open surgical approaches. It should be considered a procedure with distinct advantages in terms of perioperative morbidity and mortality when selecting a therapeutic approach for patients with anterior skull base lesions. PMID:22470264

  1. ELECTRON MICROSCOPY OF STRUCTURAL DETAIL IN FROZEN BIOLOGICAL SPECIMENS

    PubMed Central

    Steere, Russell L.

    1957-01-01

    A procedure is described whereby preshadowed replicas can be obtained from frozen biological specimens which have been cut and then etched by sublimation of the ice from their surfaces. Electron micrographs showing details of the internal structure of plant virus crystals are presented to demonstrate the values of the procedure. Crystals of purified tobacco ringspot virus and squash mosaic virus and some portions of turnip yellow mosaic virus crystals have been shown to exhibit hexagonal packing. Sections through in situ crystals of tobacco mosaic virus show the rods to be parallel within each layer and arranged in a square net as viewed end on. Individual rods in each layer of the latter measure 300 mµ in length and are somewhat tilted with respect to the rods of adjacent layers. This results in the formation of a herring-bone appearance when a crystal is cut perpendicular to its hexagonal face. It is suggested that the procedure outlined here might well serve to supplement other procedures for the preparation of many cytological specimens for electron microscopy. PMID:13416310

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

    PubMed

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

    2013-01-01

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

  3. Therapeutic surfactant-stripped frozen micelles

    NASA Astrophysics Data System (ADS)

    Zhang, Yumiao; Song, Wentao; Geng, Jumin; Chitgupi, Upendra; Unsal, Hande; Federizon, Jasmin; Rzayev, Javid; Sukumaran, Dinesh K.; Alexandridis, Paschalis; Lovell, Jonathan F.

    2016-05-01

    Injectable hydrophobic drugs are typically dissolved in surfactants and non-aqueous solvents which can induce negative side-effects. Alternatives like `top-down' fine milling of excipient-free injectable drug suspensions are not yet clinically viable and `bottom-up' self-assembled delivery systems usually substitute one solubilizing excipient for another, bringing new issues to consider. Here, we show that Pluronic (Poloxamer) block copolymers are amenable to low-temperature processing to strip away all free and loosely bound surfactant, leaving behind concentrated, kinetically frozen drug micelles containing minimal solubilizing excipient. This approach was validated for phylloquinone, cyclosporine, testosterone undecanoate, cabazitaxel and seven other bioactive molecules, achieving sizes between 45 and 160 nm and drug to solubilizer molar ratios 2-3 orders of magnitude higher than current formulations. Hypertonic saline or co-loaded cargo was found to prevent aggregation in some cases. Use of surfactant-stripped micelles avoided potential risks associated with other injectable formulations. Mechanistic insights are elucidated and therapeutic dose responses are demonstrated.

  4. Therapeutic surfactant-stripped frozen micelles

    PubMed Central

    Zhang, Yumiao; Song, Wentao; Geng, Jumin; Chitgupi, Upendra; Unsal, Hande; Federizon, Jasmin; Rzayev, Javid; Sukumaran, Dinesh K.; Alexandridis, Paschalis; Lovell, Jonathan F.

    2016-01-01

    Injectable hydrophobic drugs are typically dissolved in surfactants and non-aqueous solvents which can induce negative side-effects. Alternatives like ‘top-down' fine milling of excipient-free injectable drug suspensions are not yet clinically viable and ‘bottom-up' self-assembled delivery systems usually substitute one solubilizing excipient for another, bringing new issues to consider. Here, we show that Pluronic (Poloxamer) block copolymers are amenable to low-temperature processing to strip away all free and loosely bound surfactant, leaving behind concentrated, kinetically frozen drug micelles containing minimal solubilizing excipient. This approach was validated for phylloquinone, cyclosporine, testosterone undecanoate, cabazitaxel and seven other bioactive molecules, achieving sizes between 45 and 160 nm and drug to solubilizer molar ratios 2–3 orders of magnitude higher than current formulations. Hypertonic saline or co-loaded cargo was found to prevent aggregation in some cases. Use of surfactant-stripped micelles avoided potential risks associated with other injectable formulations. Mechanistic insights are elucidated and therapeutic dose responses are demonstrated. PMID:27193558

  5. Perioperative nutrition in abdominal surgery: recommendations and reality.

    PubMed

    Cerantola, Yannick; Grass, Fabian; Cristaudi, Alessandra; Demartines, Nicolas; Schäfer, Markus; Hübner, Martin

    2011-01-01

    Introduction. Preoperative malnutrition is a major risk factor for increased postoperative morbidity and mortality. Definition and diagnosis of malnutrition and its treatment is still subject for controversy. Furthermore, practical implementation of nutrition-related guidelines is unknown. Methods. A review of the available literature and of current guidelines on perioperative nutrition was conducted. We focused on nutritional screening and perioperative nutrition in patients undergoing digestive surgery, and we assessed translation of recent guidelines in clinical practice. Results and Conclusions. Malnutrition is a well-recognized risk factor for poor postoperative outcome. The prevalence of malnutrition depends largely on its definition; about 40% of patients undergoing major surgery fulfil current diagnostic criteria of being at nutritional risk. The Nutritional Risk Score is a pragmatic and validated tool to identify patients who should benefit from nutritional support. Adequate nutritional intervention entails reduced (infectious) complications, hospital stay, and costs. Preoperative oral supplementation of a minimum of five days is preferable; depending on the patient and the type of surgery, immune-enhancing formulas are recommended. However, surgeons' compliance with evidence-based guidelines remains poor and efforts are necessary to implement routine nutritional screening and nutritional support.

  6. Factors Associated with Echinococcosis-Induced Perioperative Anaphylactic Shock

    PubMed Central

    Ye, Jianrong; Zhang, Qin; Xuan, Yan; Chen, Siyu; Ma, Long; Zhang, Yongqiang; Zheng, Hong

    2016-01-01

    This retrospective case-control study explored the factors associated with anaphylactic shock during surgery for cystic echinococcosis (CE) at the First Affiliated Hospital of Xinjiang Medical University between October 2008 and September 2013. Patients who suffered from anaphylactic shock (n=16) were age-matched 3:1 to patients who did not (n=43). Multivariate analysis suggested that IL-4 levels (odds ratio=1.096; 95% confidence interval=1.015–1.185; P=0.02) and cyst size (odds ratio=3.028, 95% confidence interval=1.259–7.283, P=0.013) were independently associated with CE-induced perioperative anaphylactic shock. Using the receiver operating characteristic (ROC) curves and a cut-off value of 415.7 ng/ml, IL-4 showed an area under the ROC (AUC) of 0.926, sensitivity of 75.0%, and specificity of 97.7%. Using a cut-off value of 7.8 cm, cyst size showed an AUC of 0.828, sensitivity of 81.3%, and specificity of 76.7%. In conclusion, results suggest that levels of IL-4 and cyst size were independently associated with echinococcosis-induced perioperative anaphylactic shock. These results could help identifying patients with echinococcosis at risk of anaphylactic shock in whom appropriate prophylaxis could be undertaken. PMID:28095662

  7. Comparison of three perioperative fluid regimes for laparoscopic donor nephrectomy

    PubMed Central

    Di Biase, Manuela; Verbrugge, Serge; IJzermans, Jan N. M.; Gommers, Diederik

    2007-01-01

    Background Pneumoperitoneum (PP), as used for laparoscopic procedures, impairs stroke volume, renal blood flow, glomerular filtration rate and urine output. This study investigated whether perioperative fluid management can abolish these negative effects of PP on hemodynamics. Methods Twenty-one patients undergoing laparoscopic donor nephrectomy (LDN) were randomized into three groups: group 1 received overnight infusion and received a bolus of colloid before induction of anesthesia, followed by a bolus just before PP; group 2 received overnight infusion and a colloid bolus before anesthesia; group 3 served as controls and received only infusion during operation. All three groups received the same total amount of crystalloids and colloids until nephrectomy. Data analysis of the donor included; mean arterial pressure (MAP), stroke volume (SV), left ventricular ejection time (LVETc), perioperative urine output and renal function measured as the creatinine clearance (CrCl) until one-year post-operative. Results SV was significantly higher in group 1 compared to controls for all measurements. In the control group SV significantly decreased after changing from the supine to lateral position whereas there was no change in SV in both pre-hydrated groups. In all groups, MAP decreased after induction of anesthesia, and restored to pre-anesthetic values during PP. CrCl decreased in the control group during PP, but not in the other groups. From two days postoperative, CrCl was comparable between the three study groups. Conclusion Overnight infusion and a bolus of colloid just before PP attenuate hemodynamic compromise from PP. PMID:17522928

  8. Perioperative endoscopy of the whole small bowel in Crohn's disease.

    PubMed Central

    Lescut, D; Vanco, D; Bonnière, P; Lecomte-Houcke, M; Quandalle, P; Wurtz, A; Colombel, J F; Delmotte, J S; Paris, J C; Cortot, A

    1993-01-01

    The aim of this study was to search for small bowel lesions by means of a perioperative endoscopy in 20 patients operated on for Crohn's disease. Seven women and 13 men (mean age 29 years) had a total retrograde exploration to the angle of Treitz during an ileocolectomy (16 of 20 patients) or a colonic or ileal resection (four of 20 patients). Endoscopic exploration was completed, through an enterotomy, from the surgical area to the angle of Treitz. Periendoscopic biopsy samples were taken on macroscopic lesions and every 20 cm systematically. In 13 of 20 cases, various lesions scattered over the whole small intestine were found. These were aphthoid ulcerations (10 patients), superficial ulcerations (seven patients), mucosal oedema (three patients), non-ulcerative stenosis (three patients), erythema (two patients), pseudopolyps (two patients), deep ulcerations (two patients), and ulcerative stenosis (one patient). In seven patients none of the lesions detected at perioperative endoscopy had been recognised by preoperative evaluation or surgical inspection of the serosal surface. A typical granuloma was found at biopsy of lesions identified by endoscopy in three cases and at biopsy of an apparently healthy area in one case. Thus 65% of patients operated on for Crohn's disease had lesions of the small intestine detected by endoscopy, which were unrecognised before surgery in more than half of the cases. PMID:8504965

  9. Perioperative Heat Loss Prevention-A Feasibility Trial.

    PubMed

    Kurnat-Thoma, Emma L; Roberts, Mary M; Corcoran, Eleanor B

    2016-10-01

    Preventing unplanned perioperative hypothermia is crucial. Thermal reflective blankets may reduce heat loss, promote normothermia, increase patient comfort, and decrease cotton blanket expenses. Our purpose was to determine whether a thermal reflective blanket plus one warmed cotton blanket provides better temperature control and thermal comfort than warmed cotton blankets only. We compared two groups of perioperative patients who received a thermal reflective blanket plus one warmed cotton blanket (n = 110) or warmed cotton blankets only (n = 114) for temperature control and comfort, and we evaluated outcomes in the preoperative holding area, the OR, and the postanesthesia care unit. There were no significant differences in patient temperature or comfort between groups. Use of thermal reflective blankets led to significantly reduced use of warmed cotton blankets (t209 = -10.51, P < .001), and a cost threshold for clinical adoption was identified. The hospital opted not to purchase thermal reflective blankets because of equivalent performance and minimal cost savings.

  10. Perioperative pain management in hip arthroscopy; what options are there?

    PubMed Central

    Bech, N. H.; Hulst, A. H.; Spuijbroek, J. A.; van Leuken, L. L. A.; Haverkamp, D.

    2016-01-01

    Hip arthroscopy is a fast growing orthopedic field of expertise. As in any field of surgery adequate postoperative pain management regimes are of utmost importance. The purpose of this review is to provide an overview of current knowledge on anesthetic options for perioperative pain management for hip arthroscopy. We searched the Pubmed/Medline and Embase database for literature and included 10 studies for our analysis. Because of the variety of pain scales and different ways of measured pain no meta-analysis could be performed and a descriptive review is performed. There are several types of pain regimens that can mostly be divided in two groups: local anesthetics and nerve blocks. Included studies show a rather large variation in reported visual analogue scale scores, post anesthesia care unit admission time and opioid usage. There are several anesthetic options available for hip arthroscopy. Different studies use different dosages, anesthetic regimens and different protocols; this partly explains the differences between studies with similar techniques. Peripheral nerve blocks seems promising but regarding current literature no clear recommendation can be made about what the best perioperative pain management option is, an overview of all reported techniques is given. PMID:27583156

  11. New challenges in perioperative management of pancreatic cancer.

    PubMed

    Puleo, Francesco; Maréchal, Raphaël; Demetter, Pieter; Bali, Maria-Antonietta; Calomme, Annabelle; Closset, Jean; Bachet, Jean-Baptiste; Deviere, Jacques; Van Laethem, Jean-Luc

    2015-02-28

    Pancreatic ductal adenocarcinoma (PDAC) is the fourth leading cause of cancer-related death in the industrialized world. Despite progress in the understanding of the molecular and genetic basis of this disease, the 5-year survival rate has remained low and usually does not exceed 5%. Only 20%-25% of patients present with potentially resectable disease and surgery represents the only chance for a cure. After decades of gemcitabine hegemony and limited therapeutic options, more active chemotherapies are emerging in advanced PDAC, like 5-Fluorouracil, folinic acid, irinotecan and oxaliplatin and nab-paclitaxel plus gemcitabine, that have profoundly impacted therapeutic possibilities. PDAC is considered a systemic disease because of the high rate of relapse after curative surgery in patients with resectable disease at diagnosis. Neoadjuvant strategies in resectable, borderline resectable, or locally advanced pancreatic cancer may improve outcomes. Incorporation of tissue biomarker testing and imaging techniques into preoperative strategies should allow clinicians to identify patients who may ultimately achieve curative benefit from surgery. This review summarizes current knowledge of adjuvant and neoadjuvant treatment for PDAC and discusses the rationale for moving from adjuvant to preoperative and perioperative therapeutic strategies in the current era of more active chemotherapies and personalized medicine. We also discuss the integration of good specimen collection, tissue biomarkers, and imaging tools into newly designed preoperative and perioperative strategies.

  12. Clinical decision support for perioperative information management systems.

    PubMed

    Wanderer, Jonathan P; Ehrenfeld, Jesse M

    2013-12-01

    Clinical decision support (CDS) systems are being used to optimize the increasingly complex care that our health care system delivers. These systems have become increasingly important in the delivery of perioperative care for patients undergoing cardiac, thoracic, and vascular procedures. The adoption of perioperative information management systems (PIMS) has allowed these technologies to enter the operating room and support the clinical work flow of anesthesiologists and operational processes. Constructing effective CDS systems necessitates an understanding of operative work flow and technical considerations as well as achieving integration with existing information systems. In this review, we describe published examples of CDS for PIMS, including support for cardiopulmonary bypass separation physiological alarms, β-blocker guideline adherence, enhanced revenue capture for arterial line placement, and detection of hemodynamic monitoring gaps. Although these and other areas are amenable to CDS systems, the challenges of latency and data reliability represent fundamental limitations on the potential application of these tools to specific types of clinical issues. Ultimately, we expect that CDS will remain an important tool in our efforts to optimize the quality of care delivered.

  13. Perioperative management of patients with lung carcinoma and cerebral metastases

    PubMed Central

    Gheorghita, Eva; Pruna, Viorel Mihai; Neagoe, Luminita; Bucur, Cristina; Cristescu, Catioara; Gorgan, Mircea Radu

    2010-01-01

    ABSTRACT Objective: The present study proposes to present the importance of perioperative therapeutic management in survival prolongation and the quality of life for patients that have undergone surgery for cerebral metastases secondary to pulmonary tumors. Method: During 2001-2009, 40 patients with ages between 43-74 years have been diagnosed in our clinic with pulmonary tumor and cerebral metastases. The patients presented single cerebral lesion (excepting one patient with 2 cerebral metastases) and pulmonary tumor. Intracranial pressure (ICP) was high in all cases. All patients have undergone operation with general anesthesia. Results:For all patients the reduction of ICP and keeping an optimal CPP (cerebral perfusion pressure) was pursued. In 38 cases, general anesthesia was performed with Sevoflurane and opioids (fentanyl, remifentanyl, sufentanyl) and in 2 cases the TIVA (total intravenous anesthesia) technique was used with propofol and remifentanyl. 14 of the patients required intraoperative depletive treatment through administering mannitol 20%. 37 patients (92%) have been discharged with improved neurological condition without showing signs of intracranial hypertension, convulsive seizures and with partially or totally remitted hemiparesis and one patient had worse postoperative neurological status. Conclusion:Pulmonary tumor with cerebral metastases represent an important cause for death rate. To solve secondary cerebral lesions, the perioperative management must include assesment and choosing an anesthesia technique with a proper intraoperative management. PMID:21977115

  14. Multiple sclerosis: basic knowledge and new insights in perioperative management.

    PubMed

    Makris, Alexandros; Piperopoulos, Alexandros; Karmaniolou, Iosifina

    2014-04-01

    Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system affecting young adults that may lead to significant disability. The clinical course varies among the types of the disease as well as among individuals. Herein we provide a brief review of the recent data concerning the clinical presentation, diagnosis, causes, and pathogenesis of MS as well as medication used, followed by the anesthetic considerations of patients diagnosed with the disease. To accomplish this, we conducted a systematic PubMed literature search for articles, using the terms multiple sclerosis, anesthesia, general, regional, perioperative, and preoperative, and we then manually reviewed the references from each pertinent article. Because randomized controlled trials on the field are rare, most information is derived by case reports and case series. We concluded that the disease itself as well as the treatment modalities may have several implications in the conduct of anesthesia and perioperative management of MS patients. General and regional anesthetic techniques have been successfully used. With thorough preoperative evaluation and in depth knowledge of the disease and its complications, the MS patients can be managed safely.

  15. New challenges in perioperative management of pancreatic cancer

    PubMed Central

    Puleo, Francesco; Maréchal, Raphaël; Demetter, Pieter; Bali, Maria-Antonietta; Calomme, Annabelle; Closset, Jean; Bachet, Jean-Baptiste; Deviere, Jacques; Van Laethem, Jean-Luc

    2015-01-01

    Pancreatic ductal adenocarcinoma (PDAC) is the fourth leading cause of cancer-related death in the industrialized world. Despite progress in the understanding of the molecular and genetic basis of this disease, the 5-year survival rate has remained low and usually does not exceed 5%. Only 20%-25% of patients present with potentially resectable disease and surgery represents the only chance for a cure. After decades of gemcitabine hegemony and limited therapeutic options, more active chemotherapies are emerging in advanced PDAC, like 5-Fluorouracil, folinic acid, irinotecan and oxaliplatin and nab-paclitaxel plus gemcitabine, that have profoundly impacted therapeutic possibilities. PDAC is considered a systemic disease because of the high rate of relapse after curative surgery in patients with resectable disease at diagnosis. Neoadjuvant strategies in resectable, borderline resectable, or locally advanced pancreatic cancer may improve outcomes. Incorporation of tissue biomarker testing and imaging techniques into preoperative strategies should allow clinicians to identify patients who may ultimately achieve curative benefit from surgery. This review summarizes current knowledge of adjuvant and neoadjuvant treatment for PDAC and discusses the rationale for moving from adjuvant to preoperative and perioperative therapeutic strategies in the current era of more active chemotherapies and personalized medicine. We also discuss the integration of good specimen collection, tissue biomarkers, and imaging tools into newly designed preoperative and perioperative strategies. PMID:25741134

  16. Instrument integrity and sterility: the perioperative practitioner's responsibilities.

    PubMed

    Gilmour, Diane

    2008-07-01

    Surgical instruments, whether single use or reusable, are defined by the University of Newcastle's Online Medical Dictionary as 'Hand held tools or implements used by health professionals for the performance of surgical tasks' (CancerWEB 1998). This definition, in its broadest terms, recognises that the inter-professional team (health professionals) are involved in the use, care and management of that tool or implement (performance of surgical tasks). Spry (2007) identifies that a surgical instrument could last 10 years if well made, carefully handled and appropriately used and that it is the responsibility of the surgical team and sterile services personnel to preserve and protect the life of each individual instrument. This article will identify the perioperative practitioner's responsibility in ensuring that each surgical instrument is fit for purpose, safe for use and will not harm the patient during use. The article will outline the process of instrument/set selection and the pre-, intra- and postoperative checks that should be made by the inter-professional team prior to, during and after use of that set/instrument. This article will also enable the practitioner to gain or reinforce their knowledge and understanding of the decontamination process and its application within the perioperative environment.

  17. X-ray microanalysis of freeze-dried and frozen-hydrated cryosections.

    PubMed

    Zierold, K

    1988-05-01

    The elemental composition and the ultrastructure of biological cells were studied by scanning transmission electron microscopy (STEM) combined with energy dispersive X-ray microanalysis. The preparation technique involves cryofixation, cryoultramicrotomy, cryotransfer, and freeze-drying of samples. Freeze-dried cryosections 100-nm thick appeared to be appropriate for measuring the distribution of diffusible elements and water in different compartments of the cells. The lateral analytical resolution was less than 50 nm, depending on ice crystal damage and section thickness. The detection limit was in the range of 10 mmol/kg dry weight for all elements with an atomic number higher than 12; for sodium and magnesium the detection limits were about 30 and 20 mmol/kg dry weight, respectively. The darkfield intensity in STEM is linearly related to the mass thickness. Thus, it becomes possible to measure the water content in intracellular compartments by using the darkfield signal of the dry mass remaining after freeze-drying. By combining the X-ray microanalytical data expressed as dry weight concentrations with the measurements of the water content, physiologically more meaningful wet weight concentrations of elements were determined. In comparison to freeze-dried cryosections frozen-hydrated sections showed poor contrast and were very sensitive against radiation damage, resulting in mass loss. The high electron exposure required for recording X-ray spectra made reproducible microanalysis of ultrathin (about 100-nm thick) frozen-hydrated sections impossible. The mass loss could be reduced by carbon coating; however, the improvement achieved thus far is still insufficient for applications in X-ray microanalysis. Therefore, at present only bulk specimens or at least 1-micron thick sections can be used for X-ray microanalysis of frozen-hydrated biological samples.

  18. Recent progress in freeze-fracturing of high-pressure frozen samples.

    PubMed

    Walther, P

    2003-10-01

    Pancreatic tissue, bacteria and lipid vesicles were high-pressure frozen and freeze-fractured. In addition to the normal holder, a new type of high-pressure freezing holder was used that is particularly suitable for suspensions. This holder can take up an EM grid that has been dipped in the suspension and clamped in between two low-mass copper platelets, as used for propane-jet freezing. Both the standard and the new suspension holder allowed us to make cryo-fractures without visible ice crystal damage. High-pressure frozen rat pancreas tissue samples were cryo-fractured and cryo-sectioned with a new type diamond knife in the microtome of a freeze-etching device. The bulk fracture faces and blockfaces were investigated in the frozen-hydrated state by use of a cryo-stage in an in-lens SEM. Additional structures can be made visible by controlled sublimation of ice ('etching'), leading to a better understanding of the three-dimensional organization of organelles, such as the endoplasmic reticulum. With this approach, relevant biological structures can be investigated with a few nanometre resolution in a near life-like state, preventing the artefacts associated with conventional fixation techniques.

  19. Photolysis of frozen iodate salts as a source of active iodine in the polar environment

    NASA Astrophysics Data System (ADS)

    Gálvez, Óscar; Baeza-Romero, M. Teresa; Sanz, Mikel; Saiz-Lopez, Alfonso

    2016-10-01

    Reactive halogens play a key role in the oxidation capacity of the polar troposphere. However, sources and mechanisms, particularly those involving active iodine, are still poorly understood. In this paper, the photolysis of an atmospherically relevant frozen iodate salt has been experimentally studied using infrared (IR) spectroscopy. The samples were generated at low temperatures in the presence of different amounts of water. The IR spectra have confirmed that, under near-ultraviolet-visible (UV-Vis) radiation, iodate is efficiently photolysed. The integrated IR absorption coefficient of the iodate anion on the band at 750 cm-1 has been measured to be A = 9.8 ± 0.5 × 10-17 cm molecule-1. The photolysis rate of the ammonium iodate salt was measured by monitoring the decay of ammonium or iodate IR bands (1430 and 750 cm-1 respectively) in the presence of a solar simulator. The absorption cross section of the liquid solutions of ammonium iodate at wavelengths relevant for the troposphere (250 to 400 nm) has been obtained and used to estimate the photolytic quantum yield for the frozen salt. Finally, using an atmospheric model, constrained with the experimental data, we suggest that the photolysis of iodate in frozen salt can potentially provide a pathway for the release of active iodine to the polar atmosphere.

  20. Spectroscopic detection of molecular hydrogen frozen in interstellar ices

    NASA Technical Reports Server (NTRS)

    Sandford, Scott A.; Allamandola, Louis J.; Geballe, Thomas R.

    1993-01-01

    A weak infrared absorption feature near 4141 wavenumbers (2.415 micrometers) in the spectrum of WL5, an infrared source in the rho Ophiuchus cloud complex, has been detected. It is attributed to molecular hydrogen created by irradiation and frozen in situ into water-rich ices. A second, broader absorption at 4125 wavenumbers centimeters (2.424 micrometers) is probably due to methanol in the ices. The column densities of frozen molecular hydrogen and methanol are inferred to be about 2.5 x 10(exp 18) and 3.0 x 10(exp 19), respectively. There is about three times more frozen molecular hydrogen than frozen carbon monoxide along this line of sight.

  1. A Frozen Lake/Glaciolacustrine Model of Crater Greg (Mars)

    NASA Astrophysics Data System (ADS)

    Kargel, J. S.; Furfaro, R.

    2012-03-01

    Crater Greg (near Hellas, Mars) exhibits some of the most compelling evidence of glaciation on Mars. The depositional environment and paleoclimatic implications are not clear. Here we propose a frozen lake model of glacier-like flow formation.

  2. View of the highway, approach to the Frozen Lake switchback ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    View of the highway, approach to the Frozen Lake switchback curve, looking east. Proposed realignment will shift the road slightly to the south (right) - Beartooth Highway, Red Lodge, Montana to Cooke City, Montana, Cody, Park County, WY

  3. Elemental distribution and sample integrity comparison of freeze-dried and frozen-hydrated biological tissue samples with nuclear microprobe

    NASA Astrophysics Data System (ADS)

    Vavpetič, P.; Vogel-Mikuš, K.; Jeromel, L.; Ogrinc Potočnik, N.; Pongrac, P.; Drobne, D.; Pipan Tkalec, Ž.; Novak, S.; Kos, M.; Koren, Š.; Regvar, M.; Pelicon, P.

    2015-04-01

    The analysis of biological samples in frozen-hydrated state with micro-PIXE technique at Jožef Stefan Institute (JSI) nuclear microprobe has matured to a point that enables us to measure and examine frozen tissue samples routinely as a standard research method. Cryotome-cut slice of frozen-hydrated biological sample is mounted between two thin foils and positioned on the sample holder. The temperature of the cold stage in the measuring chamber is kept below 130 K throughout the insertion of the samples and the proton beam exposure. Matrix composition of frozen-hydrated tissue is consisted mostly of ice. Sample deterioration during proton beam exposure is monitored during the experiment, as both Elastic Backscattering Spectrometry (EBS) and Scanning Transmission Ion Microscopy (STIM) in on-off axis geometry are recorded together with the events in two PIXE detectors and backscattered ions from the chopper in a single list-mode file. The aim of this experiment was to determine differences and similarities between two kinds of biological sample preparation techniques for micro-PIXE analysis, namely freeze-drying and frozen-hydrated sample preparation in order to evaluate the improvements in the elemental localisation of the latter technique if any. In the presented work, a standard micro-PIXE configuration for tissue mapping at JSI was used with five detection systems operating in parallel, with proton beam cross section of 1.0 × 1.0 μm2 and a beam current of 100 pA. The comparison of the resulting elemental distributions measured at the biological tissue prepared in the frozen-hydrated and in the freeze-dried state revealed differences in elemental distribution of particular elements at the cellular level due to the morphology alteration in particular tissue compartments induced either by water removal in the lyophilisation process or by unsatisfactory preparation of samples for cutting and mounting during the shock-freezing phase of sample preparation.

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

    PubMed

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

    2008-07-15

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

  5. 7 CFR 319.56-12 - Importation of frozen fruits and vegetables.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 5 2010-01-01 2010-01-01 false Importation of frozen fruits and vegetables. 319.56-12... § 319.56-12 Importation of frozen fruits and vegetables. Frozen fruits and vegetables may be imported... with the requirements for importing frozen fruits and vegetables in part 305 of this chapter....

  6. 7 CFR 52.802 - Grades of frozen red tart pitted cherries.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 2 2014-01-01 2014-01-01 false Grades of frozen red tart pitted cherries. 52.802... of Frozen Red Tart Pitted Cherries Product Description and Grades § 52.802 Grades of frozen red tart pitted cherries. (a) “U.S. Grade A” (or “U.S. Fancy”) is the quality of frozen red tart pitted...

  7. 7 CFR 52.802 - Grades of frozen red tart pitted cherries.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 2 2013-01-01 2013-01-01 false Grades of frozen red tart pitted cherries. 52.802... of Frozen Red Tart Pitted Cherries Product Description and Grades § 52.802 Grades of frozen red tart pitted cherries. (a) “U.S. Grade A” (or “U.S. Fancy”) is the quality of frozen red tart pitted...

  8. Oxy- and carboxyhemoglobin saturation determination in frozen small vessels.

    PubMed

    Zhu, N H; Weiss, H R

    1991-02-01

    A four-wavelength microspectrophotometric method has been developed to determine both O2 and CO saturation of hemoglobin in frozen small vessels. This method compensates for the nonspecific light loss related to the ice crystals and in addition can simultaneously measure both hemoglobin O2 and CO saturation in frozen blood. By using four wavelengths in the 540-580 nm range, it is possible to determine both O2 and CO saturations in frozen blood. This four-wavelength method demonstrated an accuracy of 6-8% within 95% confidence limits (SE of estimate = 3-4%) for both CO and O2 saturation determinations in frozen blood. The linear regression of the hemoglobin O2 saturation calibration was significant with an r2 value of 0.989. The linear regression of the CO saturation calibration was also significant with an r2 of 0.996. The repeatability of each measurement was on the order of 1-6%. This method also represents an accuracy within 5% for measurements in the frozen rabbit heart for both CO and O2 in vessels between 20 and 100 microns in diameter. It compares favorably with other previously reported methods. It shows a similar accuracy but requires fewer repeat measurements than the three-wavelength method. This method can provide accurate measurement of O2 and CO saturation in small frozen arterioles and venules of any organ.

  9. Perioperative Bridging Anticoagulation in Patients with Atrial Fibrillation

    PubMed Central

    Douketis, James D.; Spyropoulos, Alex C.; Kaatz, Scott; Becker, Richard C.; Caprini, Joseph A.; Dunn, Andrew S.; Garcia, David A.; Jacobson, Alan; Jaffer, Amir K.; Kong, David F.; Schulman, Sam; Turpie, Alexander G.G.; Hasselblad, Vic; Ortel, Thomas L.

    2016-01-01

    BACKGROUND It is uncertain whether bridging anticoagulation is necessary for patients with atrial fibrillation who need an interruption in warfarin treatment for an elective operation or other elective invasive procedure. We hypothesized that forgoing bridging anticoagulation would be noninferior to bridging with low-molecular-weight heparin for the prevention of perioperative arterial thromboembolism and would be superior to bridging with respect to major bleeding. METHODS We performed a randomized, double-blind, placebo-controlled trial in which, after perioperative interruption of warfarin therapy, patients were randomly assigned to receive bridging anticoagulation therapy with low-molecular-weight heparin (100 IU of dalteparin per kilogram of body weight) or matching placebo administered subcutaneously twice daily, from 3 days before the procedure until 24 hours before the procedure and then for 5 to 10 days after the procedure. Warfarin treatment was stopped 5 days before the procedure and was resumed within 24 hours after the procedure. Follow-up of patients continued for 30 days after the procedure. The primary outcomes were arterial thromboembolism (stroke, systemic embolism, or transient ischemic attack) and major bleeding. RESULTS In total, 1884 patients were enrolled, with 950 assigned to receive no bridging therapy and 934 assigned to receive bridging therapy. The incidence of arterial thromboembolism was 0.4% in the no-bridging group and 0.3% in the bridging group (risk difference, 0.1 percentage points; 95% confidence interval [CI], −0.6 to 0.8; P = 0.01 for noninferiority). The incidence of major bleeding was 1.3% in the no-bridging group and 3.2% in the bridging group (relative risk, 0.41; 95% CI, 0.20 to 0.78; P = 0.005 for superiority). CONCLUSIONS In patients with atrial fibrillation who had warfarin treatment interrupted for an elective operation or other elective invasive procedure, forgoing bridging anticoagulation was noninferior to

  10. Organ transplantation and drug eluting stents: Perioperative challenges

    PubMed Central

    Dalal, Aparna

    2016-01-01

    Patients listed for organ transplant frequently have severe coronary artery disease (CAD), which may be treated with drug eluting stents (DES). Everolimus and zotarolimus eluting stents are commonly used. Newer generation biolimus and novolimus eluting biodegradable stents are becoming increasingly popular. Patients undergoing transplant surgery soon after the placement of DES are at increased risk of stent thrombosis (ST) in the perioperative period. Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor such as clopidogrel, prasugrel and ticagrelor is instated post stenting to decrease the incident of ST. Cangrelor has recently been approved by Food and Drug Administration and can be used as a bridging antiplatelet drug. The risk of ischemia vs bleeding must be considered when discontinuing or continuing DAPT for surgery. Though living donor transplant surgery is an elective procedure and can be optimally timed, cadaveric organ availability is unpredictable, therefore, discontinuation of antiplatelet medication cannot be optimally timed. The type of stent and timing of transplant surgery can be of utmost importance. Many platelet function point of care tests such as Light Transmittance Aggregrometry, Thromboelastography Platelet Mapping, VerifyNow, Multiple Electrode Aggregrometry are used to assess bleeding risk and guide perioperative platelet transfusion. Response to allogenic platelet transfusion to control severe intraoperative bleeding may differ with the antiplatelet drug. In stent thrombosis is an emergency where management with either a drug eluting balloon or a DES has shown superior outcomes. Post-transplant complications often involved stenosis of an important vessel that may need revascularization. DES are now used for endovascular interventions for transplant orthotropic heart CAD, hepatic artery stenosis post liver transplantation, transplant renal artery stenosis following kidney transplantation, etc. Several antiproliferative drugs

  11. Use of Low Temperature Scanning Electron Microscopy to Observe Frozen Hydrated Specimens of Nematodes

    PubMed Central

    Wergin, William P.; Sayre, Richard M.; Erbe, Eric F.

    1993-01-01

    Frozen hydrated specimens of Pratylenchus agilis and dauer larvae of Steinernema carpocapsae were observed with low-temperature field emission scanning electron microscopy. This new technique provides information about the surface features of nematodes and also allows specimens to be fractured to reveal their internal structure. Furthermore, both halves of fractured specimens can be retained, examined, and photographed either as two-dimensional micrographs or as three-dimensional images for stereo observation (stereology) or quantitative measurements (stereometry). This technique avoids artifacts normally associated with procedures required to prepare nematodes for examination in the transmission and scanning electron microscopes, such as chemical fixation, dehydration, and sectioning or critical point drying. PMID:19279761

  12. Pharmacokinetics of the Perioperative Use of Cancer Chemotherapy in Peritoneal Surface Malignancy Patients

    PubMed Central

    Van der Speeten, K.; Govaerts, K.; Stuart, O. A.; Sugarbaker, P. H.

    2012-01-01

    Background. The peritoneal surface is an acknowledged locoregional failure site of abdominal malignancies. Previous treatment attempts with medical therapy alone did not result in long-term survival. During the last two decades, new treatment protocols combining cytoreductive surgery with perioperative intraperitoneal and intravenous cancer chemotherapy have demonstrated very encouraging clinical results. This paper aims to clarify the pharmacologic base underlying these treatment regimens. Materials and Methods. A review of the current pharmacologic data regarding these perioperative chemotherapy protocols was undertaken. Conclusions. There is a clear pharmacokinetic and pharmacodynamic rationale for perioperative intraperitoneal and intravenous cancer chemotherapy in peritoneal surface malignancy patients. PMID:22778722

  13. Perioperative sleep apnea: a real problem or did we invent a new disease?

    PubMed Central

    Zaremba, Sebastian; Mojica, James E.; Eikermann, Matthias

    2016-01-01

    Depending on the subpopulation, obstructive sleep apnea (OSA) can affect more than 75% of surgical patients. An increasing body of evidence supports the association between OSA  and perioperative complications, but some data indicate important perioperative outcomes do not differ between patients with and without OSA. In this review we will provide an overview of the pathophysiology of sleep apnea and the risk factors for perioperative complications related to sleep apnea. We also discuss a clinical algorithm for the identification and management of OSA patients facing surgery. PMID:27006758

  14. The Benefits of Perioperative Screening for Sleep Apnea in Surgical Patients.

    PubMed

    Subramani, Yamini; Wong, Jean; Nagappa, Mahesh; Chung, Frances

    2017-03-01

    Obstructive sleep apnea (OSA) is a chronic disease affecting millions of people worldwide. Untreated OSA can lead to about a 2-fold increase in medical expenses, mainly because of cardiovascular morbidity. OSA is highly prevalent in the surgical population, with an increased risk of perioperative complications. This article describes the perioperative and long-term social and economic benefits of preoperative screening for OSA. Screening patients to identify high-risk OSA is important to decrease the adverse outcomes and associated health care costs in the perioperative period. Screening for OSA is particularly relevant because most patients are undiagnosed at the time of surgery.

  15. Pleiotropic vascular protective effects of statins in perioperative medicine.

    PubMed

    Fang, Shin-Yuan; Roan, Jun-Neng; Luo, Chwan-Yau; Tsai, Yu-Chuan; Lam, Chen-Fuh

    2013-09-01

    3-Hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor (statins) is one of the most commonly prescribed agents for controlling hyperlipidemia. Apart from their lipid-lowering property, statins are well known for their pleiotropic effects, such as improvement of vascular endothelial dysfunction, attenuation of inflammatory responses, stabilization of atherosclerotic plaques, inhibition of vascular smooth muscle proliferation, and modulation of procoagulant activity and platelet function. The vasculo-protective effect of statins is mainly mediated by inhibition of the mevalonate pathway and oxidized low-density lipoprotein generation, thereby enhancing the biosynthesis of endothelium-derived nitric oxide. Accumulating clinical evidence strongly suggests that administration of statins reduces overall mortality, the development myocardial infarction and atrial fibrillation, and length of hospital stay after a major cardiac/noncardiac surgery. This review updates the clinical pharmacology and therapeutic applications of statins during major operations, and highlights the anesthesia considerations for perioperative statin therapy.

  16. Anaphylactic and anaphylactoid reactions during the perioperative period.

    PubMed

    Lagopoulos, V; Gigi, E

    2011-04-01

    Anaphylactic reactions in the peri-operative period are often serious and potentially life-threatening conditions, involving multiple organ systems in which the clinical manifestations are the consequence of the release of preformed mediators from mast cells and basophils. Anaphylaxis is an immune mediated type I allergic reaction following the massive release of mediators from mast cells and basophils as a response to an allergen. Anaphylactoid reactions are defined as those reactions that produce the same clinical picture with anaphylaxis but are not IgE mediated, occur through a direct nonimmune-mediated release of mediators from mast cells and/or basophils or result from direct complement activation. The occurrence of these reactions during anesthesia, although quite rare, remains a major concern for the anesthesiologists. Thus, the need for systematic screening before surgery and the awareness and expert advice to anaesthesiologists seems to be very critical.

  17. Brugada syndrome and its relevance in the perioperative period

    PubMed Central

    Sorajja, Dan; Ramakrishna, Harish; Poterack, A. Karl; Shen, Win-Kuang; Mookadam, Farouk

    2015-01-01

    Brugada syndrome is an autosomal dominant genetic disorder associated with an increased risk of sudden cardiac death, as well as ventricular tachyarrhythmias. The defective cardiac sodium channels result in usual electrocardiographic findings of a coved-type ST elevation in precordial leads V1 to V3. The majority of patients have uncomplicated courses with anesthesia, surgery, and invasive procedures. However there is risk of worsening ST elevation and ventricular arrhythmias due to perioperative medications, surgical insult, electrolyte abnormalities, fever, autonomic nervous system tone, as well as other perturbations. Given the increasing numbers of patients with inherited conduction disorders presenting for non-cardiac surgery that are at risk of sudden cardiac death, safe anesthetic management depends upon a detailed knowledge of these conditions. PMID:26139749

  18. [ASA and clopidogrel for urological operations. Perioperative management].

    PubMed

    Fischer, C; Lümmen, G

    2013-11-01

    In a systematic overview and meta-analysis among more than 50,000 patients at risk for coronary artery disease, not adhering to or discontinuing aspirin (acetylsalicylic acid, ASA) was associated with a significantly increased risk of non-fatal myocardial infarction or death. Withdrawal of low dose aspirin was correlated with a threefold increase in the risk of adverse cardiovascular events. This risk is present irrespective of the length of time patients had been taking low dose aspirin. Therefore, in patients on chronic low dose aspirin for secondary prevention of cardiovascular disease, aspirin should never be discontinued. In the few available studies in urological surgery the increase in bleeding does not translate into a significant increase in specific morbidity. This seems to be also true for the additional administration of clopidogrel to aspirin. Nevertheless, in patients with drug-eluting stents and dual antiplatelet therapy, urologists should ensure a multidisciplinary management of the perioperative course.

  19. Ranking Slope Stability in Frozen Terrain

    NASA Astrophysics Data System (ADS)

    Stothoff, S.; Dinwiddie, C. L.; Walter, G. R.; Necsoiu, M.

    2011-12-01

    Motivated by the need to assess the risk of permafrost thaw to infrastructure, such as roads, bridges, and pipelines, a landscape-scale approach was developed to rank the risk of slope failures and thermokarst development in areas of seasonally frozen soils underlain by permafrost. The approach has two parts: (i) identifying locations where permafrost thaw is likely to occur under future climates, and (ii) identifying areas where thaw would have consequences with respect to a disturbance. The developed screening tool uses (i) land classification maps developed from remotely sensed data and (ii) a thermohydrologic hazard risk assessment to identify areas susceptible to slope instability under current and future climate states. The screening tool combines a numerical ground thawing and freezing dynamics model for calculating the thickness of the active layer and depth of permafrost with a simple slope stability model that is based upon the Level I Stability Analysis (LISA) approach of Harrell et al. (1992). Instead of using the numerical models directly within probabilistic sampling, a response function for the factor of safety in slope stability is developed from numerical simulations that systematically vary input parameters across their range of applicability. The response function is used within Monte Carlo sampling for each grid cell in a landscape model, with a probability distribution for each input parameter assigned to each grid cell based on (i) classes defined for each grid cell; (ii) a digital elevation model; (iii) empirical, mathematical, and numerical interpretive models; and (iv) probabilistic descriptions of the parameters in the interpretive models. For example, the root cohesion distribution is defined by vegetation class, with vegetation spread across the landscape using Landsat-derived vegetation classification maps. The probability of slope failure is the fraction of parameter realizations that result in a factor of safety less than 1. Ranking

  20. Hot climate and perioperative outcome in elderly patients

    PubMed Central

    Gautam, Parshotam Lal; Kathuria, Sunit; Chhabra, Sunita

    2011-01-01

    Background: It is well known that heat wave is a major cause of weather related mortality in extreme of ages. While auditing our hospital mortality record, we found higher surgical mortality in the months of summer season which inspired us to look into the impact of hot climate in elderly surgical patients. Materials and Methods: An observational prospective cohort study was undertaken to study the impact of hot climate on elderly (age > 60 yrs) surgical patients over one year when outside temperature was more than 20°C. 98 elderly patients requiring general anaesthesia for surgery were enrolled. Patients were grouped on the basis of peak outdoor temperature with a cut off value of 30°C. Group I- when peak outdoor temperature ranged between 20-30°C (comfortable zone) and Group II - when peak outdoor temperature ranged above 30°C. To reduce the bias, inclusion and exclusion criterion were defined. Meteorological factors, patient characteristics, surgical risk factors and other related data were noted. Data was analyzed using student's‘t’ and z-test for statistical significance. Results: There were statistically significant complications and prolonged hospital stay in group II as compared to I (13.21±6.44 Vs 9.81±3.54 days, P value =0.01) on univariate analysis. High risk patients had more complications in hot weather. Stepwise multivariate regression analysis showed higher adverse impact of poor physical and cardiac status than hot climate. Conclusion: Hot and humid weather adversely affect the perioperative outcome in elderly surgical patients. Patients with poor reserves are at greater perioperative risk during hot and humid climate. PMID:21814372

  1. Perioperative Hemoglobin Trajectory in Adult Cardiac Surgical Patients

    PubMed Central

    Scott, David A.; Tung, Hon-Ming Andrew; Slater, Reuben

    2015-01-01

    Abstract: Preoperative anemia and nadir hemoglobin (Hb) during cardiopulmonary bypass (CPB) have been identified as significant risk factors for blood transfusion during cardiac surgery. The aim of this study was to confirm the association between preoperative anemia, perioperative fluid management, and blood transfusion. In addition, the proportion of elective cardiac surgery patients presenting for surgery with anemia was identified to examine whether the opportunity exists for timely diagnosis and intervention. Data from referral until hospital discharge were comprehensively reviewed over a 12-month period for all nonemergency cardiac surgical patients operated on in our institution. Of the 342 patients identified, elective cases were referred a median of 35 days before preoperative clinic and operated on a median of 14 days subsequently. Subacute cases had a median of 3 days from referral to surgery. As per the World Health Organization (WHO) criteria for anemia, 24.2% of elective and 29.6% of subacute patients were anemic. Blood transfusion was administered to 46.2% of patients during their admission. Transfusion was more likely in patients who were female (odds ratio [OR]: 2.45, 95%confidence interval [CI]: 1.28–4.70), had a low body mass index (BMI) (OR: .89, 95% CI: .84–.94), preoperative anemia (OR: 5.15, 95% CI: 2.59–10.24), or renal impairment (OR: 5.44, 95% CI: 2.42–12.22). Hemodilution minimization strategies reduced the Hb fall during CPB, but not transfusion rates. This study identifies a high prevalence of preoperative anemia with sufficient time for elective referrals to undergo appropriate diagnosis and interventions. It also confirms that low red cell mass (anemia and low BMI) and renal impairment are predictors of perioperative blood transfusion. Perfusion strategies to reduce hemodilution are effective at minimizing the intraoperative fall in Hb concentration but did not influence transfusion rate. PMID:26543251

  2. French clinical guidelines on perioperative nutrition. Update of the 1994 consensus conference on perioperative artificial nutrition for elective surgery in adults.

    PubMed

    Chambrier, C; Sztark, F

    2012-10-01

    Surgical patient is a stressed patient. Aggression is more intense and prolonged as surgery is important. Surgery induces secretion of stress hormones, inflammatory mediators and metabolic changes resulting in significant catabolic phenomena. The presence of malnutrition is an independent risk factor for postoperative complications. Malnutrition increases morbidity (infections, delayed healing), mortality, length of stay and costs and impacts human quality of life for patients. It has been shown that the management of perioperative malnutrition reduces the additional risk generated by it. Perioperative nutritional support should not be systematically provided. Since 1994, recommendations on perioperative nutrition, the care of patients and the available resources have changed dramatically. An update of these recommendations was needed. In 2010, an expert panel of the French society of Anesthesiology (SFAR) and the French-speaking society of Clinical Nutrition and Metabolism (SFNEP) has made recommendations for good clinical practice of perioperative nutrition. They are presented. Thus, the perioperative nutritional management must be integrated in a process to reduce the operative risk: risk reduction due to preoperative malnutrition, reduced risk of postoperative malnutrition which may compromise the following treatments, reduction of postoperative metabolic complications, reducing the postoperative morbidity, especially infectious, through the use of pharmaconutrients either preoperatively or postoperatively in some patients.

  3. Use of Hydrocolloids as Cryoprotectant for Frozen Foods.

    PubMed

    Maity, Tanushree; Saxena, Alok

    2016-05-12

    Freezing is one of the widely used preservation methods to preserve the quality of food products but it also results in deteriorative changes in textural properties of food which in turn affects its marketability. Different foodstuffs undergo different types of changes in texture, taste and overall acceptability upon freezing and subsequent frozen storage. Freezing and thawing of pre-cut or whole fruits and vegetables causes many deleterious effects including texture and drip losses. The major problem in stability of ice-cream is re-crystallization phenomena which happens due to temperature fluctuations during storage and finally impairs the quality of ice-cream. Frozen storage for longer periods causes rubbery texture in meat and fish products. To overcome these problems, hydrocolloids which are polysaccharides of high molecular weight, are used in numerous food applications involving gelling, thickening, stabilizing, emulsifying etc. They could improve the rheological and textural characteristics of food systems by changing the viscosity. They play a major role in retaining texture of fruits and vegetables after freezing. They provide thermodynamic stability to ice cream to control the process of re-crystallization. Hydrocolloids find application in frozen surimi, minced fish and meat products due to their water binding ability. They are also added to frozen bakery products to improve shelf-stability by retaining sufficient moisture and retarding staling. Various hydrocolloids impart different cryoprotective effects to food products depending upon their solubility, water holding capacity, rheological properties, and synergistic effect with other ingredients during freezing and frozen storage.

  4. Fresh-frozen, optimal cutting temperature (OCT) compound-embedded bone marrow aspirates: a reliable resource for morphological, immunohistochemical and molecular examinations.

    PubMed

    Lim, J; Kim, Y; Lee, W; Kim, M; Lee, E J; Kang, C S; Han, K

    2010-02-01

    The usefulness of fresh-frozen, optimal cutting temperature (OCT) compound-embedded (FFOE) bone marrow (BM) aspirates was evaluated as a reliable resource for morphological, immunohistochemical and molecular examinations. One hundred BM aspirates were collected in polypropylene tubes and immediately frozen for 2 h in a deep freezer. Frozen BM was transferred to a cryomold filled with OCT compound and the prepared samples were stored in a deep freezer. Histological examination and immunohistochemical staining, polymerase chain reaction (PCR), sequencing and reverse transcription (RT)-PCR were performed to evaluate the quality of the FFOE BM sections in 10% of randomly selected samples. FFOE BM sections revealed better morphologies than paraffin-embedded clot sections in haematoxylin and eosin staining because mature erythrocytes were removed during the staining process in frozen BM sections. Immunohistochemical staining for CD34 revealed excellent staining quality and oil red O staining showed that fat vacuoles in cells were well preserved. The quality of genomic DNA in FFOE BM sections was suitable for obtaining about 2000 bp PCR product for the human leucocyte antigen-A locus followed by direct sequencing of the sample, and the quality of total RNA was suitable for detection of BCR-ABL fusion transcript. FFOE BM aspirates are a reliable resource for various laboratory tests of diagnostic and research arenas.

  5. CHD associated with syndromic diagnoses: peri-operative risk factors and early outcomes

    PubMed Central

    Landis, Benjamin J.; Cooper, David S.; Hinton, Robert B.

    2016-01-01

    CHD is frequently associated with a genetic syndrome. These syndromes often present specific cardiovascular and non-cardiovascular co-morbidities that confer significant peri-operative risks affecting multiple organ systems. Although surgical outcomes have improved over time, these co-morbidities continue to contribute substantially to poor peri-operative mortality and morbidity outcomes. Peri-operative morbidity may have long-standing ramifications on neurodevelopment and overall health. Recognising the cardiovascular and non-cardiovascular risks associated with specific syndromic diagnoses will facilitate expectant management, early detection of clinical problems, and improved outcomes – for example, the development of syndrome-based protocols for peri-operative evaluation and prophylactic actions may improve outcomes for the more frequently encountered syndromes such as 22q11 deletion syndrome. PMID:26345374

  6. Perioperative posterior reversible encephalopathy syndrome in 2 pediatric neurosurgery patients with brainstem ependymoma.

    PubMed

    Gephart, Melanie G Hayden; Taft, Bonnie P; Giese, Anne-Katrin; Guzman, Raphael; Edwards, Michael S B

    2011-03-01

    Posterior reversible encephalopathy syndrome (PRES) has been described in pediatric neurooncology patients, although it has not been documented perioperatively in pediatric neurosurgery patients not actively receiving chemotherapy. Recently at the authors' facility, 2 cases of PRES were diagnosed perioperatively in children with brainstem ependymoma. Both patients had presented with hypertension, altered mental status, and seizures and demonstrated MR imaging features consistent with PRES. The patients were treated with antiseizure and antihypertension medications, leading to improvement in both clinical symptoms and neuroimaging findings. These cases are the first to document PRES in perioperative pediatric neurosurgery patients not actively receiving chemotherapy. Both patients had ependymoma involving the brainstem, which may have led to intra- and perioperative hemodynamic instability (including hypertension) and predisposed them to this syndrome. An awareness of PRES in similar scenarios will aid in the prevention, diagnosis, and treatment of pediatric neurosurgery patients with this syndrome.

  7. Perioperative Management of a Patient With an Intrathecal Drug Delivery Device Infusing Ziconotide: A Case Report.

    PubMed

    Patel, Sephalie; Hafez, Osama; Sexton, Wade J; Edwards, David A

    2017-02-15

    Intrathecal ziconotide is used for the treatment of chronic pain and is delivered by an implanted drug delivery device. Anesthesiologists should be familiar with the perioperative management of the pump as well as the potential adverse events related to continued ziconotide infusion during general anesthesia. A case is presented demonstrating the perioperative management of an intrathecal drug delivery device infusing ziconotide in a patient presenting for radical cystectomy with pelvic lymphadenectomy and ileal conduit diversion.

  8. Perioperative Management of a Patient With an Intrathecal Drug Delivery Device Infusing Ziconotide.

    PubMed

    Patel, Sephalie; Hafez, Osama; Sexton, Wade J; Edwards, David A

    2016-12-09

    Intrathecal ziconotide is used for the treatment of chronic pain and is delivered by an implanted drug delivery device. Anesthesiologists should be familiar with the perioperative management of the pump as well as the potential adverse events related to continued ziconotide infusion during general anesthesia. A case is presented demonstrating the perioperative management of an intrathecal drug delivery device infusing ziconotide in a patient presenting for radical cystectomy with pelvic lymphadenectomy and ileal conduit diversion.

  9. Perioperative Management of Hysterectomy in a Patient with Polycystic Kidney Disease

    PubMed Central

    K, Savitri.; S, Sreedevi

    2014-01-01

    Polycystic disease of the kidney, inherited as an autosomal dominant trait is characterised by progressive expansion of numerous fluid-filled cysts resulting in massive enlargement of the kidneys ultimately resulting in kidney failure. An understanding of alterations in the renal physiology due to hemodynamic changes is important for successful perioperative management. We report a successful perioperative management of a vaginal hysterectomy in a female patient with adult polycystic kidney disease. PMID:25177578

  10. Production of viable trout offspring derived from frozen whole fish

    PubMed Central

    Lee, Seungki; Seki, Shinsuke; Katayama, Naoto; Yoshizaki, Goro

    2015-01-01

    Long-term preservation of fish fertility is essential for the conservation of endangered fishes. However, cryopreservation techniques for fish oocytes and embryos have not yet been developed. In the present study, functional eggs and sperm were derived from whole rainbow trout that had been frozen in a freezer and stored without the aid of exogenous cryoprotectants. Type A spermatogonia retrieved from frozen-thawed whole trout remained viable after freezing duration up to 1,113 days. Long-term-frozen trout spermatogonia that were intraperitoneally transplanted into triploid salmon hatchlings migrated toward the recipient gonads, where they were incorporated, and proliferated rapidly. Although all triploid recipients that did not undergo transplantation were functionally sterile, 2 of 12 female recipients and 4 of 13 male recipients reached sexual maturity. Eggs and sperm obtained from the salmon recipients were capable of producing donor-derived trout offspring. This methodology is thus a convenient emergency tool for the preservation of endangered fishes. PMID:26522018

  11. Perioperative administration of propranolol to women undergoing ovarian cancer surgery: A pilot study

    PubMed Central

    Jang, Hye-In; Lim, Soo-Hyun; Lee, Yoo-Young; Kim, Tae-Joong; Lee, Jeong-Won; Kim, Byoung-Gie; Bae, Duk-Soo

    2017-01-01

    Objective This study was done to evaluate whether perioperative propranolol (ß-blocker) in ovarian cancer patients undergoing debulking surgery reduced perioperative tumor growth induced by surgical stress. Methods This was a prospective randomized single institution analysis. The primary objective was to compare the changes in CA 125 level (changes between preoperation day 2 and postoperative day 7). As a study arm, patients received a low dose of propranolol 40 mg/day (4×10 mg) starting two days before surgery and 40 mg twice daily for three days following surgery. Results Twenty-two patients were enrolled and 16 were evaluable for efficacy. The drug was well tolerated. The mean decrease of CA 125 during the seven perioperative days was 83.1±8.9% in the propranolol group and 72.4±14.7% in the placebo group. The difference was statistically significant (P=0.044). The change of C-reactive protein, cortisol, and anxiety score (State-Trait Anxiety Inventory-X1) were not different between the two groups. Conclusion This preliminary result is the first to directly test the role of perioperative propranolol on tumor growth. Even with the small sample size and short term use of the drug, perioperative propranolol was effective in reducing tumor burden (as measured by CA 125) suggesting its potential benefits in decreasing perioperative tumor growth. PMID:28344958

  12. Changes in left ventricular performance related to perioperative myocardial infarction in coronary artery bypass graft surgery

    SciTech Connect

    Roberts, A.J.; Spies, S.M.; Lichtenthal, P.R.; Moran, J.M.; Sanders, J.H.; Michaelis, L.L.

    1983-05-01

    Strict electrocardiographic, enzymatic, scintigraphic, and hemodynamic criteria for perioperative myocardial infarction (MI) were defined and related to serial assessments of left ventricular performance during rest and exercise in patients seen early and late after coronary artery bypass graft operation. Global left ventricular performance was determined by radionuclide ventriculography from which changes in the pattern of serial postoperative ejection fractions (EF) were obtained. Patients were divided into two groups based on the presence or absence of perioperative MI, and were matched in pairs on the basis of preoperative EF and extent as well as location of coronary artery obstructions. The results indicate that neither short- nor long-term depression in resting EF occurred subsequent to perioperative MI. However, an exercise-related increase in EF eight months postoperatively was depressed in patients who had perioperative MI compared with those who did not. Patients with new Q waves and abnormal postoperative elevation in serum levels of the myocardial isoenzyme of creatine kinase (CK-MB) had a greater early decrease in EF compared with patients without evidence of perioperative MI. However, seven days after operation, the EF in both groups returned to preoperative levels. Patients with abnormal technetium 99m-pyrophosphate scintigrams had changes in perioperative EF similar to those in patients without MI. The presence of low cardiac output syndrome immediately after operation was associated with immediate and short-term decreases in EF, which were not seen in any of the other patient subgroups.

  13. Perioperative aspirin management after POISE-2: some answers, but questions remain.

    PubMed

    Gerstein, Neal Stuart; Carey, Michael Christopher; Cigarroa, Joaquin E; Schulman, Peter M

    2015-03-01

    Aspirin constitutes important uninterrupted lifelong therapy for many patients with cardiovascular (CV) disease or significant (CV) risk factors. However, whether aspirin should be continued or withheld in patients undergoing noncardiac surgery is a common clinical conundrum that balances the potential of aspirin for decreasing thrombotic risk with its possibility for increasing perioperative blood loss. In this focused review, we describe the role of aspirin in treating and preventing cardiovascular disease, summarize the most important literature on the perioperative use of aspirin (including the recently published PeriOperative ISchemic Evaluation [POISE]-2 trial), and offer current recommendations for managing aspirin during the perioperative period. POISE-2 suggests that aspirin administration during the perioperative period does not change the risk of a cardiovascular event and may result in increased bleeding. However, these findings are tempered by a number of methodological issues related to the study. On the basis of currently available literature, including POISE-2, aspirin should not be administered to patients undergoing surgery unless there is a definitive guideline-based primary or secondary prevention indication. Aside from closed-space procedures, intramedullary spine surgery, or possibly prostate surgery, moderate-risk patients taking lifelong aspirin for a guideline-based primary or secondary indication may warrant continuation of their aspirin throughout the perioperative period.

  14. 21 CFR 158.170 - Frozen peas.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... and designations shall apply: Size designation Round hole sieve size through which peas will pass..., specified in paragraph (b)(3)(i) (a) or (b) of this section, diluted to 9.5 liters with water). (iii) Drying... securely and immerse in water bath with continuous flow at room temperature. Avoid agitation of bag...

  15. Design of a frozen spin target for CLAS

    SciTech Connect

    C.D. Keith; M.L. Seely; O. Dzyubak

    2005-02-01

    A frozen spin target for the CEBAF Large Acceptance Spectrometer (CLAS) is under construction for a series of experiments that scatter tagged, polarized photons from both longitudinally and transversely polarized protons. Compared to the polarized target previously used inside CLAS, the proposed frozen spin target will better utilize the spectrometer's nearly 4pi acceptance. The target material will be dynamically polarized at 5 T and 0.3 K and then cooled to about 0.05 K by a horizontal 3He/4He dilution refrigerator. The polarization will be preserved by internal supercvnducting coils providing 0.3-0.5 T.

  16. Frozen flux violation, electron demagnetization and magnetic reconnection

    SciTech Connect

    Scudder, J. D.; Karimabadi, H.; Roytershteyn, V.; Daughton, W.

    2015-10-15

    We argue that the analogue in collisionless plasma of the collisional diffusion region of magnetic reconnection is properly defined in terms of the demagnetization of the plasma electrons that enable “frozen flux” slippage to occur. This condition differs from the violation of the “frozen-in” condition, which only implies that two fluid effects are involved, rather than the necessary slippage of magnetic flux as viewed in the electron frame. Using 2D Particle In Cell (PIC) simulations, this approach properly finds the saddle point region of the flux function. Our demagnetization conditions are the dimensionless guiding center approximation expansion parameters for electrons which we show are observable and determined locally by the ratio of non-ideal electric to magnetic field strengths. Proxies for frozen flux slippage are developed that (a) are measurable on a single spacecraft, (b) are dimensionless with theoretically justified threshold values of significance, and (c) are shown in 2D simulations to recover distinctions theoretically possible with the (unmeasurable) flux function. A new potentially observable dimensionless frozen flux rate, Λ{sub Φ}, differentiates significant from anecdotal frozen flux slippage. A single spacecraft observable, ϒ, is shown with PIC simulations to be essentially proportional to the unobservable local Maxwell frozen flux rate. This relationship theoretically establishes electron demagnetization in 3D as the general cause of frozen flux slippage. In simple 2D cases with an isolated central diffusion region surrounded by separatrices, these diagnostics uniquely identify the traditional diffusion region (without confusing it with the two fluid “ion-diffusion” region) and clarify the role of the separatrices where frozen flux violations do occur but are not substantial. In the more complicated guide and asymmetric 2D cases, substantial flux slippage regions extend out along, but inside of, the preferred separatrices

  17. Frozen shoulder: A systematic review of therapeutic options.

    PubMed

    Uppal, Harpal Singh; Evans, Jonathan Peter; Smith, Christopher

    2015-03-18

    Frozen shoulder is a common disease which causes significant morbidity. Despite over a hundred years of treating this condition the definition, diagnosis, pathology and most efficacious treatments are still largely unclear. This systematic review of current treatments for frozen shoulder reviews the evidence base behind physiotherapy, both oral and intra articular steroid, hydrodilatation, manipulation under anaesthesia and arthroscopic capsular release. Key areas in which future research could be directed are identified, in particular with regard to the increasing role of arthroscopic capsular release as a treatment.

  18. Cryoelectrolysis—electrolytic processes in a frozen physiological saline medium

    PubMed Central

    Lugnani, Franco; Macchioro, Matteo

    2017-01-01

    Background Cryoelectrolysis is a new minimally invasive tissue ablation surgical technique that combines the ablation techniques of electrolytic ablation with cryosurgery. The goal of this study is to examine the hypothesis that electrolysis can take place in a frozen aqueous saline solution. Method To examine the hypothesis we performed a cryoelectrolytic ablation protocol in which electrolysis and cryosurgery are delivered simultaneously in a tissue simulant made of physiological saline gel with a pH dye. We measured current flow, voltage and extents of freezing and pH dye staining. Results Using optical measurements and measurements of currents, we have shown that electrolysis can occur in frozen physiological saline, at high subzero freezing temperatures, above the eutectic temperature of the frozen salt solution. It was observed that electrolysis occurs when the tissue resides at high subzero temperatures during the freezing stage and essentially throughout the entire thawing stage. We also found that during thawing, the frozen lesion temperature raises rapidly to high subfreezing values and remains at those values throughout the thawing stage. Substantial electrolysis occurs during the thawing stage. Another interesting finding is that electro-osmotic flows affect the process of cryoelectrolysis at the anode and cathode, in different ways. Discussion The results showing that electrical current flow and electrolysis occur in frozen saline solutions imply a mechanism involving ionic movement in the fluid concentrated saline solution channels between ice crystals, at high subfreezing temperatures. Temperatures higher than the eutectic are required for the brine to be fluid. The particular pattern of temperature and electrical currents during the thawing stage of frozen tissue, can be explained by the large amounts of energy that must be removed at the outer edge of the frozen lesion because of the solid/liquid phase transformation on that interface. Conclusion

  19. A digital rat atlas of sectional anatomy

    NASA Astrophysics Data System (ADS)

    Yu, Li; Liu, Qian; Bai, Xueling; Liao, Yinping; Luo, Qingming; Gong, Hui

    2006-09-01

    This paper describes a digital rat alias of sectional anatomy made by milling. Two healthy Sprague-Dawley (SD) rat weighing 160-180 g were used for the generation of this atlas. The rats were depilated completely, then euthanized by Co II. One was via vascular perfusion, the other was directly frozen at -85 °C over 24 hour. After that, the frozen specimens were transferred into iron molds for embedding. A 3% gelatin solution colored blue was used to fill the molds and then frozen at -85 °C for one or two days. The frozen specimen-blocks were subsequently sectioned on the cryosection-milling machine in a plane oriented approximately transverse to the long axis of the body. The surface of specimen-blocks were imaged by a scanner and digitalized into 4,600 x2,580 x 24 bit array through a computer. Finally 9,475 sectional images (arterial vessel were not perfused) and 1,646 sectional images (arterial vessel were perfused) were captured, which made the volume of the digital atlas up to 369.35 Gbyte. This digital rat atlas is aimed at the whole rat and the rat arterial vessels are also presented. We have reconstructed this atlas. The information from the two-dimensional (2-D) images of serial sections and three-dimensional (3-D) surface model all shows that the digital rat atlas we constructed is high quality. This work lays the foundation for a deeper study of digital rat.

  20. Perioperative Results Eversion Carotid Endarterectomy in Bilateral Symptomatic Stenosis

    PubMed Central

    Djedovic, Muhamed; Djedovic, Samed; Rustempasic, Nedzad; Totic, Dragan

    2015-01-01

    Introduction: Carotid endarterectomy (CEA) is a standard treatment for the prevention of stroke and death in patients with significant stenosis of the internal carotid artery. Eversion endarterectomy is warranted in patients with symptoms of cerebral ischemia and the degree of stenosis of 70-99%. The same is suitable for treating a symptomatic carotid artery stenosis with contralateral stenosis (50-70%). Purpose: The aim of this study was to evaluate perioperative complications (ICV, TIA, MI, mortality) in patients treated with carotid eversion endarterectomy with unilateral and bilateral symptomatic stenosis (with bilateral stenosis treated with ACI stenosis ≥70%). Patients and Methods: The study included 139 patients with symptomatic carotid artery stenosis at the Department of Vascular Surgery of the University Clinical Center of Sarajevo in the period from January 2012 to December 2014 year. Given the involvement of ACI stenosis patients were divided into two groups. Group A consisted of 74 patients with bilateral stenosis (surgically treated with ACI stenosis ≥70%, while the degree of stenosis opposite ACI was from 50-70%), and group B of 65 patients with unilateral stenosis ≥70%. Results: Of the 139 patients included in the study, in the group A was 74, of which 46 male (62.2%) and 28 female (37.8%), while in group B were 42 male (64.6%) and 23 female (35.4%) (p = 0.90). The subjects in group A were slightly older 65.9 (± 7.8) compared to group B 64.2 (± 7.7) (p = 0.17). Analysis of risk factors indicating a higher number in Group A compared to group B, but the difference was not statistically significant: 34 smokers (45.9%) versus 36 (55.4%); p = 0:34), patients with hypertension (63 (85.1%) against the 52 (80.0%); p = 0.56), with statin therapy (62 (83.8%) versus 52 (80.0%); p = 0.72), diabetes (18 (24.3%) versus 18 (27.7%); p = 0.79) and with a heart disease (18 (24.3%) versus 7 (10.8%); p = 0.06). Analysis of the frequency of perioperative

  1. 9 CFR 94.2 - Fresh (chilled or frozen) products (other than meat), and milk and milk products of ruminants and...

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... (other than meat), and milk and milk products of ruminants and swine. 94.2 Section 94.2 Animals and... (chilled or frozen) products (other than meat), and milk and milk products of ruminants and swine. (a) The... ruminants or swine, originating in, shipped from, or transiting any region designated in § 94.1(a) as...

  2. 21 CFR 101.95 - “Fresh,” “freshly frozen,” “fresh frozen,” “frozen fresh.”

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... expressly or implicitly refers to the food on labels or labeling, including use in a brand name and use as a..., Drug, and Cosmetic Act (the act). (a) The term “fresh,” when used on the label or in labeling of a food... fresh,” when used on the label or in labeling of a food, mean that the food was quickly frozen...

  3. 21 CFR 101.95 - “Fresh,” “freshly frozen,” “fresh frozen,” “frozen fresh.”

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... expressly or implicitly refers to the food on labels or labeling, including use in a brand name and use as a..., Drug, and Cosmetic Act (the act). (a) The term “fresh,” when used on the label or in labeling of a food... fresh,” when used on the label or in labeling of a food, mean that the food was quickly frozen...

  4. 21 CFR 101.95 - “Fresh,” “freshly frozen,” “fresh frozen,” “frozen fresh.”

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... expressly or implicitly refers to the food on labels or labeling, including use in a brand name and use as a..., Drug, and Cosmetic Act (the act). (a) The term “fresh,” when used on the label or in labeling of a food... fresh,” when used on the label or in labeling of a food, mean that the food was quickly frozen...

  5. Analysis of Metmyoglobin Formation Rates in Frozen Tuna Meat during Frozen Storage

    NASA Astrophysics Data System (ADS)

    Viriyarattanasak, Chotika; Watanabe, Manabu; Suzuki, Toru

    Formation of metmyoglobin (metMb) in frozen tuna meat stored at -90, -60, -40, -30, -20, and -10°C for approximately 6 months was investigated. The reaction rate of metMB formation was estimated from a linear plot of ln ([M∞ . Mt] /[M∞ . Mo]) and storage time (t) for each storage temperature (Ts) (M∞, Mt, and Mo are metMb contents at times t = t∞, t, and 0, respectively). When M∞ was assumed to be 100%, the rate of metMb formation followed the first-order reaction only during the early stage of storage period. MetMb formation, however obeyed the first-order reaction for all test temperatures even during long-term storage when M∞ was assumed to be dependent on storage temperature (M∞(Ts)). A discontinuity was observed in the temperature dependence of M∞(Ts) at storage temperature range between -60 and -40°C, which was attributed to the glass transition of protein system. On the other hand, the temperature dependence of metMb formation did not show a significant change over all storage temperatures.

  6. Antioxidant, mutagenic, and antimutagenic activity of frozen fruits.

    PubMed

    Spada, Patrícia D S; de Souza, Gabrielle Gianna Nunes; Bortolini, Giovana Vera; Henriques, João A P; Salvador, Mirian

    2008-03-01

    Many studies have focused on the effect of fresh fruits on the risk of developing cancer and other diseases involved with reactive species and free radicals. The intake of frozen fruits has spread widely in the last years, but, until now, their biological activity is not completely known. In this study, 23 samples of frozen fruits were analyzed for their nutritional composition, total polyphenols, total carotenoids, and vitamin C content. Antioxidant, mutagenic, and antimutagenic effects were also evaluated. Antioxidant assays included 2,2-diphenyl-1-picrylhydrazyl radical (DPPH(.)) scavenging activity and determination of superoxide dismutase (SOD)- and catalase (CAT)-like activities. Mutagenic and antimutagenic evaluations were performed in eukaryotic cells of Saccharomyces cerevisiae yeast. Most samples (74%) showed antioxidant activity similar to vitamin C in the DPPH(.) assay, and this activity was positively correlated (r = 0.366; P frozen fruits, even after freezing. These data suggest that frozen fruits contribute to the prevention of biological damages.

  7. Sanitization Treatment of Blueberries for the Frozen/Processing Market

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Fresh blueberries are packed without washing, however, those for the frozen and other processing markets are usually washed prior to packing. Washing is usually done by dipping the berries in a water bath or by spraying water on them. This step can result in an increase in microbial load and contami...

  8. Characteristics of frozen colostrum thawed in a microwave oven

    SciTech Connect

    Jones, L.R.; Taylor, A.W.; Hines, H.C.

    1987-09-01

    Use of a microwave oven to thaw frozen colostrum was evaluated. Colostrum was collected from nine cows, four of which were immunized to produce specific colostral antibodies. Colostrum from each cow was frozen, subsequently thawed, and pooled. One-liter aliquots of the pooled colostrum were frozen and assigned randomly to three thawing treatments. Colostrum was thawed using one of three regimens: 10 min in a microwave oven at full power (650 W), 17 min in a microwave oven at half power (325 W), and 25 min in 45 degrees C water. Colostrum thawed in the microwave oven was slightly coagulated and had lower volume and total protein content than colostrum thawed in water. Casein and pH were not different among treatments. Both concentration and total content of immunoglobulin A were higher in the control than in microwave treatments. Neither amount nor concentration of immunoglobulin G and immunoglobulin M were different among treatments. Immunological activity, measured by a hemolytic test, was lower for microwave treatments than the control but did not differ between microwave treatments. Frozen colostrum thawed in a microwave oven should provide a reasonable source of colostrum when fresh high quality colostrum is not available.

  9. 9 CFR 381.158 - Poultry dinners (frozen) and pies.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 9 Animals and Animal Products 2 2012-01-01 2012-01-01 false Poultry dinners (frozen) and pies. 381... AGRICULTURE AGENCY ORGANIZATION AND TERMINOLOGY; MANDATORY MEAT AND POULTRY PRODUCTS INSPECTION AND VOLUNTARY INSPECTION AND CERTIFICATION POULTRY PRODUCTS INSPECTION REGULATIONS Definitions and Standards of Identity...

  10. 9 CFR 381.158 - Poultry dinners (frozen) and pies.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 9 Animals and Animal Products 2 2013-01-01 2013-01-01 false Poultry dinners (frozen) and pies. 381... AGRICULTURE AGENCY ORGANIZATION AND TERMINOLOGY; MANDATORY MEAT AND POULTRY PRODUCTS INSPECTION AND VOLUNTARY INSPECTION AND CERTIFICATION POULTRY PRODUCTS INSPECTION REGULATIONS Definitions and Standards of Identity...

  11. 9 CFR 381.158 - Poultry dinners (frozen) and pies.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 9 Animals and Animal Products 2 2014-01-01 2014-01-01 false Poultry dinners (frozen) and pies. 381... AGRICULTURE AGENCY ORGANIZATION AND TERMINOLOGY; MANDATORY MEAT AND POULTRY PRODUCTS INSPECTION AND VOLUNTARY INSPECTION AND CERTIFICATION POULTRY PRODUCTS INSPECTION REGULATIONS Definitions and Standards of Identity...

  12. 9 CFR 381.158 - Poultry dinners (frozen) and pies.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 9 Animals and Animal Products 2 2011-01-01 2011-01-01 false Poultry dinners (frozen) and pies. 381... AGRICULTURE AGENCY ORGANIZATION AND TERMINOLOGY; MANDATORY MEAT AND POULTRY PRODUCTS INSPECTION AND VOLUNTARY INSPECTION AND CERTIFICATION POULTRY PRODUCTS INSPECTION REGULATIONS Definitions and Standards of Identity...

  13. 9 CFR 381.158 - Poultry dinners (frozen) and pies.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Poultry dinners (frozen) and pies. 381... AGRICULTURE AGENCY ORGANIZATION AND TERMINOLOGY; MANDATORY MEAT AND POULTRY PRODUCTS INSPECTION AND VOLUNTARY INSPECTION AND CERTIFICATION POULTRY PRODUCTS INSPECTION REGULATIONS Definitions and Standards of Identity...

  14. Speakers' Sensitivity to Rules of Frozen Word Order.

    ERIC Educational Resources Information Center

    Pinker, Steven; Birdsong, David

    1979-01-01

    Two studies elicited native speaker and nonnative speaker judgments regarding preferred word order of the idioms known as "freezes." The results support the notion that rules of frozen word order are psychologically real and reflect universal language rules. (Author/AM)

  15. Quality indices of Jew's mallow and spinach during frozen storage.

    PubMed

    Labib, A A; Abd el-Latife, S A; Omran, H

    1997-01-01

    In this study, Jew's mallow and spinach were heat treated and kept frozen, at -18 degrees C, for 3 months. Analysis of some chemical components and enzymatic activities as well as a sensory evaluation were undertaken. At the end of the storage period, blanched spinach showed no PPO (polyphenyloxidase) activity at all, but still contained PO (peroxydase) and LO (lipoxygenase) activities. The untreated spinach stored under the same conditions showed high activities of PO, PPO and LO. The heat treated mallow still contained high enzyme activities which decreased slowly during frozen storage. Statistical analysis of the chemical composition and the sensory evaluation results indicated that heat treatments of mallow caused significant differences in total solids, pH, chlorophyll a and total chlorophyll, while frozen storage, of samples of the same treatment for 3 months caused no significant differences in moisture, ash, oxalic acid, pH, chlorophyll a and total chlorophyll. No significant differences could be noticed in the overall acceptability between mallow samples mixed with hot water and those mixed with a hot 0.1% MgCO3 solution. Significant differences were found between the heat treated and the untreated mallow. Changes of the chemical composition and the overall acceptability of blanched spinach during frozen storage showed almost the same trend noticed for the Jew's mallow.

  16. Inexpensive treatment of frozen dairy products for membrane filtration.

    PubMed Central

    Peterkin, P I; Sharpe, A N; Warburton, D W

    1982-01-01

    Treatment of frozen dairy products with trypsin and Tween 80 before membrane filtration for microbiological analysis was faster and cost less than treatment with Streptomyces griseus protease-Tween 80. Viable cell counts so Escherichia coli, Staphylococcus aureus, Streptococcus faecium, and Salmonella typhimurium were not reduced. PMID:7036901

  17. Cryoprotectant redistribution along the frozen straw probed by Raman spectroscopy.

    PubMed

    Karpegina, Yu A; Okotrub, K A; Brusentsev, E Yu; Amstislavsky, S Ya; Surovtsev, N V

    2016-04-01

    The distribution of cryoprotectant (10% glycerol) and ice along the frozen plastic straw (the most useful container for freezing mammalian semen, oocytes and embryos) was studied by Raman scattering technique. Raman spectroscopy being a contactless, non-invasive tool was applied for the straws filled with the cryoprotectant solution and frozen by controlled rate programs commonly used for mammalian embryos freezing. Analysis of Raman spectra measured at different points along the straw reveals a non-uniform distribution of the cryoprotectant. The ratio between non-crystalline solution and ice was found to be increased by several times at the bottom side of the solution column frozen by the standard freezing program. The increase of the cryoprotectant fraction occurs in the area where embryos or oocytes are normally placed during their freezing. Possible effects of the cooling rate and the ice nucleation temperature on the cryoprotectant fraction at the bottom side of the solution column were considered. Our findings highlight that the ice fraction around cryopreserved embryos or oocytes can differ significantly from the averaged one in the frozen plastic straws.

  18. Nitrate Concentration near the Surface of Frozen Aqueous Solutions.

    PubMed

    Marrocco, Harley A; Michelsen, Rebecca R H

    2014-12-26

    Photolysis of nitrate plays an important role in the emission of nitrogen oxides from snow and ice, which affects the composition of the overlying atmosphere. In order to quantify these reactions, it is necessary to know how much nitrate is available for photolysis near the surfaces of snow and ice. The concentration of nitrate excluded from frozen solutions of nitric acid, sodium nitrate, and magnesium nitrate was measured with attenuated total reflection infrared spectroscopy. Liquid water and nitrate were observed at and near the bottom surface of frozen aqueous solutions during annealing from -18 to -2 °C. At -2 °C, the nitrate concentration was determined to be ∼1.0 mol/L for frozen NaNO(3) and Mg(NO(3))(2) solutions and ∼0.8 mol/L for frozen HNO(3) solutions. At lower temperatures, nitrate concentration ranged from 1.6 to 3.7 mol/L. Ideal thermodynamics overestimates nitrate concentration at colder temperatures where the brine is highly concentrated for all solutions. The nitrate concentration at ice surfaces is well described by bulk freezing point depression data close to the melting point of ice and for nitric acid at colder temperatures. Effects of temperature and counterions and implications for modeling snow chemistry are discussed.

  19. Present status of spin frozen deuteron target at KEK

    SciTech Connect

    Hiramatsu, S.; Isagawa, S.; Ishimoto, S.; Masaike, A.; Morimoto, K.

    1983-01-01

    Brief report on the present status of a spin frozen deuteron target at KEK is presented. Deuterons in fully deterated propanediol (D-8) with EHBA-Cr/sup v/ complex were polarized up to 40% in a high cooling power dilution refrigerator which was installed in a large aperture spectrometer. 4 references, 5 figures.

  20. 78 FR 50381 - Certain Frozen Warmwater Shrimp From Malaysia: Final Affirmative Countervailing Duty Determination

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-19

    ... International Trade Administration Certain Frozen Warmwater Shrimp From Malaysia: Final Affirmative... subsidies are being provided to producers and exporters of certain frozen warmwater shrimp from Malaysia...) Sdn. Bhd., and Charoen Pokphand Foods (Malaysia) Sdn. Bhd., (collectively, the Asia...

  1. 78 FR 56209 - Certain Frozen Warmwater Shrimp From the People's Republic of China: Final Results of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-12

    ... affiliated group of companies that includes Yangjiang City Yelin Hoitat Quick Frozen Seafood Co., Ltd... Anyang Food Co., Ltd., Yangjiang City Yelin Hoi Tat Quick Frozen Seafood Co., Ltd., Yangjiang...

  2. 78 FR 54912 - Frozen Warmwater Shrimp from Indonesia and Thailand; Termination of Investigations

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-06

    ... From the Federal Register Online via the Government Publishing Office INTERNATIONAL TRADE COMMISSION Frozen Warmwater Shrimp from Indonesia and Thailand; Termination of Investigations AGENCY: United...(a)), the countervailing duty investigations concerning frozen warmwater shrimp from Indonesia...

  3. 76 FR 31575 - United States Standards for Grades of Frozen Onions

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-01

    ... Agricultural Marketing Service United States Standards for Grades of Frozen Onions AGENCY: Agricultural Marketing Service, USDA. ACTION: Notice and request for comments. SUMMARY: The Agricultural Marketing... United States Standards for Grades of Frozen Onions. USDA has received additional industry comments...

  4. 78 FR 13325 - Certain Frozen Warmwater Shrimp From the People's Republic of China, Ecuador, India, Indonesia...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-27

    ...-815] Certain Frozen Warmwater Shrimp From the People's Republic of China, Ecuador, India, Indonesia... frozen warmwater shrimp from the People's Republic of China, Ecuador, India, Indonesia, Malaysia... of China,Ecuador, India, Indonesia, Malaysia, Thailand, and the Socialist Republic of...

  5. 78 FR 6297 - Certain Frozen Fish Fillets From the Socialist Republic of Vietnam: Preliminary Results of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-30

    ... International Trade Administration Certain Frozen Fish Fillets From the Socialist Republic of Vietnam... frozen fish fillets from the Socialist Republic of Vietnam (``Vietnam''). The period of review (``POR... Republic of Vietnam'' from Christian Marsh, Deputy Assistant Secretary for Antidumping and...

  6. Clinical performance feedback and quality improvement opportunities for perioperative physicians

    PubMed Central

    Kaye, Alan David; Okanlawon, Olutoyin J; Urman, Richard D

    2014-01-01

    Clinical performance feedback is an important component of the ongoing development and education of health care practitioners. For physicians, feedback about their clinical practice and outcomes is central to developing both confidence and competence at all stages of their medical careers. Cultural and financial infrastructures need to be in place, and the concept of feedback needs to be readily embraced and encouraged by clinical leadership and other stakeholders. The “buy-in” includes the expectation and view that feedback occurs on a routine basis, and those engaged in the process are both encouraged to participate and held accountable. Feedback must be part of an overarching quality improvement and physician education agenda; it is not meant to be an isolated, fragmented initiative that is typically undermined by lack of resources or systemic barriers to gaining improvement within programs. Effective feedback should be an integral part of clinical practice. Anesthesiologists and other perioperative physicians are identifying specialty-specific indicators that can be used when creating a broader quality improvement agenda. Placing a more immediate formal feedback strategy that focuses on goal-oriented behavior is rapidly becoming a mainstay. Physicians may use their individual feedback reports for reflection and designing personal development plans as lifelong learners and leaders in improving patient care. PMID:24833948

  7. Perioperative care of a patient with neuronal ceroid lipofuscinoses

    PubMed Central

    Kako, Hiromi; Martin, David P.; Tobias, Joseph D.

    2013-01-01

    The neuronal ceroid lipofuscinoses (NCL) are a group of inherited, autosomal recessive, and progressive neurodegenerative diseases, which result from an enzymatic defect or the deficiency of a transmembrane protein, leading to the accumulation of lipopigments (lipofuscin) in various tissues. NCL results in the impairment of function in several end-organs including the central nervous system with loss of cognitive and motor function, myoclonus, and intractable seizures. Additional involvement includes the cardiovascular system with arrhythmias and bradycardia as well as impairment of thermoregulation leading to perioperative hypothermia. Given the complexity of the end-organ involvement and the progressive nature of the disorder, the anesthetic care of such patients can be challenging. Till date, there are a limited number of reports regarding the anesthetic management of patients with NCL. We present an 18-year-old patient with NCL who required anesthetic care during replacement of a vagal nerve stimulator. Previous reports of anesthetic care for these patients are reviewed, the end-organ involvement of NCL discussed, and options for anesthetic care presented. PMID:24015141

  8. Surgically-Induced Neuropathic Pain (SNPP): Understanding the Perioperative Process

    PubMed Central

    Borsook, David; Kussman, Barry D.; George, Edward; Becerra, Lino R.; Burke, Dennis W.

    2012-01-01

    Objective Nerve damage takes place during surgery. As a consequence, significant numbers (10–40%) of patients experience chronic neuropathic pain termed surgically induced neuropathic pain (SNPP). Background The initiating surgery and nerve damage set off a cascade of events that includes both pain and an inflammatory response, resulting in ‘peripheral’ and ‘central sensitization’, with the latter resulting from repeated barrages of neural activity from nociceptors. In affected patients these initial events produce chemical, structural and functional changes in the peripheral (PNS) and central nervous (CNS) systems. The maladaptive changes in damaged nerves lead to peripheral manifestations of the neuropathic state – allodynia, sensory loss, shooting pains etc., that can manifest long after the effects of the surgical injury have resolved. The CNS manifestations that occur are termed ‘centralization of pain’ and affect sensory, emotional and other (e.g., cognitive) systems as well as contributing to some of the manifestations of the chronic pain syndrome (e.g., depression). Conclusions Currently there are no objective measures of pain in the peri-operative period. As such intermittent pain or continuous may take place during and after surgery. New technologies including direct measures of specific brain function of nociception and new insights into preoperative evaluation of patients including genetic predisposition appear to provide initial opportunities for decreasing the burden of SNPP until treatments with high efficacy and low side effects that either prevent or treat pain are discovered. PMID:23059501

  9. Determinants of perioperative morbidity and mortality after pneumonectomy

    SciTech Connect

    Wahi, R.; McMurtrey, M.J.; DeCaro, L.F.; Mountain, C.F.; Ali, M.K.; Smith, T.L.; Roth, J.A. )

    1989-07-01

    A total of 197 consecutive patients undergoing pneumonectomy at the M.D. Anderson Cancer Center from 1982 to 1987 were reviewed. Sixty-five variables were analyzed for the predictive value for perioperative risk. The operative mortality rate was 7% (14/197). Patients having a right pneumonectomy (n = 95) had a higher operative mortality rate (12%) than patients having a left pneumonectomy (1%, p less than 0.05). The extent of resection correlated with the operative mortality rate (chest wall resection or extrapleural pneumonectomy, n = 39, 15%; versus simple or intrapericardial pneumonectomy, n = 158, 5%; p less than 0.05). Patients whose predicted postoperative pulmonary function, by spirometry and xenon 133 regional pulmonary function studies, was a forced expiratory volume in 1 second greater than 1.65 L, forced expiratory volume in 1 second greater than 58% of the preoperative value, forced vital capacity greater than 2.5 L, or forced vital capacity greater than 60% of the preoperative value had a lower operative mortality rate (p less than 0.05). Atrial arrhythmia was the most common postoperative complication (23%). Xenon 133 regional pulmonary function studies are useful in predicting the risks of pneumonectomy.

  10. Perioperative anemia management in colorectal cancer patients: A pragmatic approach

    PubMed Central

    Muñoz, Manuel; Gómez-Ramírez, Susana; Martín-Montañez, Elisa; Auerbach, Michael

    2014-01-01

    Anemia, usually due to iron deficiency, is highly prevalent among patients with colorectal cancer. Inflammatory cytokines lead to iron restricted erythropoiesis further decreasing iron availability and impairing iron utilization. Preoperative anemia predicts for decreased survival. Allogeneic blood transfusion is widely used to correct anemia and is associated with poorer surgical outcomes, increased post-operative nosocomial infections, longer hospital stays, increased rates of cancer recurrence and perioperative venous thromboembolism. Infections are more likely to occur in those with low preoperative serum ferritin level compared to those with normal levels. A multidisciplinary, multimodal, individualized strategy, collectively termed Patient Blood Management, minimizes or eliminates allogeneic blood transfusion. This includes restrictive transfusion policy, thromboprophylaxis and anemia management to improve outcomes. Normalization of preoperative hemoglobin levels is a World Health Organization recommendation. Iron repletion should be routinely ordered when indicated. Oral iron is poorly tolerated with low adherence based on published evidence. Intravenous iron is safe and effective but is frequently avoided due to misinformation and misinterpretation concerning the incidence and clinical nature of minor infusion reactions. Serious adverse events with intravenous iron are extremely rare. Newer formulations allow complete replacement dosing in 15-60 min markedly facilitating care. Erythropoiesis stimulating agents may improve response rates. A multidisciplinary, multimodal, individualized strategy, collectively termed Patient Blood Management used to minimize or eliminate allogeneic blood transfusion is indicated to improve outcomes. PMID:24587673

  11. Perioperative chemotherapy for resectable gastric cancer - what is the evidence?

    PubMed

    Bringeland, Erling A; Wasmuth, Hans H; Grønbech, Jon E

    2017-02-28

    The UK MAGIC trial published in 2006 was the first RCT to identify improved long-term survival rates using preoperative chemotherapy for resectable gastric or gastroesophageal cancer. Overnight, the treatment regimen impacted European guidelines. However, the majority of patients underwent limited lymph node dissection, and analyses of the rates of curative resection, downsizing and downstaging were not by intention to treat, rightfully raising concerns about their validity. For the subset of true gastric cancers, meta-analyses may even question the claims of improved long-term survival rates by present-day regimens. A rhetorical question can be posed as to whether downstaging and improved survival rates by preoperative (radio)-chemotherapy for cancers of the distal esophagus or gastric cardia, has confounded our conclusions on the (lack of) effect of present-day regimens of perioperative chemotherapy for true gastric cancers, let alone in a situation with proper lymph node dissection. At present, a plea can be made to move one step back and revert to an RCT with a surgery alone arm. Inclusion criteria and analyses of future RCTs must stratify on tumor location and the Lauren type and embrace the newly developed scheme of sub-classification of gastric cancers based on extensive molecular profiling as reported in the seminal Cancer Genome Atlas Study.

  12. Perioperative haemostatic management of haemophilic mice using normal mouse plasma.

    PubMed

    Tatsumi, K; Ohashi, K; Kanegae, K; Shim, I K; Okano, T

    2013-11-01

    Intense haemostatic interventions are required to avoid bleeding complications when surgical procedures are performed on haemophilia patients. The objective of this study was to establish an appropriate protocol for perioperative haemostatic management of haemophilic mice. We assessed the prophylactic haemostatic effects of normal mouse plasma (NMP) on haemophilia B (HB) mice for both a skin flap procedure and a laparotomy. When 500 μL of NMP was administered to the mice, plasma factor IX (FIX:C) levels peaked at 15.1% immediately after intravenous (IV) administration, at 6.1% 2 h after intraperitoneal (IP) administration and at 2.7% 6 h after subcutaneous administration. Administering 500 μL of NMP via IP or IV 30 min in advance enabled the skin flap procedure to be performed safely without any complications. After the laparotomy procedure, several mice in the IP administration group exhibited lethal bleeding, but all mice survived in the IV administration group. Anti-mouse FIX inhibitors did not develop, even after repetitive administrations of NMP. However, human FIX concentrates, especially plasma-derived concentrates, elicited the anti-human FIX inhibitors. The results show that administering 500 μL of NMP via IV or IP 30 min in advance enables surgical procedures to be safely performed on HB mice, and that IV administration is more desirable than IP if the procedure requires opening of the abdominal wall.

  13. Anaesthetic perioperative management of patients with pancreatic cancer

    PubMed Central

    De Pietri, Lesley; Montalti, Roberto; Begliomini, Bruno

    2014-01-01

    Pancreatic cancer remains a significant and unresolved therapeutic challenge. Currently, the only curative treatment for pancreatic cancer is surgical resection. Pancreatic surgery represents a technically demanding major abdominal procedure that can occasionally lead to a number of pathophysiological alterations resulting in increased morbidity and mortality. Systemic, rather than surgical complications, cause the majority of deaths. Because patients are increasingly referred to surgery with at advanced ages and because pancreatic surgery is extremely complex, anaesthesiologists and surgeons play a crucial role in preoperative evaluations and diagnoses for surgical intervention. The anaesthetist plays a key role in perioperative management and can significantly influence patient outcome. To optimise overall care, patients should be appropriately referred to tertiary centres, where multidisciplinary teams (surgical, medical, radiation oncologists, gastroenterologists, interventional radiologists and anaesthetists) work together and where close cooperation between surgeons and anaesthesiologists promotes the safe performance of major gastrointestinal surgeries with acceptable morbidity and mortality rates. In this review, we sought to provide simple daily recommendations to the clinicians who manage pancreatic surgery patients to make their work easier and suggest a joint approach between surgeons and anaesthesiologists in daily decision making. PMID:24605028

  14. Perioperative critical care management for patients with aneurysmal subarachnoid hemorrhage

    PubMed Central

    Choi, H. Alex; Edwards, Nancy; Chang, Tiffany; Sladen, Robert N.

    2014-01-01

    Despite significant regional and risk factor-related variations, the overall mortality rate in patients suffering from aneurysmal subarachnoid hemorrhage (SAH) remains high. Compared to ischemic stroke, which is typically irreversible, hemorrhagic stroke tends to carry a higher mortality, but patients who do survive have less disability. Technologies to monitor and treat complications of SAH have advanced considerably in recent years, but good long-term functional outcome still depends on prompt diagnosis, early aggressive management, and avoidance of premature withdrawal of support. Endovascular procedures and open craniotomy to secure a ruptured aneurysm represent some of the numerous critical steps required to achieve the best possible result. In this review, we have attempted to provide a contemporary, evidence-based outline of the perioperative critical care management of patients with SAH. This is a challenging and potentially fatal disease with a wide spectrum of severity and complications and an often protracted course. The dynamic nature of this illness, especially in its most severe forms, requires considerable flexibility in clinician management, especially given the panoply of available treatment modalities. Judicious hemodynamic monitoring and adaptive therapy are essential to respond to the fluctuating nature of cerebral vasospasm and the varying oxygen demands of the injured brain that may readily induce acute or delayed cerebral ischemia. PMID:25237442

  15. Perioperative visual loss in ocular and nonocular surgery

    PubMed Central

    Berg, Kathleen T; Harrison, Andrew R; Lee, Michael S

    2010-01-01

    Incidence estimates for perioperative vision loss (POVL) after nonocular surgery range from 0.013% for all surgeries up to 0.2% following spine surgery. The most common neuro-ophthalmologic causes of POVL are the ischemic optic neuropathies (ION), either anterior (AION) or posterior (PION). We identified 111 case reports of AION following nonocular surgery in the literature, with most occurring after cardiac surgery, and 165 case reports of PION following nonocular surgery, with most occurring after spine surgery or radical neck dissection. There were an additional 526 cases of ION that did not specify if the diagnosis was AION or PION. We also identified 933 case reports of central retinal artery occlusion (CRAO), 33 cases of pituitary apoplexy, and 245 cases of cortical blindness following nonocular surgery. The incidence of POVL following ocular surgery appears to be much lower than that seen following nonocular surgery. We identified five cases in the literature of direct optic nerve trauma, 47 cases of AION, and five cases of PION following ocular surgery. The specific pathogenesis and risk factors underlying these neuro-ophthalmic complications remain unknown, and physicians should be alert to the potential for loss of vision in the postoperative period. PMID:20596508

  16. [An Overview of Incidence and Outcome of Perioperative Pulmonary Aspiration].

    PubMed

    Nakazawa, Koichi; Shinoda, Ken

    2016-01-01

    Examination of the literature suggests that the incidence of aspiration pneumonia in the perioperative period is relatively infrequent. Since Mendelson's report of aspiration pneumonitis in 1946, the factors that contribute to the likelihood of aspiration have been identified, and numerous attempts for preventions for regurgitation or pulmonary aspiration have been made. The low incidence of major morbidity of anesthesia-related pulmonary aspiration may be due to adopting quality measures, applying practice guidelines for preoperative fasting, and the use of pharmacologic agents to reduce the risk of pulmonary aspiration. More systematic preoperative checking and more careful selection of patients are necessary when a supraglottic airway is used in preference to a tracheal tube. Second generation supraglottic airways may not reduce the risk of regurgitation, but may reduce the chance of aspiration if the mask position is correct and drain tube works well. Because the mortality and morbidity of aspiration pneumonia remain relatively high, the preoperative risk evaluation is very important to avoid regurgitation or aspiration.

  17. Cleft lift procedure for pilonidal disease: technique and perioperative management.

    PubMed

    Favuzza, J; Brand, M; Francescatti, A; Orkin, B

    2015-08-01

    Pilonidal disease is a common condition affecting young patients. It is often disruptive to their lifestyle due to recurrent abscesses or chronic wound drainage. The most common surgical treatment, "cystectomy," removes useful tissue unnecessarily and does not address the etiology of the condition. Herein, we describe the etiology of pilonidal disease and our technique for definitive management of pilonidal disease using the cleft lift procedure. In this paper, we present our method of performing the cleft lift procedure for pilonidal disease including perioperative management and surgical technique. We have used the cleft lift procedure in nearly 200 patients with pilonidal disease, in both primary and salvage procedures settings. It has been equally successful in both settings with a high rate of success. It results in a closed wound with relatively minimal discomfort and straightforward wound care. We have described our current approach to recurrent and complex pilonidal disease using the cleft lift procedure. Once learned, the cleft lift procedure is a straightforward and highly successful solution to a chronic and challenging condition.

  18. [Perioperative conflicts between anaesthesiologists and surgeons: ethics and professionalism].

    PubMed

    Bazin, J-E; Attias, A; Baghdadi, H; Baumann, A; Bizouarn, P; Claudot, F; Eon, B; Fieux, F; Frot, C; Guibet Lafaye, C; Muzard, O; Nicolas-Robin, A; Orjubin, V; Otero-Lopez, M; Pelluchon, C; Pereira, J; Roussin, F; Vigué, B; Beydon, L

    2014-05-01

    In the perioperative period, several potential conflicts between anaesthetists/intensive care specialists and surgeons may exist. They are detrimental to the quality of patient care and to the well-being of the teams. They are a source of medical errors and contribute to burn-out. Patients can become the victims of such conflicts, which deserve ethical reflection. Their resolution through analysis and shared solutions is necessary. This article seeks to analyse these conflicts, taking into account their specificities and constraints. In order to understand this context, it is important to consider the specificities of each group involved and the records of such situations. Several factors can prevent these conflicts, first and foremost the patients themselves and the quality of the care that is provided. Medical deontology aims mainly at preventing and resolving these conflicts. Generally speaking, the quality approach which is increasingly applied in health care institutions (involving declarations of adverse events, morbidity/mortality reviews, benchmarking, analysis and improvement of practices, etc.) also contributes to the prevention and resolution of disagreements. The teaching of communication techniques that begins with the initial training, the evaluation of team behaviours (through simulation training for example), the respect of others' constraints, particularly when it comes to learning, as well as transparency regarding conflicts of interests, are all additional elements of conflict prevention. Lastly, conflicts may at times be caused by deviant behaviours, which must be met with a clear and uncompromising collective and institutional approach. This article concludes by offering a standardised approach for conflict resolution.

  19. [Implantable Cardioverter Defibrillator and Perioperative Magnet Application: A Case Report].

    PubMed

    Inoue, Miho; Tokuhira, Natsuko; Sawa, Teiji; Ibuki, Takae

    2015-02-01

    An implantable cardioverter defibrillator (ICD) can falsely recognize noise by monopolar electrocautery as tachyarrhythmia and deliver inappropriate antitachycardia therapy. Application of a clinical magnet on an ICD suspends antitachycardia therapy, but it has not been widely used for this purpose. A 67-year-old male underwent laryngopharyngectomy, cervical esophagectomy, right neck dissection, tracheostomy and reconstruction with free jejunal transplant for recurrent hypopharyngeal cancer. He had an ICD (PARADYM DR8550, Sorin) implanted below the left clavicle for ventricular tachycardia and prolonged QT syndrome. During the operation, a clinical magnet was left on the ICD to disable antitachycardia therapy. The magnet mode of the ICD provided asynchronous AAI pacing at 96 beats x min(-1). The surgery proceeded uneventfully. No episode of ventricular tachyarrythmia or pacing inhibition by electromagnetic interference was observed on electrocardiogram. This case illustrated the potential role of a clinical magnet as an alternative to reprogramming of an ICD by a programmer in the perioperative management of a patient with an ICD when a technical expert to operate a programmer is not available.

  20. Emerging Roles for MicroRNAs in Perioperative Medicine

    PubMed Central

    Neudecker, Viola; Brodsky, Kelley S.; Kreth, Simone; Ginde, Adit A.; Eltzschig, Holger K.

    2016-01-01

    MicroRNAs (miRNAs) are small, non-protein-coding, single-stranded RNAs. They function as posttranscriptional regulators of gene expression by interacting with target mRNAs. This process prevents translation of target mRNAs into a functional protein. miRNAs are considered to be functionally involved in virtually all physiologic processes, including differentiation and proliferation, metabolism, hemostasis, apoptosis, and inflammation. Many of these functions have important implications for anesthesiology and critical care medicine. Studies indicate that miRNA expression levels can be used to predict the risk for eminent organ injury or sepsis. Pharmacologic approaches targeting miRNAs for the treatment of human diseases are currently being tested in clinical trials. The present review highlights the important biological functions of miRNAs and their usefulness as perioperative biomarkers and discusses the pharmacologic approaches that modulate miRNA functions for disease treatment. In addition, the authors discuss the pharmacologic interactions of miRNAs with currently used anesthetics and their potential to impact anesthetic toxicity and side effects. PMID:26632665