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Sample records for perioperative frozen section

  1. ULTRATHIN FROZEN SECTIONS

    PubMed Central

    Bernhard, W.; Leduc, Elizabeth H.

    1967-01-01

    A relatively simple method for obtaining ultrathin, frozen sections for electron microscopy has been developed. Tissues, cultured cells, and bacteria may be employed. They are fixed in 1.25–4% glutaraldehyde for 1–4 hr, are washed overnight in buffer at 3°C, and are embedded in 20% thiolated gelatin or pure gelatin. Before sectioning they are partially dehydrated in 50% glycerol, frozen in liquid nitrogen on a modified tissue holder, and subsequently maintained at -70°C with dry ice. Finally, they are sectioned very rapidly with glass knives on a slightly modified Porter-Blum MT-1 microtome in a commercial deep-freeze maintained at -35°C and are floated in the trough of the knife on a 40% solution of dimethylsulfoxide (DMSO). The sections are picked up in plastic loops and transferred to distilled water at room temperature for thawing and removal of the DMSO, placed on grids coated with Formvar and carbon, air-dried, and stained with phosphotungstic acid, sodium silicotungstate, or a triple stain of osmium tetroxide, uranyl acetate, and lead. Large flat sections are obtained in which ultrastructural preservation is good. They are particularly useful for cytochemical studies. PMID:4167504

  2. ULTRATHIN FROZEN SECTIONS

    PubMed Central

    Leduc, Elizabeth H.; Bernhard, W.; Holt, S. J.; Tranzer, J. P.

    1967-01-01

    Endogenous enzyme activity can be readily and routinely demonstrated in ultrathin, frozen sections for electron microscopy. The procedure employed to obtain the best structural preservation as well as enzyme activity in thin sections involved fixation in glutaraldehyde, embedding in thiolated gelatin or pure gelatin, partial dehydration in glycerol, and sectioning in a cryostat at -35°C with a slightly modified Porter-Blum microtome on which the tissue is maintained at -70°C and the knife at -23°C. Kidney cortex was used as test tissue, but a few other organs were occasionally used. Thin sections were floated on the surface of several incubation media routinely employed for enzyme cytochemistry. Positive, specific reactions were obtained for alkaline phosphatase in kidney brush border, for adenosine triphosphatase in brush border and in basal membranes of distal tubules, for acid phosphatase and esterase in lysosomes, and for NADH diaphorase in mitochondria. Mitochondrial ATPase was sporadically evident only in the distal tubule of the kidney. Localizations of enzyme activity reported by other technical approaches were confirmed and in some cases somewhat improved. PMID:4293006

  3. [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.

  4. 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.

  5. [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.

  6. Preparation of frozen sections for analysis.

    PubMed

    Bratthauer, Gary L

    2010-01-01

    The analysis of frozen tissue by antibodies can be accomplished by the quick freezing of a small tissue sample in liquid nitrogen. Super-cooled isopentane can also be used to further the preservation process. Freezing preserves the available proteins in a near-native state for their identification by antibodies raised against naturally folded proteins. The tissues are sectioned onto charged glass slides where they can be optimally fixed in weakly or non-denaturing solutions such as acetone or those that are alcohol-based. Following mild pretreatment steps to allow for antibody use with low background, (the endogenous peroxidase enzyme or oxidative compounds quenched in a hydrogen peroxide solution and available charged sites blocked by incubation in a normal serum solution) the sections are ready for antigen detection.

  7. [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.

  8. [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.

  9. Frozen Section Technique to Evaluate Early Burn Wound Biopsy: A comparison with the Rapid Section Technique

    DTIC Science & Technology

    1985-01-01

    Lf Frozen Section Technique to Evaluate Early Burn Wound V Biopsy : A Comparison with the Rapid Section Technique SEUNG H. KIM, M.D., GENE B. HUBBARD...wound biopsies , most of which have been unsuccessful. A frozen section Just ificat i on- technique which facilitates quick, reliable evaluation of... biopsies was developed, and has been used in the evaluation of 169 biopsies over a period of 18 months. The frozen section technique takes 30 minutes

  10. An audit of intraoperative frozen section in Johor.

    PubMed

    Khoo, J J

    2004-03-01

    A 4-year-review was carried out on intraoperative frozen section consultations in Sultanah Aminah Hospital, Johor Bahru. Two hundred and fifteen specimens were received from 79 patients in the period between January 1999 and December 2002. An average of 2.72 specimens per patient was received. The overall diagnostic accuracy was high, 97.56%. The diagnoses were deferred in 4.65% of the specimens. False positive diagnoses were made in 3 specimens (1.46%) and false negative diagnoses in 2 specimens (0.98%). This gave an error rate of 2.44%. The main cause of error was incorrect interpretation of the pathologic findings. In the present study, frozen sections showed good sensitivity (97.98%) and specificity (97.16%). Despite its limitations, frozen section is still generally considered to be an accurate mode of intraoperative consultation to assist the surgeon in deciding the best therapeutic approach for his patient at the operating table. The use of frozen section with proper indications was cost-effective as it helped lower the number of reoperations. An audit of intraoperative frozen section from time to time serves as part of an ongoing quality assurance program and should be recommended where the service is available.

  11. Biopsy of uterine leiomyomata and frozen sections before laparoscopic morcellation.

    PubMed

    Tulandi, Togas; Ferenczy, Alex

    2014-01-01

    Uterine sarcoma is rare. However, its morcellation can be associated with spread of disease. The definitive diagnosis of uterine sarcomas is made via histology. To date, the only reliable preoperative test for determination of the types of myometrial tumors is analysis of either frozen sections or permanent formalin-fixed tissue sections of surgical specimens. We report 2 cases in which the feasibility of obtaining multiple biopsy specimens of uterine leiomyomas and frozen sections before laparoscopic morcellation is demonstrated. This procedure might reduce the risk of laparoscopic morcellation of unsuspected leiomyosarcomas while still offering the advantages of a minimally invasive technique. Copyright © 2014 AAGL. Published by Elsevier Inc. All rights reserved.

  12. Potential role of increasing number of sections in frozen section diagnosis of ovarian tumors.

    PubMed

    Ayhan, Ali; Ozler, Ali; Dursun, Polat; Haberal, A Nihan

    2016-11-01

    To assess the accuracy of intraoperative frozen section of ovarian tumours at our institution and to identify the possible reasons for misdiagnosis. Between January 2002 and August 2013, a total of 684 patients were included in the study. Frozen section diagnosis was compared with the final paraffin section diagnosis as the gold standard. The sensitivity, specificity, and positive and negative predictive values of frozen-section diagnosis were calculated for benign, borderline and malignant tumours. Clinicopathological parameters influenced by misdiagnosis were evaluated performing multivariate logistic regression analysis. The overall accuracy was detected as 96.1%. Frozen-section diagnoses of 26 patients (3.8%) showed discordance. The specificity (99.7%) and PPV (99.4%) of frozen-section diagnosis was highest in the malignant category. In BOTs, diagnostic agreement was observed in 57 of 70 (81.4%) cases. The PPV (81.4%) was lowest for these patients. Tumour diameter of ≥10 cm (OR [95% CI]= 3.0 [1.1 to 8.2]; P=0.030) and mucinous histology (OR [95% CI]= 2.5 [1.0 to 6.2]; P=0.042) were significant predictors of misdiagnosis. With the increase in the number of sections, the accuracy rate of frozen section diagnosis was decreased. While not statistically significant (p=0.361). The number of sections is increased parallel to increase in tumor diameters. On the contrary, the diagnostic accuracy was no significantly increased with an increase in the number of sections. This discrepancy may be associated with falling tumor size per frozen section. A prospective study based on a certain tumour diameter per frozen section may better demonstrate the positive effect of the number of sections.

  13. Properties of frozen sections relevant to quantitative microanalysis.

    PubMed

    Hall, T A

    1986-03-01

    Difficulties in the quantitative X-ray microanalysis of frozen sections may conceivably arise from ice-crystal damage and from electron-beam damage. X-ray peak-to-continuum ratios are commonly taken as a quantitative index of elemental concentrations. But recent reports suggest that in dehydrated frozen sections such ratios vary greatly with the scale of ice-crystal formation existing prior to sublimation. The experiments in these reports are re-interpreted here; it is argued that peak intensities may be affected by ice-crystal scale but that ratios of peak to continuum should not be affected after corrections for exogenous continuum. The accuracy of the peak-to-continuum method is affected by beam-induced loss of mass from microvolumes during analysis. Mass loss can be reduced or slowed by a cold-stage. For example, the radiation sensitivity for loss of chlorine from PVC is reduced by a factor of 1000 or more with reduction of temperature from 300 to 100 K. For sections of soft tissue the effectiveness of cooling is not nearly so striking but at 100 K, analyses of 1 micron frozen-hydrated sections by the continuum method, with spatial resolution of the order of 1 micron, can be completed before substantial mass loss occurs. However, analysis of frozen-hydrated sections by the continuum method at much higher resolution, say 100 nm resolution in 100 nm sections, is precluded by mass loss. Measurements of local mass can be achieved with much lower dose by observation and calibration of the electron transmission or backscattering. But even with these methods, several problems remain in achieving quantitative X-ray analysis at very high resolution.

  14. IMPROVED TECHNIQUES FOR THE PREPARATION OF ULTRATHIN FROZEN SECTIONS

    PubMed Central

    Bernhard, W.; Viron, Annie

    1971-01-01

    Ultrathin frozen sections of biological tissues for electron microscopy provide certain advantages in cytochemical studies in which the penetration of cells by large molecules is necessary and in morphological studies of cellular constituents which are dissolved by the reagents employed in routine plastic embedding. The recent introduction of several types of commercially available cryo-ultramicrotomes makes it possible for many laboratories to employ this valuable tool. This paper summarizes recent improvements in the methods developed in this laboratory for preparing ultrathin frozen sections and reviews some of the inherent problems involved in their use. These procedures may serve as a baseline for other investigators who can then modify or adapt them for their specific purposes. PMID:4103954

  15. 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

  16. Frozen Section Evaluation of Margin Status in Primary Squamous Cell Carcinomas of the Head and Neck: A Correlation Study of Frozen Section and Final Diagnoses.

    PubMed

    Layfield, Eleanor M; Schmidt, Robert L; Esebua, Magda; Layfield, Lester J

    2017-08-23

    Frozen section is routinely used for intraoperative margin evaluation in carcinomas of the head and neck. We studied a series of frozen sections performed for margin status of head and neck tumors to determine diagnostic accuracy. All frozen sections for margin control of squamous carcinomas of the head and neck were studied from a 66 month period. Frozen and permanent section diagnoses were classified as negative or malignant. Correlation of diagnoses was performed to determine accuracy. One thousand seven hundred and ninety-six pairs of frozen section and corresponding permanent section diagnoses were obtained. Discordances were found in 55 (3.1%) pairs. In 35 pairs (1.9%), frozen section was reported as benign, but permanent sections disclosed carcinoma. In 21 cases, the discrepancy was due to sampling and in the remaining cases it was an interpretive error. In 20 cases (1.1%), frozen section was malignant, but the permanent section was interpreted as negative. Frozen section is an accurate method for evaluation of operative margins for head and neck carcinomas with concordance between frozen and permanent results of 97%. Most errors are false negative results with the majority of these being due to sampling issues.

  17. [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.

  18. 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

  19. 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.

  20. 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.

  1. 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.

  2. The Use of Frozen Section in the Early Diagnosis of Acute Invasive Fungal Sinusitis.

    PubMed

    Melancon, C Claire; Clinger, John D

    2017-08-01

    Objectives Acute invasive fungal sinusitis (AIFS) remains a significant cause of morbidity and mortality in the immunocompromised patient population. Early diagnosis is key to improving patient outcomes. Frozen section biopsies have been shown to decrease time to diagnosis when compared with permanent pathology. However, its accuracy has not been adequately described in the literature, specifically in regard to AIFS. The aim of this study is to evaluate the statistical diagnostic accuracy of frozen sections and to review the etiology, clinical presentation, and current diagnostic protocols in management of AIFS. Study Design Case series with chart review. Setting Tertiary referral center. Subjects and Methods Retrospective review included 67 pathologic records in Co-Path, with search criteria including invasive fungal, clinical history, frozen section, and final diagnosis between the dates of 2006 and 2015. Results Sixty-seven cases were reviewed per the search criteria in Co-Path. Of these, 31 met further criteria of having had frozen section analysis. Variables such as sensitivity, specificity, positive predictive value, and negative predictive value were assessed. All 21 positive frozen sections correlated with positive permanent pathology, giving a positive predictive value of 100%. Frozen section biopsies were 87.5% sensitive and 100% specific. Conclusion Early diagnosis of AIFS has been shown to decrease morbidity and mortality. Frozen section biopsies remain key in obtaining an early diagnosis among patients with a high clinical suspicion for invasive fungal sinusitis. Frozen section biopsies positive for invasive fungal pathology were universally consistent with definitive diagnosis.

  3. Breslow thickness of cutaneous malignant melanoma in paraffin wax and frozen sections.

    PubMed Central

    Kirkham, N; Blessing, K; Gibson, B; Price, M L

    1991-01-01

    Breslow tumour thickness was measured in frozen and paraffin wax sections from 21 excision biopsies of cutaneous malignant melanomas by two observers. There was no consistent variation between frozen and paraffin wax sections, with recorded differences ranging from +0.3 mm to -0.2 mm. Interobserver differences ranged from +0.4 mm to -0.2 mm. The interobserver variations exceeded the intraobserver variations, but neither were significant. These findings show conclusively that, when using high quality frozen sections, there is no significant difference between Breslow thickness measured in frozen or paraffin wax sections and therefore that frozen sections can be used to microstage melanoma. Interobserver variations seem to be a more likely source of erroneous measurements of tumour thickness. Images PMID:1890198

  4. 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.

  5. 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.

  6. 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.

  7. Freezing in Sealed Capillaries for Preparation of Frozen Hydrated Sections

    PubMed Central

    Yakovlev, Sergey; Downing, Kenneth H.

    2014-01-01

    We have investigated the freezing of specimens in a confined volume for preparation of vitreous samples for cryosectioning. With 15% dextran as a cryoprotectant, a sample sealed in a copper tube begins to freeze into crystalline ice when plunged into liquid ethane. Crystallization rapidly causes an increase in the pressure to the point that much of the sample freezes in a vitreous state. We used synchrotron X-ray diffraction of samples frozen with various amounts of dextran to characterize the ice phases and crystal orientation, providing insights on the freezing process. We have characterized cryosections obtained from these samples to explore the optimum amount of cryoprotectant. Images of cryosectioned bacteria frozen with various levels of cryoprotectant illustrate effects of cryoprotectant concentration. PMID:22077543

  8. Utility and significance of ureteric frozen section analysis during radical cystectomy.

    PubMed

    Satkunasivam, Raj; Hu, Brian; Metcalfe, Charles; Ghodoussipour, Saum B; Aron, Manju; Cai, Jie; Miranda, Gus; Gill, Inderbir; Daneshmand, Siamak

    2016-03-01

    To assess the utility of routine frozen section analysis of ureters at the time of radical cystectomy (RC) for urothelial cancer (UC), and the long-term outcomes of adverse ureteric pathology. Pathological data on 2 047 patients undergoing RC for UC with routine frozen section analysis of ureters (January 1971 to December 2009) were analysed. Univariate and multivariable logistic and Cox proportional hazards models were used to determine the risk of upper tract UC (UTUC) recurrence, local recurrence and overall survival in those identified as having adverse pathology (severe atypia/carcinoma in situ [CIS] or UC) at time of frozen section analysis. Adverse pathology was identified by frozen section analysis in 178 patients (8.6%). Frozen section analysis was found to have poor sensitivity in identifying adverse pathology (59.1%), which was improved in patients with preoperative CIS (68.0%). After a median (interquartile range) follow-up of 12.4 (1.9-10.1) years, 28 patients (1.4%) developed UTUC recurrence. There were no uretero-enteric anastomotic recurrences. Adverse pathology on frozen section analysis was associated with UTUC recurrence on univariate analysis (hazard ratio [HR] 6.2, 95% confidence interval [CI] 2.9-13.5), but 15/28 patients (54%) with UTUC recurrence had benign ureteric frozen section analysis on initial sectioning. Adverse pathology on frozen section analysis was not independently associated with the risk of local recurrence (HR 1.08, 95% CI 0.61-1.89) or overall survival (HR 1.12, 95% CI 0.94-1.35) in multivariate models. Ureteric frozen section analysis has poor sensitivity and may be marginally improved in pre-existing CIS. UTUC recurrence is rare and can occur despite negative frozen section analysis. Our data question the utility of routine frozen section analysis of the distal ureteric margin at the time of RC. © 2015 The Authors BJU International © 2015 BJU International Published by John Wiley & Sons Ltd.

  9. 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.

  10. The centennial anniversary of the frozen section technique at the Mayo Clinic.

    PubMed

    Gal, Anthony A

    2005-12-01

    The frozen section technique has become an invaluable tool to assist the surgeon with intraoperative diagnosis. Although there were various descriptions of frozen section technique before and after the turn of the 20th century, the publication by Louis B. Wilson, MD, at the Mayo Clinic in 1905 heralded the beginning of a new era in intraoperative diagnosis. This historical review traces the circumstances that led to this landmark publication 100 years ago.

  11. Clinical assessment, gross examination, frozen section of ovarian masses: do patients benefit?

    PubMed

    Ghaemmaghami, Fatemah; Fakour, Fereshteh; Karimi Zarchi, Mojgan; Behtash, Nadereh; Modares Gilani, Mitra; Mousavi, Azamsadat; Shariat, Mamak

    2008-09-01

    The overall risk of malignancy in ovarian neoplasm is 13% in premenopausal women and 45% in postmenopausal women. Differentiating benign and malignant disease with frozen section is possible during operation; however, information on patients' history, physical examination, paraclinical criteria (tumour markers, imaging) and gross examination of tumour can also be helpful in planing the surgery. This study was conducted on 150 women who underwent laparotomy due to adnexal mass between April 2003 and October 2005 at Vali-e-Asr Hospital, Tehran, Iran. Sensitivity and specificity of clinical assessment (history, tumour marker and imaging), gross examination and frozen section were calculated. Based on our findings frozen section had the highest sensitivity for diagnosing malignant tumour comparing with other methods of diagnosis (88.9%). Sensitivity was 71.3% for preoperative clinical examination, 83% for ultrasonography, 89.8% for CT scan, 70% for CA125 and 84.1% for gross examination, likewise the highest specificity was seen for frozen section (93.5%). This data confirm that frozen section diagnosis is a reliable method for the surgical management of patients with an ovarian mass, but history of disease, Para clinical criteria and gross examination can help to surgeon to perform on appropriate operation in the areas where frozen section is not possible.

  12. Accuracy of intraoperative frozen section for the evaluation of ovarian neoplasms: an institutional experience.

    PubMed

    Hashmi, Atif Ali; Naz, Samreen; Edhi, Muhammad Muzzammil; Faridi, Naveen; Hussain, Syed Danish; Mumtaz, Shazia; Khan, Mehmood

    2016-03-31

    Ovarian neoplasms are a heterogeneous group of tumors including surface epithelial, germ cell and sex cord stromal tumors with a subset having low malignant potential (borderline tumors). While the surgical management plan differs in different categories of tumors, preoperative diagnosis is seldom available. In these circumstances, the role of frozen section becomes invaluable. In the current study, we aimed to evaluate the accuracy of the frozen section of ovarian tumors in our setup. It was a retrospective study involving 141 cases of ovarian tumors undergoing surgical resection with frozen section evaluation from January 2009 to December 2014. After gross examination, one to five blocks were prepared on the frozen section depending upon the size of the specimen. After frozen section reporting, specimens were processed routinely for final paraffin section evaluation. Results of frozen and paraffin sections were categorized in benign, borderline, and malignant, and accuracy of frozen section was determined. Out of 141 cases, 107 were diagnosed as benign on final (paraffin) examination, while 6 were borderline and 28 were malignant. Out of 107 benign cases, 45 were non-neoplastic cystic lesions of the ovary including endometriotic, follicular, and corpus luteal cysts. The most common benign neoplastic tumor was mature cystic teratoma (20 cases) followed by mucinous cystadenoma (19 cases), serous cystadenoma (14 cases), sex cord stromal tumors (8 cases), and Brenner tumor (1 case). Among borderline cases, four cases were serous and two of mucinous neoplasms. The most common malignant neoplasm was serous carcinoma (11 cases) followed by mucinous carcinoma (6 cases). The overall accuracy of frozen section diagnosis is above 99 %. The sensitivity and specificity for benign tumors were found to be 100 and 97 %, respectively. The sensitivity and specificity for borderline tumors was 83 and 99 %, respectively, while for malignant tumors, it was 96 and 100

  13. Utility of frozen section analysis for fungal organisms in soft tissue wound debridement margin determination.

    PubMed

    Zimmermann, Nives; Hagen, Matthew C; Schrager, Jason J; Hebbeler-Clark, Renee S; Masineni, Sreeharsha

    2015-10-15

    Zygomycetes cause different patterns of infection in immunosuppressed individuals, including sino-orbito-cerebral, pulmonary, skin/soft tissue infection and disseminated disease. Infections with Zygomycetes have a high mortality rate, even with prompt treatment, which includes anti-fungal agents and surgical debridement. In some centers, clear margins are monitored by serial frozen sections, but there are no specific guidelines for the use of frozen sections during surgical debridement. Studies in fungal rhinosinusitis found 62.5-85 % sensitivity of frozen section analysis in margin assessment. However, the utility of frozen section analysis for margin evaluation in debridement of skin/soft tissue infection has not been published. We present a case of zygomycosis of decubitus ulcers in which we assessed statistical measures of performance of frozen section analysis for presence of fungal organisms on the margin, compared with formalin-fixed paraffin embedded (FFPE) sections as gold standard. A total of 33 specimens (94 blocks) were sectioned, stained with H&E and evaluated by both frozen and FFPE analysis. Negative interpretations were confirmed by Gomori methenamine silver stain on FFPE sections. H&E staining of frozen sections had 68.4 % sensitivity and 100 % specificity for assessing margins clear of fungal organisms. The negative and positive predictive values were 70.0 % and 100 %, respectively. Using presence of acute inflammation and necrosis as markers of fungal infection improved sensitivity (100 %) at the expense of specificity (42.9 %). Use of intraoperative assessment of skin and soft tissue margins for fungal infection is a valuable tool in the management of skin and soft tissue fungal infection treatment.

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

    PubMed

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

    2016-11-01

    In women with endometrial hyperplasia, there is a risk for co-existent endometrial cancer when patients are subjected to immediate surgical treatment. 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. Retrospective cross-sectional study. 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. 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. 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 no available method for obtaining frozen sections

  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. 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.

  17. Intraoperative Frozen Section Evaluation of Sentinel Lymph Nodes in Breast Carcinoma: Single-Institution Indian Experience.

    PubMed

    Somashekhar, S P; Naikoo, Zahoor Ahmed; Zaveri, Shabber S; Holla, Soumya; Chandra, Suresh; Mishra, Suniti; Parameswaran, R V

    2015-12-01

    Sentinel lymph node biopsy is an established way of predicting axillary nodal metastasis in early breast cancer. Intraoperative frozen sections (FS) of sentinel lymph nodes (SLNs) can be used to detect metastatic disease, allowing immediate axillary lymph node dissection. The purpose of this study was to evaluate the accuracy of intraoperative frozen sections in evaluation of sentinel lymph nodes in cases of breast cancer. Between March 2006 and August 2010, a total of 164 patients with clinically node-negative operable breast cancer were subjected to sentinel lymph node biopsy of axillary lymph nodes using preoperative peritumoral injection of radioactive colloid and methylene blue. Intraoperative identification of sentinel nodes was done using a handheld gamma probe and identification of blue-stained nodes. The nodes were sent for frozen section examination. The results of frozen section were compared with the final histopathology. Out of the 164 cases, metastases were detected in SLN by frozen section in 38 cases. There were three false-negative cases (all showing micrometastasis on final histopathology). FS had sensitivity of 92.6 %, specificity of 100 %, and overall accuracy of 98.1 %. The positive predictive value was 100 %, and the negative predictive value was 97.6 %. FS for diagnosis of metastasis of SLNs is reliable. Patients with negative SLNs by the FS diagnosis can avoid reoperation for axillary lymph node dissection. However, FS may fail to detect micrometastases, especially in cases with small tumors.

  18. 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.

  19. 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.

  20. 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

  1. 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.

  2. 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

  3. 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

  4. Utility of Conization with Frozen Section for Intraoperative Triage Prior to Definitive Hysterectomy

    PubMed Central

    Martinelli, Fabio; Schmeler, Kathleen M.; Johnson, Chelsea; Brown, Jubilee; Euscher, Elizabeth D.; Ramirez, Pedro T.; Frumovitz, Michael

    2014-01-01

    Objective To review our experience with conization with intraoperative frozen section analysis and to compare results from our tertiary cancer center with those from 2 community hospitals. Methods The records of all women who underwent conization with intraoperative frozen section analysis from January 1, 1997, through April 30, 2011, at The University of Texas MD Anderson Cancer Center and 2 community hospitals—The Woman’s Hospital of Texas and St. Luke’s Episcopal Hospital—were reviewed. Findings on pathologic analysis of frozen sections, permanent loop electrosurgical excisional procedure/conization specimens, and hysterectomy specimens were compared for each patient, and results from the cancer center were compared to those from the community hospitals. Results One hundred fifty-three patients met the inclusion criteria. Rates of accuracy of conization with frozen section analysis in predicting definitive pathologic findings were as follows: cervix with no residual disease after prior extirpative procedure 96.5% (95% CI 86.9–100%); cervical squamous carcinoma in situ, 95.4% (95% CI 84.5–100%); cervical adenocarcinoma in situ, 98.7% (95% CI 92.7–100%); microinvasive carcinoma, 97.4% (95% CI 90.1–100%); and invasive carcinoma ≥ 3 mm, 100%. Most importantly, conization with frozen section analysis was 100% accurate for triaging patients to simple or radical hysterectomy. Finally, this approach performed equally well in the cancer center with subspecialized pathologists and the 2 community hospitals with general pathologists. Conclusion Conization with frozen section analysis is an effective technique for intraoperative triage of patients to immediate simple or radical hysterectomy and can be accurately performed in both academic and community hospitals. PMID:22842126

  5. Primary frozen section diagnosis by robotic microscopy and virtual slide telepathology: the University Health Network experience.

    PubMed

    Evans, Andrew J; Chetty, Runjan; Clarke, Blaise A; Croul, Sidney; Ghazarian, Danny M; Kiehl, Tim-Rasmus; Perez Ordonez, Bayardo; Ilaalagan, Suganthi; Asa, Sylvia L

    2009-08-01

    Although telepathology (TP) has not been widely implemented for primary frozen section diagnoses, interest in its use is growing as we move into an age of increasing subspecialization and centralization of pathology services. University Health Network is a 3-site academic institution in downtown Toronto. The pathology department is consolidated at its Toronto General Hospital (TGH) site. The Toronto Western Hospital (TWH), located 1 mile to west of TGH, has no on-site pathologist, and generates 5 to 10 frozen section cases per week. More than 95% of these frozen sections are submitted by neurosurgeons, in most cases to confirm the presence of lesional tissue and establish a tissue diagnosis. In 2004, we implemented a robotic microscopy (RM) TP system to cover these frozen sections. In 2006, we changed to a virtual slide (VS) TP system. Between November 2004 and September 2006, 350 primary frozen section diagnoses were made by RM. An additional 633 have been reported by VS TP since October 2006, giving a total of 983 frozen sections from 790 patients. Of these cases, 88% have been single specimens with total turnaround times averaging 19.98 and 15.68 minutes per case by RM and VS TP, respectively (P < .0001). Pathologists required an average of 9.65 minutes to review a slide by RM. This decreased 4-fold to 2.25 minutes after the change to VS TP (P < .00001). Diagnostic accuracy has been 98% with both modalities, and our overall deferral rate has been 7.7%. Midcase technical failure has occurred in 3 cases (0.3%) resulting in a delay, where a pathologist went to TWH to report the frozen section. Discrepant cases have typically involved minor interpretive errors related to tumor type. None of our discrepant TP diagnoses has had clinical impact to date. We have found TP to be reliable and accurate for frozen section diagnoses. In addition to its superior speed and image quality, the VS approach readily facilitates consultation with colleagues on difficult cases. As a

  6. Primary frozen section diagnosis by robotic microscopy and virtual slide telepathology: the University Health Network experience.

    PubMed

    Evans, Andrew J; Chetty, Runjan; Clarke, Blaise A; Croul, Sidney; Ghazarian, Danny M; Kiehl, Tim-Rasmus; Ordonez, Bayardo Perez; Ilaalagan, Suganthi; Asa, Sylvia L

    2009-11-01

    Although telepathology (TP) has not been widely implemented for primary frozen section diagnoses, interest in its use is growing as we move into an age of increasing sub-specialization and centralization of pathology services. University Health Network (UHN) is a 3-site academic institution in downtown Toronto. The pathology department is consolidated at its Toronto General Hospital (TGH) site. The Toronto Western Hospital (TWH), located 1 mile to west of TGH, has no on-site pathologist and generates 5-10 frozen section cases per week. Over 95% of these frozen sections are submitted by neurosurgeons, in most cases to confirm the presence of lesional tissue and establish a tissue diagnosis. In 2004, we implemented a robotic microscopy (RM) TP system to cover these frozen sections. In 2006, we changed to a virtual slide (VS) TP system. Between November 2004 and September 2006, 350 primary frozen section diagnoses were made by RM. An additional 633 have been reported by VS TP since October 2006, giving a total of 983 frozen sections from 790 patients. Eighty-eight percent of these cases have been single specimens with total turnaround times averaging 19.98 and 15.68 minutes per case by RM and VS TP, respectively (P < 0.0001). Pathologists required an average of 9.65 minutes to review a slide by RM. This decreased 4 fold to 2.25 minutes following the change to VS TP (P < 0.00001). Diagnostic accuracy has been 98% with both modalities and our overall deferral rate has been 7.7%. Mid-case technical failure has occurred in 3 cases (0.3%) resulting in a delay where a pathologist went to TWH to report the frozen section. Discrepant cases have typically involved minor interpretive errors related to tumor type. None of our discrepant TP diagnoses have had clinical impact to date. We have found TP to be reliable and accurate for frozen section diagnoses. In addition to its superior speed and image quality, the VS approach readily facilitates consultation with colleagues on

  7. 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.

  8. Intraoperative frozen section analysis for the diagnosis of early stage ovarian cancer in suspicious pelvic masses.

    PubMed

    Ratnavelu, Nithya D G; Brown, Andrew P; Mallett, Susan; Scholten, Rob J P M; Patel, Amit; Founta, Christina; Galaal, Khadra; Cross, Paul; Naik, Raj

    2016-03-01

    Women with suspected early-stage ovarian cancer need surgical staging which involves taking samples from areas within the abdominal cavity and retroperitoneal lymph nodes in order to inform further treatment. One potential strategy is to surgically stage all women with suspicious ovarian masses, without any histological information during surgery. This avoids incomplete staging, but puts more women at risk of potential surgical over-treatment.A second strategy is to perform a two-stage procedure to remove the pelvic mass and subject it to paraffin sectioning, which involves formal tissue fixing with formalin and paraffin embedding, prior to ultrathin sectioning and multiple site sampling of the tumour. Surgeons may then base further surgical staging on this histology, reducing the rate of over-treatment, but conferring additional surgical and anaesthetic morbidity.A third strategy is to perform a rapid histological analysis on the ovarian mass during surgery, known as 'frozen section'. Tissues are snap frozen to allow fine tissue sections to be cut and basic histochemical staining to be performed. Surgeons can perform or avoid the full surgical staging procedure depending on the results. However, this is a relatively crude test compared to paraffin sections, which take many hours to perform. With frozen section there is therefore a risk of misdiagnosing malignancy and understaging women subsequently found to have a presumed early-stage malignancy (false negative), or overstaging women without a malignancy (false positive). Therefore it is important to evaluate the accuracy and usefulness of adding frozen section to the clinical decision-making process. To assess the diagnostic test accuracy of frozen section (index test) to diagnose histopathological ovarian cancer in women with suspicious pelvic masses as verified by paraffin section (reference standard). We searched MEDLINE (January 1946 to January 2015), EMBASE (January 1980 to January 2015) and relevant

  9. Excision of periocular basal cell carcinoma guided by en face frozen section.

    PubMed

    Tullett, Mark; Sagili, Suresh; Barrett, Andrew; Malhotra, Raman

    2013-09-01

    We describe a technique for monitoring excision margins in periocular basal cell carcinoma (BCC) using en face frozen sections and report outcomes. We excised periocular BCC with 3mm margins. An outer 1mm sliver of the perimeter of the specimen was mapped and sent for evaluation by en face frozen section. The central tumour mass was processed using routine paraffin sections. A further 3mm level was excised at the site of any affected margin and the outer 1mm sliver was again evaluated by frozen section. We identified 78 patients from November 2003 to July 2009; 67 had primary tumours and 11 (14%) had recurrent BCC of which 52 (66%) were located on the lower eyelid. Growth patterns were nodular (n=34, 43%), infiltrative (n=25, 32%), micronodular (n=12, 16%), and superficial (n=7, 9%). A third of BCC with a clinically nodular appearance showed additional histological patterns including infiltrative and micronodular growth patterns. Of 30 clinically nodular carcinomas, 29 were excised completely with one level, and one required 2 levels of excision for clearance after evaluation by frozen section. Mean follow-up was 23 months (range 2-60). There was one recurrence (1%). Excision of margins guided by en face frozen section is justified by the low rates of recurrence, and it can easily be taught or imported into hospital practice. Clinically nodular BCC have subclinical extensions that can be missed on bread loaf sectioning, which makes the sampling of margins a standard for periocular BCC. Copyright © 2012 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

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

    PubMed

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

    2016-12-01

    To show the importance of frozen section-controlled excision to avoid the re-recurrence of recurrent basal cell carcinoma (BCC) of the eyelids. 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. 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%). Frozen section control can provide low re-recurrence rate in patients with recurrent BCC of the eyelids.

  11. Quantitation of DNA Extracted after Micropreparation of Cells from Frozen and Formalin-Fixed Tissue Sections

    PubMed Central

    Serth, Jürgen; Kuczyk, Markus A.; Paeslack, Ute; Lichtinghagen, Ralf; Jonas, Udo

    2000-01-01

    Quantitation of DNA from microdissected fresh-frozen or paraffin-embedded tissue sections would be not only a valuable tool for ensuring optimum reaction conditions for many types of qualitative polymerase chain reaction (PCR) analyses, but also a prerequisite for any kind of subsequently performed genetic analyses aimed at the absolute quantitation of target sequences. The present study describes the quantitation of DNA after microdissection and extraction of cells with the PicoGreen fluorescence method. The limits of detection and of quantitative determination, respectively, have been determined by measuring dilutional series of three different DNA extractions, using either a medium-scale preparation from a solid tissue specimen or a known number of leukocytes or microdissected cells from frozen tumor sections. As corresponding limits of detection, 26, 24, and about 40 diploid genomes, and as limits of quantitative determination, 80, 73, and about 120 diploid genomes were obtained. Furthermore, it was shown that formalin fixation as well as hematoxylin staining of frozen sections with Delafield’s and Mayer’s alum or Weigert’s iron hematoxylin before microdissection significantly diminishes the amount of extractable DNA and may lead to less reliable results, even of qualitative PCR analysis. In conclusion, the PicoGreen method allows precise quantitation of DNA corresponding to a minimum of about 120 diploid cells. It provides the basis for reliable qualitative analyses as well as the precondition for further quantitative genetic measurements from microdissected frozen or formalin-fixed and paraffin-embedded tissue sections. PMID:10751344

  12. 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

  13. 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.

  14. 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.

  15. FROZEN THIN SECTIONS OF FRESH TISSUE FOR ELECTRON MICROSCOPY, WITH A DESCRIPTION OF PANCREAS AND LIVER

    PubMed Central

    Christensen, A. Kent

    1971-01-01

    A simple method has been developed that allows frozen thin sections of fresh-frozen tissue to be cut on a virtually unmodified ultramicrotome kept at room temperature. A bowl-shaped Dewar flask with a knifeholder in its depths replaces the stage of the microtome; a bar extends down into the bowl from the microtome's cutting arm and bears the frozen tissue near its lower end. When the microtome is operated, the tissue passes a glass or diamond knife in the depths of the bowl as in normal cutting. The cutting temperature is maintained by flushing the bowl with cold nitrogen gas, and can be set anywhere from about -160°C up to about -30°C. The microtome is set for a cutting thickness of 540–1000 A. Sections are picked up from the dry knife edge, and are placed on membrane-coated grids, flattened with the polished end of a copper rod, and either dried in nitrogen gas or freeze-dried. Throughout the entire process the tissue is kept cold and does not come in contact with any solvent. The morphology seen in frozen thin sections of rat pancreas and liver generally resembles that in conventional preparations, although freezing damage and low contrast limit the detail that can be discerned. Among unusual findings is a frequent abundance of mitochondrial granules in material prepared by this method. PMID:4942776

  16. [Frozen-section biopsy in ovarian neoplasm diagnosis: diagnostic correlation according to diameter and weight in tumors of epithelial origin].

    PubMed

    Cuello, M; Galleguillos, G; Zárate, C; Córdova, M; Brañes, J; Chuaqui, R; Wild, R

    1999-10-01

    Adequate management and treatment of ovarian carcinoma requires a complete surgical staging supported by frozen-section examination. To achieve this goal it is necessary a high level of accuracy. To evaluate the accuracy of frozen-sections in ovarian carcinoma considering the influence of tumor diameter and weight. Retrospective study of frozen-sections performed in patients with ovarian tumors who underwent surgery. Frozen- and permanent-sections were divided into three categories (benign, borderline and malignant) and stratified by diameter (< 10 cm, 10 to 20 cm, > 20 cm) and weight (< 700 g, 700 a 1400 g, > 1400 g). The diagnostic correlation, sensitivity, specificity, predictive values and accuracy of each frozen-section diagnosis were determined. Eight hundred forty two ovarian tumors that underwent frozen-sections between January 1988 and October 1998 were studied. Final diagnosis was 86.7% benign, 2.7% low malignant potential (LMP) and 10.6% malignant. The diagnosis correlation between frozen- and permanent-sections was 98.2%. Misdiagnosis was in epithelial ovarian tumors, particularly in LMP tumors. Sensitivity, specificity, positive- and negative-predictive values and accuracy of the four hundred eighty nine epithelial tumor were 92.6%, 99.2%, 96.7%, 98.2% and 97.9%, respectively. Diagnostic correlation was higher in epithelial ovarian tumors with diameter < 10 cm (98.2% v/s 93.8%) and weight < 700 g (96.9% v/s 88.9%). Diagnostic correlation with permanent-section examination, sensitivity, specificity and predictive values of frozen-sections are high in ovarian tumors. Accurate diagnosis at frozen sections of epithelial ovarian tumors with diameter > 10 cm or weight > 700 g (particularly in LMP tumors) is difficult because of the extensive sampling required. Frozen-sections diagnoses are important to determine the type and extent of surgery performed at the initial operation.

  17. Diagnosis of lung adenocarcinoma in situ and minimally invasive adenocarcinoma from intraoperative frozen sections: an analysis of 136 cases.

    PubMed

    He, Ping; Yao, Guangyu; Guan, Yubao; Lin, Yunen; He, Jianxing

    2016-12-01

    To determine the diagnostic accuracy and contraindications for intraoperative diagnosis of lung adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) from frozen sections. A retrospective analysis of data from 136 patients pathologically diagnosed with early-stage (T1N0M0) AIS or MIA from paraffin-embedded sections. The rate of concordance between the diagnoses from intraoperative frozen sections and paraffin-embedded sections was determined, and the interpretive features that contributed to errors and deferrals in frozen-section diagnoses were identified. Of the 136 patients, diagnoses from frozen sections and paraffin-embedded sections were concordant in 86 (63.24%) cases intraoperatively diagnosed with AIS or MIA, and 44 (32.35%) cases were intraoperatively diagnosed with adenocarcinoma as the range of infiltration could not be determined from the frozen sections. From the remaining six (4.41%) cases, the frozen section and paraffin-embedded section diagnoses were discordant. The reasons for frozen section errors and deferrals included larger tumour volume, tumour located close to the visceral pleura, interstitial inflammation or fibrosis, absence of prominent atypia and differential morphology in the deeper levels of the paraffin block. Diagnosis of AIS and MIA from intraoperative frozen sections is feasible. We provide several modifications that may improve the diagnostic accuracy of intraoperative frozen sections for early-stage lung adenocarcinoma. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  18. 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.

  19. Diagnostic Value of Frozen Section in Patients with Non-Palpable Breast Lesions.

    PubMed

    Abuoglu, Hacı Hasan; Günay, Emre; Sunamak, Oğuzhan; Yiğitbaşı, M Rafet

    2016-01-01

    We analyzed wire-marking, frozen section (FS) and surgical approach in malignancy-suspicious non-palpable lesions detected on mammography (MG) and ultrasonography (US) as breast mass, microcalcifications and distorsions. Material and Methods: A hundred patients in whom wiremarking and frozen section analysis was performed because of non-palpable, malignancy-suspected breast lesions at General Surgery Department, Goztepe Training and Research Hospital, Istanbul were analyzed retrospectively. Results: Seventy-six % of the cases was in BIRADS 4, 21% in BIRADS 3 and 3% BIRADS 5, according to Breast Imaging Reporting and Data System (BIRADS) classification. There was a statistically significant correlation between paraffin block (PB) and frozen section analyses (kappa statistics: 0.872; p 0.01). In BIRADS 4 group of the patients, there was a significant correlation between PB and FS results (Correlation ratio was 85.3% and kappa statistics: 0.853; p 0.01). In early stage breast cancer wire-marking and resection method is an important diagnostic tool. In BIRADS 4 patients with non-palpable breast lesions, wire marking, resection under general anesthesia and FS can be used trustfully. In patients with early breast cancer, breast-conserving surgery and sentinel lymphnode biopsy may avoid unnecessary axillary lymph node dissection. Celsius.

  20. Intraoperative frozen section of the prostate decreases positive margin rate while ensuring nerve sparing procedure during radical prostatectomy.

    PubMed

    von Bodman, Christian; Brock, Marko; Roghmann, Florian; Byers, Anne; Löppenberg, Björn; Braun, Katharina; Pastor, Jobst; Sommerer, Florian; Noldus, Joachim; Palisaar, Rein Jüri

    2013-08-01

    We evaluated whether intraoperative frozen section analysis of the prostate surface might provide significant information to ensure nerve sparing and minimize the positive margin rate. In 236 patients treated with radical prostatectomy between June 2011 and September 2012 whole surface frozen section analysis of the removed prostate was done intraoperatively. The apex and base were circumferentially dissected as well as the whole posterolateral tissue corresponding to the neurovascular bundles. Multiple perpendicular sections were cut systematically for frozen section analysis. Pathology results were reported to navigate the procedure. Frozen section analysis identified positive surgical margins in 22% of cases, including the neurovascular bundles in 56.9%, apex in 34.5% and base in 8.6%. Of positive frozen section cases 92.3% could be converted to negative status, while 7.7% remained positive. The final positive margin rate in the total cohort was 3%, including a false-negative frozen section rate of 1.6%. In 14.8% of cases the initial nerve sparing plan was changed intraoperatively due to the positive frozen section and the secondary resected specimen detected cancer in 25%. Final pathology results showed Gleason upgrading or up-staging in 40.7% of cases compared to preoperative variables. When comparing patients with positive vs negative frozen sections, preoperative variables did not significantly differ, while postoperatively pathological stage, tumor volume, operative time and final margin status differed significantly. Of patients with exclusively unilateral positive biopsies 13% had a positive surgical margin intraoperatively on the opposite, biopsy negative side. The surface frozen section technique is associated with a low false-negative surgical margin rate. It might allow for safer preservation of functional anatomical structures in misclassified patients or even patients at higher preoperative risk. Copyright © 2013 American Urological Association

  1. Utility of birefringent crystal identification by polarized light microscopy in distinguishing thyroid from parathyroid tissue on intraoperative frozen sections.

    PubMed

    Wong, Kristine S; Lewis, James S; Gottipati, Srinivas; Chernock, Rebecca D

    2014-09-01

    Differentiating parathyroid with pseudofollicular architecture from thyroid tissue can be challenging on intraoperative frozen sections. Birefringent calcium oxalate crystals are present in colloid of normal thyroid follicles, whereas crystals are rare in parathyroid tissue. It has been suggested that crystal identification using polarized microscopy could aid in distinguishing thyroid from parathyroid tissue on frozen sections when other ancillary studies are not available. However, the actual clinical utility of crystal detection on frozen sections has not been assessed. We reviewed all deferred or discrepant parathyroid versus thyroid intraoperative frozen section diagnoses over a 12.5-year period (17 cases). For comparison, we also reviewed 20 cases each of hypercellular parathyroid glands with pseudofollicular architecture, follicular adenomas, follicular carcinomas, follicular variant of papillary thyroid carcinomas, and nodular hyperplasias with a microfollicular pattern. These are diagnoses that could be difficult to differentiate tissue of origin (thyroid vs. parathyroid) on frozen section biopsies. Crystals were more common in thyroid (60/80) than in parathyroid (2/20) microfollicular/pseudofollicular lesions (75% vs. 10%, P<0.001). In 9 of 12 cases (75%) for which the frozen section was interpreted as or favored to be parathyroid but permanent sections showed only thyroid tissue, identification of crystals on the actual frozen section slides would have aided interpretation. This included 1 case of papillary thyroid carcinoma that was reimplanted into the patient's neck after a frozen section misdiagnosis of "parathyroid tissue" was made. We recommend examination of difficult follicular patterned parathyroid frozen sections by polarizing microscopy and deferring the diagnosis if crystals are found.

  2. Category-1 caesarean section: a survey of anaesthetic and peri-operative management in the UK.

    PubMed

    Kinsella, S M; Walton, B; Sashidharan, R; Draycott, T

    2010-04-01

    A national survey of anaesthetic and peri-operative management of category-1 caesarean section was sent to 245 consultant-led maternity units. There was a 70% response rate. The median (IQR [range]) general anaesthetic rate was 51% (29%-80% [6%-100%]), 12% (9%-16% [3%-93%]), 4% (2%-5% [<1%-18%]), for category-1 caesarean section, categories 1-3 (non-elective/emergency) and category-4 (elective) caesarean section, respectively. The main operating theatre for caesarean section is on the delivery suite in 151 (88%) units, and 112 (66%) units also have a second theatre in the same location. One hundred and thirty-nine (81%) use the standard urgency classification described in the NICE caesarean section guideline. However, only 72 (42%), 24 (14%), and 16 (9%) units comply with this guideline's recommended decision-delivery intervals for category-1 (< or = 30 min), category-2 (< or = 30 min) and category-3 (< or = 75 min) caesarean sections, respectively. Practice in the smaller units was similar to that in the larger units, although there was less availability of a dedicated anaesthetist, intra-uterine resuscitation guidelines and operating theatres on the delivery suite in the smaller units.

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

    PubMed

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

    2016-01-01

    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. 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. 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 near tissue folds and air bubbles. Panoptiq

  4. Role of frozen section analysis of surgical margins during robot-assisted laparoscopic radical prostatectomy: a 2608-case experience.

    PubMed

    Kakiuchi, Yasuhiro; Choy, Bonnie; Gordetsky, Jennifer; Izumi, Koji; Wu, Guan; Rashid, Hani; Joseph, Jean V; Miyamoto, Hiroshi

    2013-08-01

    It remains unanswered whether and how intraoperative frozen section analysis contributes to the surgical margin status on radical prostatectomy specimens. We aimed to determine whether frozen section analysis during radical prostatectomy reduces the incidence of positive surgical margins. We retrospectively analyzed a consecutive series of patients undergoing robot-assisted laparoscopic radical prostatectomy performed at our institution between 2004 and 2011. We identified 2608 cases, including 1128 (43.3%) where intraoperative frozen section analysis was performed to assess surgical margins. Of the cases with positive (n = 60; 5.3%)/negative (n = 1029; 91.2%)/atypical or indeterminate (n = 39; 3.5%) frozen section analyses, 22 (36.7%)/83 (8.1%)/4 (10.3%) were found to have positive surgical margins on radical prostatectomy specimens, respectively. Thus, 109 (9.7%) of 1128 cases with frozen section analysis had positive surgical margins, compared with 163 (11.0%) of 1480 cases with no frozen section analysis (P = .264). When the patients were subgrouped by histopathologic characteristics, frozen section analysis led to a considerable reduction in the rate of positive surgical margins in cases with biopsy Gleason score 7 (12.4% → 8.7%; P = .087)/8 (28.6% → 16.3%; P = .048)/≥7 (15.3% → 10.1%; P = .012) tumor or pT3b (36.6% → 23.2%; P = .075)/≥pT3b (38.1% → 25.4%; P = .091) disease. Multivariate analysis further revealed that performing frozen section analysis in biopsy Gleason score 7 or higher tumors was an independent predictor of negative surgical margins (odds ratio, 0.61; P = .018). In addition, frozen section analysis of the distal urethra or apex of the prostate (7.5%, P = .035) as well as multiple negative frozen section analyses (≥2: 6.2%, P = .001; ≥4: 2.2%, P = .007) correlated with significantly lower rates of positive surgical margin, compared with no frozen section analysis. Overall, intraoperative frozen section analysis did not

  5. [FLUORESCENCE DISTRIBUTION IN BONE AND CARTILAGE TISSUE BY SECTIONING OF FROZEN UNDECALCIFIED BONE].

    PubMed

    Sun, Zhen; Yin, Heyong; Sui, Xiang; Yu, Xiaoming; Peng, Jiang; Wang, Yu; Wang, Aiyuan; Guo, Quanyi; Liu Shuyun; Meng, Haoye; Lu, Shibi

    2015-11-01

    To introduce a technique of frozen sections for undecalcified bone and discuss its feasiblity by observing the fluorescence distribution of the bone and cartilage. The male Sprague Dawley transgenic rats at the age of 8 weeks, which express green fluoreschent protein were selected to isolate the whole knee sectioned by teh undecalicified bone fronze section techynique. Under the fluorescence and light microscopy, the fluorescence and structure were observed within the organization of slice. Immunohistochemical staining (collagen type I and II, He staining, toluidine blue staining, and Alizarin red staining were performed to observe the distribution of fluorescent substance and cartilage and bone structure. The thickness of sections prepared by this technology was 6 µm. General observation showed that the structure of secioned joint was complete. Under the light microscope, the morphology of cartilage cells, the arrangement of subchondral bone, and trabecular bone traveling could be clearly distinguished. Under fluorescence microscope, green fluorescence was shonw in the joint soft tissue, cartilage tissue, and bone tissue; collagen type I expressed in the bone tissue, collage type II in cartilage tissue. HE staining and toluidine blue staining could clearly distinguish the morphology of the cartilage layer. Alizarin red staining showed the structural integrity of subchondral bone plate and the organization within the meniscus, and proximal tibia cortical bone continuity. The fluorescence distribution can be directly observe in the bone and cartilage by sectioning of frozen undecalcified bone. This new technology can shorten the cycle of preparing sections.

  6. [Value of intraoperative frozen section of sentinel lymph node in breast cancer. Retrospective study about 293 patients].

    PubMed

    Hoen, N; Pral, L; Golfier, F

    2016-05-01

    Intraoperative positive frozen section of sentinel axillary lymph node in breast cancer allows the full node dissection at the same time of the breast surgery and the enhancement of adjuvant therapies with no delay. The low frequency of node involvement and the high rate of false-negative, make consider the value of intraoperative frozen section. The aim of this study was to analyze the potential advantage of intraoperative frozen section performed routinely. Retrospective monocentric study of 293 patients, operated on for stage pT1 or pT2 breast cancer with a sentinel node biopsy (SNB). A total of 289 patients had an intraoperative frozen section of the SNB. A sentinel node was identified in 98.6% of the cases. On intraoperative section, sentinel node was negative, positive or was not performed in 252 (86%), 37 (12.6%) and 4 (1.4%) cases respectively. In total, ibtraoperative frozen sections identified 48.7% of the metastatic SNB (37/76). The metastatic lymph node distribution, after final histological analysis, was as follows: 17% macro metastasis, 5.8% micro metastasis and 3% isolated tumor cells. The false-negatives rate was 13.5%. Fifty-eight patients (19.8%) underwent axillary full lymph node dissection: 39 during a primary surgery and 19 during a secondary one. Histological analysis of the lymph nodes was totally negative in 62% of cases. Intraoperative frozen sections benefited to 12.8% of the patients who had their full lymph node dissection at the same surgery. The intraoperative frozen section of SNB benefits to a limited number of patients, due to its high rate of false-negatives. Sensitivity of frozen sections could be lowered if the preoperative axillary ultrasound examination becomes a routine, which would question its value. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  7. A simple stain for myelin in frozen sections: a modification of Mahon's method.

    PubMed

    Jebb, A H; Woolsey, T A

    1977-11-01

    A simple and rapid method for demonstrating myelinated nerve fibers in frozen sections of the central and peripheral nervous system is described. Material fixed by perfusion with mixed aldehydes gives the best results but the method also works on specimens fixed by immersion in formaldehyde. Frozen sections varying in thickness from 15-50 micron are mounted on slides subbed with chrome alum-gelatin. After hydration (60-120 min), sections are mordanted (20-40 min) in 2.5% iron alum and rinsed briefly in three changes of distilled H2O (total 2 min). Staining is for 60-180 min in 20 cc freshly made 10% alcoholic hematoxylin diluted with 165 cc distilled H2O to which 15 cc saturated Li2CO3 is added. The sections are washed in distilled H2O (5-15 min) and dehydrated in graded alcohols without differentiation in mordant, and covered. Myelin stains a dark blue-purple against a light grey background. Fiber tracts, as well as individual myelinated fibers, are clearly demonstrated.

  8. Immunoarchitecture of normal human bone marrow: a study of frozen and fixed tissue sections.

    PubMed

    Shin, S S; Sheibani, K; Kezirian, J; Nademanee, A; Forman, S J; Lee, S K; Winberg, C D

    1992-06-01

    To provide baseline information on the immunoarchitecture of normal bone marrow, we studied cryostat-cut, frozen, and paraffin-embedded, fixed tissue sections prepared from 21 core biopsies of normal bone marrow obtained during bone marrow harvests for transplantation. A large panel of antibodies was applied that included, for frozen tissue, Leu-6 (CD1), T11 (CD2), Leu-3a (CD4), Leu-1 (CD5), Leu-2a (CD8), J5 (CD10), My7 (CD13), Leu-11 (CD16), B4 (CD19), B1 (CD20), B2 (CD21), Tac (CD25), My9 (CD33), T200 (CD45), NKH-1 (CD56), kappa and lambda chains, beta F1, Ki-67, HLA-DR, TQ1, and keratin, and for fixed tissue, leukocyte common antigen (CD45), L26 (CD20), LN1 (CDw75), LN2 (CD74), LN3, LN4, LN5, MB1 (CD45R), MB2, MT1 (CD43), MT2 (CD45R), UCHL1 (CD45R0), BM1, Ki-1 (CD30), Leu-M1 (CD15), lysozyme, KP1 (CD68), actin, S100, neuron-specific enolase, vimentin, and keratin. On fresh-frozen sections CD19 and CD2 were the most reliable and sensitive markers for B and T cells, staining 5% and 9% of marrow cells, respectively. Immunoglobulins generally showed heavy background staining, which frequently precluded an accurate assessment. The CD4 to CD8 ratio in the bone marrow was reversed from that of peripheral blood. On fixed tissues, leukocyte common antigen was found in 14% of the marrow cells, corresponding roughly to the lymphocyte population. L26, a pan-B-cell marker, stained 3% of the marrow cells. Among the other B-cell markers, LN1 and MB2 stained a large number of cells (40% to 70%), indicating reactivity with cells of the myeloid or erythroid series in addition to lymphocytes. Among the T-cell markers, UCHL1 and MT1 stained 66% and 50% of the cells, respectively, which could be explained by their cross-reactivity with myeloid cells. Nonspecific myelomonocytic markers (Leu-M1, KP1, and lysozyme) also showed reactivity in a high percentage of cells. No particular architectural distribution patterns of B or T lymphocytes were noted in either frozen or fixed bone

  9. Solitary peripheral pulmonary papilloma evaluation on frozen section: a potential pitfall for the pathologist.

    PubMed

    Emerson, Lyska L; Layfield, Lester J

    2012-12-15

    Endobronchial papilloma is a rare entity that is in the differential for solitary pulmonary nodule. It almost always follows a benign course, with only rare malignant transformation being reported in the squamous variant. No malignant transformation of the glandular variant has been reported to the best of our knowledge, and therefore endobronchial papilloma must be distinguished from more aggressive neoplasms. This distinction is particularly important when one encounters this neoplasm in a peripheral location at frozen section. We report a case of a 65-year-old female with an incidentally discovered solitary peripheral pulmonary nodule identified during a commercial whole-body screening computed tomography (CT) scan. Interval scans revealed a concerning doubling time, and she presented to the surgical service for removal of the mass. Intraoperative frozen section evaluation revealed histologic characteristics favoring a benign neoplasm. Permanent histologic section revealed a glandular papilloma. Over 7 years of follow-up revealed a benign clinical course. Copyright © 2012 Elsevier GmbH. All rights reserved.

  10. 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.

  11. Detection of Active Yeast Cells (Saccharomyces cerevisiae) in Frozen Dough Sections

    PubMed Central

    Autio, K.; Mattila-Sandholm, T.

    1992-01-01

    A new method based on fluorescence microscopy was developed to detect active yeast cells in cryosections of wheat dough. The sections were stained with 4′,6-diamidino-2-phenylindole (DAPI) and counterstained with Evans blue. The active yeast cells in the sections appeared brilliant yellow and were readily distinguished from the red dough matrix. The dead cells allowed penetration of the Evans blue through the cell membrane, which interfered with the DAPI staining and caused the dead cells to blend into the red environment. The number of active yeast cells in fermenting dough sections containing different proportions of living and dead yeast cells correlated well with the gas-forming capability of the yeast in the dough but not with the results of the conventional plate count method. The new method allows the study of yeast activity not only during the different stages of frozen dough processing but also during the fermentation of doughs. Images PMID:16348731

  12. Detection of Active Yeast Cells (Saccharomyces cerevisiae) in Frozen Dough Sections.

    PubMed

    Autio, K; Mattila-Sandholm, T

    1992-07-01

    A new method based on fluorescence microscopy was developed to detect active yeast cells in cryosections of wheat dough. The sections were stained with 4',6-diamidino-2-phenylindole (DAPI) and counterstained with Evans blue. The active yeast cells in the sections appeared brilliant yellow and were readily distinguished from the red dough matrix. The dead cells allowed penetration of the Evans blue through the cell membrane, which interfered with the DAPI staining and caused the dead cells to blend into the red environment. The number of active yeast cells in fermenting dough sections containing different proportions of living and dead yeast cells correlated well with the gas-forming capability of the yeast in the dough but not with the results of the conventional plate count method. The new method allows the study of yeast activity not only during the different stages of frozen dough processing but also during the fermentation of doughs.

  13. 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.

  14. Autofluorescence and Nonspecific Immunofluorescent Labeling in Frozen Bovine Intestinal Tissue Sections: Solutions for Multicolor Immunofluorescence Experiments.

    PubMed

    Jenvey, Caitlin J; Stabel, Judith R

    2017-09-01

    Autofluorescent compounds present in intestinal tissue often hinder the ability to utilize multiple, spectrally different, fluorophores. In addition, fixatives and blocking solutions may contribute to background autofluorescence or nonspecific immunofluorescent labeling. During immunofluorescence protocol development, autofluorescent pigments were observed in frozen bovine mid-ileal intestinal tissue sections. Coagulant fixatives, normal serum blocking, histochemical stains Sudan Black B (SBB) and 3,3'-diaminobenzidine (DAB), and spectral separation using imaging software were compared for their ability to reduce autofluorescence, as well as their effect on immunofluorescent labeling. Fluorescent pigments of frozen bovine mid-ileal intestinal tissue sections, most likely caused by eosinophils and lipofuscin, were masked successfully with a combination of DAB and SBB. Little to no statistical differences were observed for all other methods investigated; however, tissue fixed with 1:1 acetone methanol and 10% horse serum diluted in 0.05 M Tris buffer demonstrated lower mean fluorescence intensities. Spectral separation of specific immunofluorescent labeling from background autofluorescence is a simple method for removing unwanted fluorescence; however, successful separation is dependent on tissue and labeling quality.

  15. 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.

  16. 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

  17. Hyalinizing trabecular tumor of thyroid: does frozen section prevent unnecessarily aggressive operation? Six new cases and a literature review.

    PubMed

    Sung, Shih-Ying; Shen, Hung-Yuan; Hsieh, Chung-Bao; Duh, Quan-Yang; Su, Ting-Fu; Chan, De-Chuan; Shih, Ming-Lang

    2014-11-01

    Fine-needle aspiration cytology (FNAC) is very accurate in detecting papillary thyroid carcinomas (PTCs). According to the Bethesda system for reporting thyroid cytopathology, the risk for malignancy is 97-99% when FNAC is used to diagnose PTC; the malignancy risk is 60-75% when FNAC results in suspected PTCs. The presence of hyalinizing trabecular tumor (HTT) of the thyroid can cause misdiagnosis because its cytological features mimic PTCs. However, the use of frozen section analysis can assist in the recognition of unique architecture features of HTT, and thus may help prevent the undertaking of an unnecessarily aggressive operation. We retrospectively reviewed all patients diagnosed with HTT by permanent histopathology from February 2009 to October 2013. After acquired agreement of the patients, we analyzed all data and reviewed another nine cases of HTT reported in the English-language medical literature to examine the efficacy of frozen section. There were six patients included in our research (5 women and 1 man), with an average age of 48.8 years. Using frozen section, four patients were diagnosed with HTT and two patients were misinterpreted as PTC. Consequently, four patients had lobectomy and two patients had total thyroidectomy, with no surgical complications. Of the nine cases of HTT reviewed from the English literature, the use of frozen section showed three HTT cases, three PTC cases, two medullary thyroid carcinoma cases, and one deferral case. Overall, the use of frozen section as a diagnostic method prevented additional surgical resection in eight patients (53%). Frozen section can sometimes but not always be used to diagnose HTT. When HTT is diagnosed by its trabecular pattern through the use of frozen section, it may prevent total thyroidectomy. Copyright © 2014. Published by Elsevier Taiwan.

  18. 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.

  19. The sensitivity and specificity of frozen-section histopathology in the management of benign oral and maxillofacial lesions.

    PubMed

    Aronovich, Sharon; Kim, Roderick Y

    2014-05-01

    The management of odontogenic cysts and tumors typically requires a biopsy, which may present significant challenges and prompt an additional visit to the operating room before definitive treatment. The aim of this study was to determine the validity of frozen-section diagnosis in the management of benign oral and maxillofacial lesions, allowing intraoperative diagnosis followed by definitive treatment under the same general anesthetic. A retrospective chart review of patients treated at the University of Michigan Health System was performed. Patients of all ages who had a diagnosis of a benign maxillofacial lesion by frozen-section and permanent histopathology reports were included for analysis. Patients were identified using the Current Procedural Terminology code for enucleation and curettage and International Classification of Diseases, Ninth Revision codes for benign cysts or tumors of skull, face, or lower jaw. Of 450 patients reviewed, 214 had intraoperative frozen-section examination available for comparison with permanent histopathology. There were 121 men (56.5%) and 93 women (43.5%), with a mean age of 41 years. Compared with final permanent histopathology, the overall sensitivity of frozen sections was 92.1%. Frozen-section histopathology had a sensitivity greater than 90% and a specificity greater than 95% for the diagnosis of dentigerous cyst and keratocyst odontogenic tumor. In this study of 214 patients with benign maxillofacial lesions, frozen-section histopathology was found to be a valid diagnostic modality with high sensitivity, specificity, and positive and negative predictive values. These results and analysis support the use of frozen-section histopathology for the treatment of benign maxillofacial lesions and underscore its value in the management of these lesions. Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  20. 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.

  1. [Perioperative management of a morbidly obese pregnant patient undergoing cesarean section under general anesthesia - case report].

    PubMed

    Benevides, Márcio Luiz; Brandão, Verônica Cristina Moraes; Lovera, Jacqueline Ivonne Arenas

    2016-01-01

    The increased prevalence of obesity in the general population extends to women of reproductive age. The aim of this study is to report the perioperative management of a morbidly obese pregnant woman, body mass index > 50 kg/m(2), who underwent cesarean section under general anesthesia. Pregnant woman in labor, 35 years of age, body mass index 59.8 kg/m(2). Caesarean section was indicated due to the presumed fetal macrosomia. The patient refused spinal anesthesia. She was placed in the ramp position with cushions from back to head to facilitate tracheal intubation. Another cushion was placed on top of the right gluteus to create an angle of approximately 15° to the operating table. Immediately before induction of anesthesia, asepsis was carried out and sterile surgical fields were placed. Anesthesia was induced in rapid sequence, with Sellick maneuver and administration of remifentanil, propofol, and succinilcolina. Intubation was performed using a gum elastic bougie, and anesthesia was maintained with sevoflurane and remifentanil. The interval between skin incision and fetal extraction was 21 minutes, with the use of a Simpson's forceps scoop to assist in the extraction. The patient gave birth to a newborn weighing 4850 g, with Apgar scores of 2 in the 1(st) minute (received positive pressure ventilation by mask for about 2 minutes) and 8 in the 5(th) minute. The patient was extubated uneventfully. Multimodal analgesia and prophylaxis of nausea and vomiting was performed. Mother and newborn were discharged on the 4(th) postoperative day. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  2. Perioperative management of a morbidly obese pregnant patient undergoing cesarean section under general anesthesia - case report.

    PubMed

    Benevides, Márcio Luiz; Brandão, Verônica Cristina Moraes; Lovera, Jacqueline Ivonne Arenas

    2016-01-01

    The increased prevalence of obesity in the general population extends to women of reproductive age. The aim of this study is to report the perioperative management of a morbidly obese pregnant woman, body mass index >50kg/m(2), who underwent cesarean section under general anesthesia. Pregnant woman in labor, 35 years of age, body mass index 59.8kg/m(2). Cesarean section was indicated due to the presumed fetal macrosomia. The patient refused spinal anesthesia. She was placed in the ramp position with cushions from back to head to facilitate tracheal intubation. Another cushion was placed on top of the right gluteus to create an angle of approximately 15° to the operating table. Immediately before induction of anesthesia, asepsis was carried out and sterile surgical fields were placed. Anesthesia was induced in rapid sequence, with Sellick maneuver and administration of remifentanil, propofol, and succinilcolina. Intubation was performed using a gum elastic bougie, and anesthesia was maintained with sevoflurane and remifentanil. The interval between skin incision and fetal extraction was 21min, with the use of a Simpson's forceps scoop to assist in the extraction. The patient gave birth to a newborn weighing 4850g, with Apgar scores of 2 in the 1st minute (received positive pressure ventilation by mask for about 2min) and 8 in the 5th minute. The patient was extubated uneventfully. Multimodal analgesia and prophylaxis of nausea and vomiting was performed. Mother and newborn were discharged on the 4th postoperative day. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  3. Subarachnoid bupivacaine and pethidine for caesarean section: assessment of quality of perioperative analgesia and side effects.

    PubMed

    Imarengiaye, C O; Asudo, F D; Akpoguado, D D; Akhideno, I I; Omoifo, C E; Ogunsakin, A T

    2011-09-01

    This study determined the quality of perioperative analgesia and side effect profile of spinal bupivacaine plus pethidine for caesarean section. Patients were randomised to receive 2.0mL of bupivacaine + pethidine 7.5mg or 2.0mL bupivacaine + saline of equal volume. Spinal anaesthesia was instituted at L2/3, L3/4 or L4/5 using a 25G pencil point spinal needle. Heart rate, blood pressure and oxygen saturation were monitored. Timelines such as time of injection of study medication, skin incision, delivery time, termination of surgery and time to first request for analgesia as well as complications were noted. Demographic characteristics were also recorded. 50 patients were studied in 2 groups and the demographic characteristics were similar. Addition of pethidine resulted in block height greater than T6 and longer duration of analgesia (256.9 ± 112.2 min.) compared with the saline group (160.5 ± 65.0 min; p = 0.0005). Maternal hypotension occurred more in the pethidine group (10/25 vs 2/25; p = 0.01). Peritoneal irritation and inadequate anaesthesia were more frequent in the saline group. Nausea and vomiting and drowsiness were mild and occurred only in the pethidine group. In the Post Anaesthetic Care Unit (PACU), more patients reported pain in the saline group (p = 0.002). Bupivacaine with pethidine 7.5mg resulted in better quality of anaesthesia, longer postoperative analgesia with acceptable side effect profile. This will be of value in the management of post-caesarean section pain particularly in the resource poor setting.

  4. Fine-needle aspiration cytology, frozen section, and open biopsy: relative significance in diagnosis of musculoskeletal tumors.

    PubMed

    Shah, Maninder Singh; Garg, Vishal; Kapoor, Sudhir K; Dhaon, B K; Gondal, Ranjana

    2003-01-01

    Fine-needle aspiration cytology (FNAC) is a minimally invasive technique used extensively in diagnosis of various tumors. Frozen section biopsy is known for its usefulness in assessing adequacy of margins of resection intraoperatively. This study assesses the usefulness and significance of these procedures in tumors of musculoskeletal origin. This study includes 91 patients and all the patients were subjected to a preoperative FNAC test on an outpatient basis. An open biopsy was done in every case under appropriate anesthesia and representative tumor tissue was sent for frozen section analysis. Out of 91 patients, FNAC was feasible in 78 patients. Out of the 78 patients aspirated, a type-specific diagnosis was made in 79.5% of cases (62 out of 78). Frozen section was possible in 85 cases. The percentage of specific diagnosis by frozen section in this study is 85.9% (73 out of 85) and overall diagnostic accuracy of 96.5% (82 out of 85). FNAC and frozen section are reliable diagnostic modalities, in the presence of clinico-radiological correlation, in the diagnosis of musculoskeletal tumors.

  5. 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.

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

    PubMed

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

    2017-01-01

    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. 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. 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). 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 average of 1.4 h/day for residents and fellows

  7. 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

  8. 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.

  9. Predictive factors for final pathologic ureteral sections on 700 radical cystectomy specimens: Implications for intraoperative frozen section decision-making.

    PubMed

    Masson-Lecomte, Alexandra; Francois, Thomas; Vordos, Dimitri; Cordonnier, Carole; Allory, Yves; Desgrandchamps, Francois; de la Taille, Alexandre; Saint, Fabien

    2017-07-14

    To identify preoperative predictive factors for final ureteral section invasion after radical cystectomy (RC) and to validate significant factors on an external independent cohort. We retrospectively reviewed data of all consecutive RC performed for bladder cancer in 2 high-volume institutions. Clinical, pathological, and follow-up data were collected prospectively and reviewed retrospectively. Pathological evaluation was performed by 2 well-trained uropathologists in each center. Logistic regression analyses were performed to identify predictive factors for final ureteral sections involvement. Significant factors in cohort A were validated in cohort B. Receiver operating curve and area under curve were modeled to evaluate predictive accuracy of the markers. A total of 441 RC were performed in center A and 307 RC were performed in center B. Mean follow-ups were 36.2 and 38.1 months, respectively. Invasion of the final ureteral section was observed on 5.5% of patients in cohort A and 4.8% of patients in cohort B. In cohort A, multivariable logistic regression identified preoperative hydronephrosis on computed tomography scan (odds ratio [OR] = 4.9, P = 0.004) and presence of Carcinoma in situ (CIS, OR = 3.9, P = 0.01) as the only factors associated with ureteral sections positivity. In cohort B, hydronephrosis and CIS were both associated with ureteral sections positivity in univariable analysis. In multivariable analysis, only hydronephrosis remained significant (OR = 5.9, P = 0.01). Predictive accuracy of hydronephrosis and CIS combined in 1 variable was 0.72. Hydronephrosis and bladder CIS have good accuracy in predicting ureteral sections positivity after RC. In the presence of those factors, ureteral frozen sections should be performed. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Intraoperative synovial C-reactive protein is as useful as frozen section to detect periprosthetic hip infection.

    PubMed

    Buttaro, Martin A; Martorell, Gabriel; Quinteros, Mauricio; Comba, Fernando; Zanotti, Gerardo; Piccaluga, Francisco

    2015-12-01

    Synovial quantification of C-reactive protein (SCRP) has been recently published with high sensitivity and specificity in the diagnosis of periprosthetic joint infection. However, to our knowledge, no studies have compared the use of this test with intraoperative frozen section, which is considered by many to be the best intraoperative test now available. We asked whether intraoperative SCRP could lead to comparable sensitivity, specificity, and predictive values as intraoperative frozen section in revision total hip arthroplasty. A prospective study was performed including 76 patients who underwent hip revision for any cause. SCRP quantification (using 9.5 mg/L as denoting infection) and the analysis of frozen section of intraoperative samples (five or more polymorphonuclear leukocytes under high magnification in 10 fields) were performed in all the patients. The definitive diagnosis of an infection was determined according to the Musculoskeletal Infection Society (MSIS). In this group, 30% of the patients were diagnosed with infection using the MSIS criteria (23 of 76 patients). With the numbers available, there were no differences between SCRP and frozen section in terms of their ability to diagnose infection. The sensitivity of SCRP was 90% (95% confidence interval [CI], 70.8%-98.6%), the specificity was 94% (95% CI, 84.5%-98.7%), the positive predictive value was 87% (95% CI, 66.3%-97%), and the negative predictive value was 96% (95% CI, 87%-99.4%); the sensitivity, specificity, positive predictive value, and negative predictive value were the same using frozen sections to diagnose infection. The positive likelihood ratio was 16.36 (95% CI, 5.4-49.5), indicating a low probability of an individual without the condition having a positive test, and the negative likelihood ratio was 0.10 (95% CI, 0.03-0.36), indicating low probability of an individual without the condition having a negative test. We found that quantitative SCRP had similar diagnostic value as

  11. Imaging of the atheroma in a frozen-section of human atheroscleotic tissue by FT-IR microscopy

    NASA Astrophysics Data System (ADS)

    Miyoshi, Norio; Yamada, Tetsushi; Ogawa, Toru; Akao, Ken-ichi; Nanba, Takao

    2004-08-01

    There is a long history of standard H. & E. staining for pathological diagnostic samples, where the organism is fixed with formaldehyde. However, one should not be neglect that the pathological diagnostic sample has an artificial, secondary protein structure, differing from the structure of just frozen-sectioned organism. We observed quantitatively the cholesterol distribution in the atheroma of a frozen-section of autopsied aorta by imaging, for the first time, using the Fourier transform infrared microscopy (FT-IRM) technique. We detected the cholesterol distribution and found that the protein structure changed to a β-sheet conformation, from an α-helix conformation on the inside edge of the calcified area.

  12. Accuracy of intraoperative frozen section in the evaluation of patients with adnexal mass: retrospective analysis of 748 cases with multivariate regression analysis.

    PubMed

    Basaran, Derman; Salman, M Coskun; Boyraz, Gokhan; Selcuk, Ilker; Usubutun, Alp; Ozgul, Nejat; Yuce, Kunter

    2015-01-01

    To evaluate the accuracy of intraoperative frozen section in the evaluation of patients with adnexal mass and to define the clinicopathological factors associated with misdiagnosis during frozen section evaluation. The clinicopathological data of patients who underwent exploratory laparotomy for adnexal mass were reviewed. Results of the intraoperative frozen section and permanent histology reports were compared. Univariate and multivariate analyses were performed to reveal factors associated with misdiagnosis. The study group consisted of 748 patients. Of these patients, 509 (68.0%) had benign, 43 (5.7%) had borderline, 196 (26.2%) had malignant histological diagnosis at permanent section. The overall agreement between intraoperative frozen section and permanent pathology was 96.8%. Twenty four out of 745 cases (3.8%) were misdiagnosed by frozen section. Univariate analysis showed that borderline histology (p < 0.0001) and tumor size larger than 10 cm (p = 0.012) were associated with misdiagnosis. According to multivariate analysis, borderline histology (OR: 22.6, p < 0.0001) was the only independent predictor for misdiagnosis during frozen examination. The frozen section evaluation of the adnexal mass is highly accurate. However, tumor size greater than 10 cm and borderline histology are the factors that adversely influence the accuracy of intraoperative frozen section. Clinicians must be aware of these pitfalls during intraoperative decision making following frozen section report.

  13. Frozen section can 'sharpen' or 'sand off' the surgeon's knife: Two case Illustrations with skull base meningioma mimics.

    PubMed

    Karthigeyan, Madhivanan; Salunke, Pravin; Gupta, Kirti; Singh, Apinderpreet; Rajasekhar, Rekhapalli

    2017-08-22

    Lesions at skull base merit careful evaluation of imaging and meticulous preoperative planning. Their needless radical resection could add to surgical morbidity. Occasionally, dura-based inflammatory/ infectious lesions at this site radiologically mimic meningiomas, which are the commonly encountered entity at this site. Not all require excision; rather it could be harmful in few. We describe two patients with skull base lesions that apparently resembled a meningioma on imaging, while the frozen section in both cases was contrary to the pre-operative diagnosis with inflammatory lesion in the first and invasive aspergillosis in the second case. Formalin-fixed paraffin embedded sections confirmed the frozen section diagnosis. Safe resection was performed in the former while surgery was abandoned and the patient started on antifungal therapy in the latter. Both had good outcome. The present report thus underscores the usefulness of intraoperative frozen section to decide on further course of treatment when faced with such unexpected situations. Frozen sections/ crush smears hold a great potential to avoid unwarranted surgical morbidity, particularly for skull base lesions. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. 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).

  15. 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.

  16. Intelligent framework for diagnosis of frozen shoulder using cross sectional survey and case studies.

    PubMed

    Batool, Humaira; Usman Akram, M; Batool, Fouzia; Butt, Wasi Haider

    2016-01-01

    Frozen shoulder is a disease in which shoulder becomes stiff. Accurate diagnosis of frozen shoulder is helpful in providing economical and effective treatment for patients. This research provides the classification of unstructured data using data mining techniques. Prediction results are validated by K-fold cross-validation method. It also provides accurate diagnosis of frozen shoulder using Naïve Bayesian and Random Forest models. At the end results are presented by performance measure techniques. In this research, 145 respondents (patients) with a severe finding of frozen shoulder are included. They are selected on premise of (clinical) assessment confirmed after by MRI. This data is taken from the department of Orthopedics (Pakistan Institute of Medical Sciences Islamabad and Railway Hospital Rawalpindi) between September 2014 to November 2015. Frozen shoulder is categorized on the basis of MRI result. The predictor variables are taken from patient survey and patient reports, which consisted of 35+ variables. The outcome variable is coded into numeric system of "intact" and "no-intact". The outcome variable is assigned into numeric code, 1 for "intact" and 0 for "no-intact". "Intact" group is used as an indication that tissue is damaged badly and "no-intact" is classified as normal. Distribution of result is 110 patients for "Intact" group and 35 patients for "No-Intact" group (false positive rate was 24 %). In this research we have utilized two methods i.e. Naive Bayes and Random Forest. A statistics regression model (Logistic regression) to categorize frozen shoulder finding into "intact" and "no-intact" classes. In the end, we validated our results by Bayesian theorem. This gives a rough estimate about the probability of frozen shoulder. In this research, our anticipated and predictive procedures gave better outcome as compared to statistical techniques. The specificity and sensitivity ratio of predicting a frozen shoulder are better in the Naïve Bayes as

  17. Comparison between CT tumor size and pathological tumor size in frozen section examinations of lung adenocarcinoma.

    PubMed

    Isaka, Tetsuya; Yokose, Tomoyuki; Ito, Hiroyuki; Imamura, Naoko; Watanabe, Masato; Imai, Kentaro; Nishii, Teppei; Woo, Tetsukan; Yamada, Kouzo; Nakayama, Haruhiko; Masuda, Munetaka

    2014-07-01

    We examined the appropriate measurement for pathological tumor size by comparing radiological and pathological tumor size of resected lung adenocarcinoma in FSE. We reviewed records of 59 resected specimens of lung adenocarcinoma for FSE from January to December 2008. Specimens were well-inflated with saline by using an injector before cutting into segments. After selecting the tumor segment of maximal diameter, we compared three ways of measuring pathological tumor size by using paired t-test: (I) macroscopic tumor size (MTS), measured with a metal straight ruler, (II) microscopic frozen section tumor size (FSTS), and (III) microscopic paraffin section tumor size (PSTS). We compared each discrepancy rate (DR) [DR=(CT tumor size-pathological tumor size)/CT tumor size×100] (%) between tumors that were air-containing type and solid-density type on CT scans, and also compared the tumors with lepidic component rates (LCR) ≥50% and LCR <50%, by using Mann-Whitney U-tests. FSE could diagnose malignancy with 100% accuracy. The mean CT tumor size was 18.36mm, and the mean pathological tumor sizes (MTS, FSTS, and PSTS) were 17.81, 14.29, and 14.23mm, respectively. FSTS and PSTS were significantly smaller than CT tumor size (p<0.001). The DR calculated with PSTS was significantly larger in air-containing than in solid-density tumors, and also larger in LCR ≥50% than in LCR <50% tumors. FSE with the inflation method diagnosed malignancy with 100% accuracy. The lung specimen must be sufficiently inflated to prevent tissue shrinking, and we propose MTS as the definition for pathological tumor size in FSE. The greater discordance observed between CT tumor size and microscopic tumor size was assumed to be due to shrinkage of the lepidic component in the tumor. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  18. 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

  19. Nurse managers' decision-making in daily unit operation in peri-operative settings: a cross-sectional descriptive study.

    PubMed

    Siirala, Eriikka; Peltonen, Laura-Maria; Lundgrén-Laine, Heljä; Salanterä, Sanna; Junttila, Kristiina

    2016-09-01

    To describe the tactical and the operational decisions made by nurse managers when managing the daily unit operation in peri-operative settings. Management is challenging as situations change rapidly and decisions are constantly made. Understanding decision-making in this complex environment helps to develop decision support systems to support nurse managers' operative and tactical decision-making. Descriptive cross-sectional design. Data were collected from 20 nurse managers with the think-aloud method during the busiest working hours and analysed using thematic content analysis. Nurse managers made over 700 decisions; either ad hoc (n = 289), near future (n = 268) or long-term (n = 187) by nature. Decisions were often made simultaneously with many interruptions. Ad hoc decisions covered staff allocation, ensuring adequate staff, rescheduling surgical procedures, confirmation tangible resources and following-up the daily unit operation. Decisions in the near future were: planning of surgical procedures and tangible resources, and planning staff allocation. Long-term decisions were: human recourses, nursing development, supplies and equipment, and finances in the unit. Decision-making was vulnerable to interruptions, which sometimes complicated the managing tasks. The results can be used when planning decision support systems and when defining the nurse managers' tasks in peri-operative settings. © 2016 John Wiley & Sons Ltd.

  20. Economic Implications of Widespread Expansion of Frozen Section Margin Analysis to Guide Surgical Resection in Women With Breast Cancer Undergoing Breast-Conserving Surgery.

    PubMed

    Boughey, Judy C; Keeney, Gary L; Radensky, Paul; Song, Christine P; Habermann, Elizabeth B

    2016-04-01

    In the current health care environment, cost effectiveness is critically important in policy setting and care of patients. This study performed a health economic analysis to assess the implications to providers and payers of expanding the use of frozen section margin analysis to minimize reoperations for patients undergoing breast cancer lumpectomy. A health care economic impact model was built to assess annual costs associated with breast lumpectomy procedures with and without frozen section margin analysis to avoid reoperation. If frozen section margin analysis is used in 20% of breast lumpectomies and under a baseline assumption that 35% of initial lumpectomies without frozen section analysis result in reoperations, the potential annual cost savings are $18.2 million to payers and $0.4 million to providers. Under the same baseline assumption, if 100% of all health care facilities adopted the use of frozen section margin analysis for breast lumpectomy procedures, the potential annual cost savings are $90.9 million to payers and $1.8 million to providers. On the basis of 10,000 simulations, use of intraoperative frozen section margin analysis yields cost saving for payers and is cost neutral to slightly cost saving for providers. This economic analysis indicates that widespread use of frozen section margin evaluation intraoperatively to guide surgical resection in breast lumpectomy cases and minimize reoperations would be beneficial to cost savings not only for the patient but also for payers and, in most cases, for providers. Copyright © 2016 by American Society of Clinical Oncology.

  1. 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

  2. Frozen section is superior to imprint cytology for the intra-operative assessment of sentinel lymph node metastasis in Stage I Breast cancer patients

    PubMed Central

    Mori, Miki; Tada, Keiichiro; Ikenaga, Motoko; Miyagi, Yumi; Nishimura, Seiichiro; Takahashi, Kaoru; Makita, Masujiro; Iwase, Takuji; Kasumi, Fujio; Koizumi, Mituru

    2006-01-01

    Background A standard intra-operative procedure for assessing sentinel lymph node metastasis in breast cancer patients has not yet been established. Patients and methods One hundred and thirty-eight patients with stage I breast cancer who underwent sentinel node biopsy using both imprint cytology and frozen section were analyzed. Results Seventeen of the 138 patients had sentinel node involvement. Results of imprint cytology included nine false negative cases (sensitivity, 47.1%). In contrast, only two cases of false negatives were found on frozen section (sensitivity, 88.2%). There were two false positive cases identified by imprint cytology (specificity, 98.3%). On the other hand, frozen section had 100% specificity. Conclusion These findings suggest that frozen section is superior to imprint cytology for the intra-operative determination of sentinel lymph node metastasis in stage I breast cancer patients. PMID:16707007

  3. Gross examination by the surgeon as an alternative to frozen section for assessment of adequacy of surgical margin in head and neck squamous cell carcinoma.

    PubMed

    Chaturvedi, Pankaj; Datta, Sourav; Nair, Sudhir; Nair, Deepa; Pawar, Prashant; Vaishampayan, Sagar; Patil, Asawari; Kane, Shubhada

    2014-04-01

    The cost-effectiveness of the frozen section for assessment of margin in head and neck squamous cell carcinoma (HNSCC) is still contentious. The purpose of this study was to evaluate whether gross examination of margin is an alternative to frozen section. It was a prospective observational study in 145 consecutive patients undergoing surgery for HNSCC. Surgical margins were first assessed by the surgeons with a metallic scale. All specimens were then examined using frozen section and permanent section. Overall, 83% of inadequate margins were detected by frozen section. The chances of inadequate margin were very low if gross surgical margin were 7 mm or more. Gross examination alone (with 7 mm as cutoff) predicted 88% of the inadequate surgical margin. There was no difference in precision of frozen section vis-à-vis gross examination with 7 mm cut off (p ≤ .8). Achievement of 7 mm surgical margin measured by a surgeon obviates the need for frozen section. Copyright © 2013 Wiley Periodicals, Inc.

  4. Development of a Whole Slide Imaging System on Smartphones and Evaluation With Frozen Section Samples.

    PubMed

    Yu, Hong; Gao, Feng; Jiang, Liren; Ma, Shuoxin

    2017-09-15

    The aim was to develop scalable Whole Slide Imaging (sWSI), a WSI system based on mainstream smartphones coupled with regular optical microscopes. This ultra-low-cost solution should offer diagnostic-ready imaging quality on par with standalone scanners, supporting both oil and dry objective lenses of different magnifications, and reasonably high throughput. These performance metrics should be evaluated by expert pathologists and match those of high-end scanners. The aim was to develop scalable Whole Slide Imaging (sWSI), a whole slide imaging system based on smartphones coupled with optical microscopes. This ultra-low-cost solution should offer diagnostic-ready imaging quality on par with standalone scanners, supporting both oil and dry object lens of different magnification. All performance metrics should be evaluated by expert pathologists and match those of high-end scanners. In the sWSI design, the digitization process is split asynchronously between light-weight clients on smartphones and powerful cloud servers. The client apps automatically capture FoVs at up to 12-megapixel resolution and process them in real-time to track the operation of users, then give instant feedback of guidance. The servers first restitch each pair of FoVs, then automatically correct the unknown nonlinear distortion introduced by the lens of the smartphone on the fly, based on pair-wise stitching, before finally combining all FoVs into one gigapixel VS for each scan. These VSs can be viewed using Internet browsers anywhere. In the evaluation experiment, 100 frozen section slides from patients randomly selected among in-patients of the participating hospital were scanned by both a high-end Leica scanner and sWSI. All VSs were examined by senior pathologists whose diagnoses were compared against those made using optical microscopy as ground truth to evaluate the image quality. The sWSI system is developed for both Android and iPhone smartphones and is currently being offered to the

  5. Development of a Whole Slide Imaging System on Smartphones and Evaluation With Frozen Section Samples

    PubMed Central

    Jiang, Liren

    2017-01-01

    Background The aim was to develop scalable Whole Slide Imaging (sWSI), a WSI system based on mainstream smartphones coupled with regular optical microscopes. This ultra-low-cost solution should offer diagnostic-ready imaging quality on par with standalone scanners, supporting both oil and dry objective lenses of different magnifications, and reasonably high throughput. These performance metrics should be evaluated by expert pathologists and match those of high-end scanners. Objective The aim was to develop scalable Whole Slide Imaging (sWSI), a whole slide imaging system based on smartphones coupled with optical microscopes. This ultra-low-cost solution should offer diagnostic-ready imaging quality on par with standalone scanners, supporting both oil and dry object lens of different magnification. All performance metrics should be evaluated by expert pathologists and match those of high-end scanners. Methods In the sWSI design, the digitization process is split asynchronously between light-weight clients on smartphones and powerful cloud servers. The client apps automatically capture FoVs at up to 12-megapixel resolution and process them in real-time to track the operation of users, then give instant feedback of guidance. The servers first restitch each pair of FoVs, then automatically correct the unknown nonlinear distortion introduced by the lens of the smartphone on the fly, based on pair-wise stitching, before finally combining all FoVs into one gigapixel VS for each scan. These VSs can be viewed using Internet browsers anywhere. In the evaluation experiment, 100 frozen section slides from patients randomly selected among in-patients of the participating hospital were scanned by both a high-end Leica scanner and sWSI. All VSs were examined by senior pathologists whose diagnoses were compared against those made using optical microscopy as ground truth to evaluate the image quality. Results The sWSI system is developed for both Android and iPhone smartphones and

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. Accuracy of frozen section, imprint cytology, and permanent histology of sub-nipple tissue for predicting occult nipple involvement in patients with breast carcinoma.

    PubMed

    Duarte, Giuliano M; Tomazini, Maria Virginia; Oliveira, André; Moreira, Luciana; Tocchet, Fernando; Worschech, Adriana; Torresan, Renato Z

    2015-10-01

    The sub-nipple tissue (SNT) examination has been used by surgeons to preserve, or not, the nipple in nipple-sparing mastectomy. However, it is uncertain whether SNT evaluation can predict nipple involvement. The aim of this study was to evaluate the accuracy, sensitivity, specificity, PPV, and NPV of the intraoperative frozen section and imprint cytology, and permanent histology of SNT to predict the involvement of the nipple in breast carcinoma and to compare the three exams. A prospective study was performed with 68 consecutive breast carcinoma women who had undergone mastectomy or central segmentectomy (removing nipple-areolar complex). After surgery, the nipple-areolar complex was dissected simulating a nipple-sparing flap (ex vivo). The SNT was subsequently removed and submitted to frozen section, imprint cytology, and permanent histology. The nipple was examined separately by paraffin histopathology and was considered the gold standard. The occult nipple involvement rate was 11.7 %. The frozen section, cytology, and permanent histology of SNT presented accuracy 86.8, 76.5, and 86.8 %; sensitivity 50, 37.5, and 62.5 %; specificity 91.7, 81.7, and 90 %; PPV 44.4, 21.4, and 45.5 %; and NPV 93.2, 90.7, and 94.7 %, respectively. The accuracy of the frozen section was similar to that of permanent histology (p = 0.77) and both were better than cytology (p = 0.01). False negative rates were 6.8 % for frozen section, 9.3 % for cytology and 5.3 % for paraffin. SNT evaluation is a good method for predicting occult nipple involvement; the outcomes showed a good accuracy and low false negative rate for the frozen section, cytology, and permanent histology exams. When we compared the exams, the frozen section was similar to permanent histology and more accurate than imprint cytology.

  11. [Application of polymer detection systems of Histofine MOUSESTAIN, Mouse MAX-PO and rat MAX-PO for mouse and rat frozen tissue sections].

    PubMed

    Kasamatsu, Toshiyuki; Kitano, Yuriko; Ohbayashi, Hirokazu

    2010-12-01

    We defined the staining applicability of Histofine MOUSESTAIN, Mouse MAX-PO and Rat MAX-PO for fixed frozen and fresh frozen tissue sections besides paraffin embedded tissue sections. Two different types of cool air dried tissue sections, fresh frozen tissues and fixed frozen tissues of nine-week old Slc: ICR mouse and nine-week old Slc: SD rat, were prepared for immunohistochemistry (IHC) staining in accordance with conventional method. Additional two steps of 1 and 2 to our recommended procedure for paraffin embedded tissue sections were examined as follows: STEP 1: Adjust reaction time of polymer; STEP 2: Add 0.2% of glutaraldehyde (GA) solution before the STEP 1, when background staining is still observed by STEP 1. The steps 1 and 2 resulted in elimination of background staining of most Histofine series. Therefore, polymer detection systems, Histofine series, are applicable for IHC staining of two different types of frozen tissue sections as well as paraffin embedded tissue sections.

  12. 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

  13. Obtaining high cure rates for challenging facial malignancies: A new method for producing rapid, accurate, high-quality frozen sections

    PubMed Central

    Boyd, Kirsty; Henderson, Colin; Joseph, Mariamma; Yardley, Nick; Temple, Claire

    2011-01-01

    PURPOSE: The authors developed a new system to provide rapid, accurate, full-face frozen sections. OBJECTIVE: To evaluate the efficacy of the system when applied to the treatment of nonmelanoma cutaneous malignancies using Mohs micrographic surgery (MMS). METHODS: Patients undergoing MMS procedures between 2003 and 2007 for nonmelanoma head and neck cutaneous malignancies were prospectively collected. Specimens were prepared either in a traditional cryostat-based manner or using the new system. RESULTS: A total of 196 patients with 234 head and neck nonmelanoma cutaneous malignancies were included. The majority of tumours were basal cell carcinomas (89.5%). Of these, 38% demonstrated aggressive histologies (sclerosing or micronodular), and 30% were recurrent. On average, two levels (range one to six) and four blocks (range two to 23) were required to obtain clear margins. The mean defect size was 3.68 cm2 (range 0.13 cm2 to 37.68 cm2). Over the five-year study period, there were two recurrences in 234 cases (less than 1%), which compares favourably with other MMS series. The new system was associated with a shorter operative time than traditional specimen preparation (102 min versus 131 min; P=0.004). The new and traditional specimen preparation groups were similar in terms of the number of previous recurrences (29% versus 30%; P=1.00), defect size (3.7 cm2 versus 4.0 cm2; P=0.81) and the number of levels required (1.9 versus 1.5; P=0.05). CONCLUSIONS: The new system enables fast, accurate, full-face frozen section specimens that are ideal for MMS. The speed of specimen preparation is demonstrated by faster operative times, and a low recurrence rate attests the accuracy and quality of the sections. PMID:22379370

  14. 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. © 2015 Wiley Periodicals, Inc.

  15. False negative rate for intraoperative sentinel lymph node frozen section in patients with breast cancer: a retrospective analysis of patients in a single Asian institution.

    PubMed

    Wong, Jolene; Yong, Wei Sean; Thike, Aye Aye; Iqbal, Jabed; Salahuddin, Ahmed Syed; Ho, Gay Hui; Madhukumar, Preetha; Tan, Benita Kiat Tee; Ong, Kong Wee; Tan, Puay Hoon

    2015-07-01

    Intraoperative frozen section of the sentinel lymph node (SLN) in clinically node negative breast cancer patients detects metastatic disease and enables axillary lymph node dissection to be performed in the same operative setting. Internationally, the false negative rate (FNR) for SLN biopsy ranges from 5.5% to 43%. The size of SLN metastasis has been identified as a key factor affecting FNR. We review our institutional experience on the accuracy of intraoperative SLN biopsy. Data were collected retrospectively from patients undergoing SLN biopsy performed at Singapore General Hospital. The SLN was identified using blue dye, radioisotope or both. Frozen section was performed intraoperatively. When SLN was positive for metastasis on frozen section, completion axillary clearance was performed. False negative cases were defined as patients in whom a negative frozen section result was obtained, whose final permanent paraffin section was positive. We determined the FNR of SLN frozen section and evaluated the factors associated with it. A total of 2202 SLN biopsies were performed between January 2005 and June 2012. There were 89 false negative cases, of which there were 23 (25.8%) cases of isolated tumour cells (ITCs), 49 (55.1%) cases of micrometastasis, and 17 (19.1%) cases of macrometastasis. The overall FNR was 13.5%. FNR was 79.3% in ITCs, 59.8% in micrometastasis, and 3.1% in macrometastatic disease. Non-ductal histological subtype, absence of lymphovascular invasion and the size of SLN metastasis were identified as significant independent factors associated with a higher FNR. FNRin our institution is acceptable when compared to other large centres. Failure to detect metastasis in frozen section in more than half of our patients was due to ITCs and micrometastasis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  16. Assessing the histological type and grade of primary parotid carcinoma by fine-needle aspiration and frozen section.

    PubMed

    Nishikawa, Shuji; Kawata, Ryo; Higashino, Masaaki; Lee, Koutetsu; Terada, Tetsuya; Kurisu, Yoshitaka; Tsuji, Motomu

    2015-12-01

    The aim of this study is to compare preoperative fine needle aspiration cytology (FNAC) and intraoperative frozen section (FS) for the correct identification of malignancy, histological grade, and histological type. FNAC was performed on all 105 patients and FS on 71 patients with parotid carcinoma. The rate of correctly determining the histological grade by FNAC and FS was 32% and 73%, respectively. The correct diagnosis rate for both the histological type and grade by FNAC and FS was 20% and 48%, respectively. The correct grading of both high and low/intermediate grade carcinoma is possible in 70-80% of patients by FS. If the histological grade is identified correctly, the extent of resection can usually be decided appropriately. Therefore, we should put emphasis on determining the histological grade. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  17. 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.

  18. Rapid and Easy Histological Evaluation of Alveolar Human Bone Quality at Dental Implant Sites Using a Nondecalcified Frozen Cryofilm Section Technique: A Technical Report.

    PubMed

    Ito, Yuichi; Fujita, Hiroshi; Kanou, Miwa; Takahashi-Nakagawa, Yasuko; Nakajima, Yoichiro; Sunano, Akihiro; Kimura, Yoshihiro; Ueno, Takaaki

    2015-08-01

    The evaluation of bone quality at the site of the alveolar bone for a dental implant is very important. This study presents an easy technique for direct evaluation of alveolar bone quality using nondecalcified cryofilm frozen sections on human alveolar bone core samples. Core samples harvested from alveolar bone were immediately frozen in cooled hexanen and slowly cut using a disposable tungsten carbide blade; the sliced sections were collected with adhesive cryofilms. Staining was performed using von toluidine blue and von Kossa for microscopic observations. All core samples clearly showed bone structure components of cortical bone, trabecular bone, bone marrow, blood vessels, and bone-related cells. These results suggest the efficacy of a nondecalcified cryofilm frozen section technique for histological observation of surgical implant sites.

  19. 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

  20. Effective Melanin Depigmentation of Human and Murine Ocular Tissues: An Improved Method for Paraffin and Frozen Sections

    PubMed Central

    Manicam, Caroline; Pitz, Susanne; Brochhausen, Christoph; Grus, Franz H.; Pfeiffer, Norbert; Gericke, Adrian

    2014-01-01

    Purpose The removal of excessive melanin pigments that obscure ocular tissue morphology is important to address scientific questions and for differential diagnosis of ocular tumours based on histology. Thus, the goal of the present study was to establish an effective and fast melanin bleaching method for paraffin and frozen mouse and human ocular tissues. Methods Paraffin-embedded and frozen ocular specimens from mice and human donors were subjected to bleaching employing two methods. The first employed potassium permanganate (KMnO4) with oxalic acid, and the second 10% hydrogen peroxide (H2O2). To determine optimal bleaching conditions, depigmentation was carried out at various incubation times. The effect of diluents used for 10% H2O2 was assessed using phosphate-buffered saline (PBS), and deionized water. Three different slide types and two fixatives, which were ice-cold acetone with 80% methanol, and 4% paraformaldehyde (PFA) were used to determine the optimal conditions for better tissue adherence during bleaching. All tissues were stained in hematoxylin and eosin for histological evaluation. Results Optimal bleaching was achieved using warm 10% H2O2 diluted in PBS at 65°C for 120 minutes. Chromium-gelatin-coated slides prevented tissue detachment. Adherence of cryosections was also improved with post-fixation using 4% PFA and overnight air-drying at RT after cryosectioning. Tissue morphology was preserved under these conditions. Conversely, tissues bleached in KMnO4/oxalic acid demonstrated poor depigmentation with extensive tissue damage. Conclusions Warm dilute H2O2 at 65°C for 120 minutes rapidly and effectively bleached both cryo- and paraffin sections of murine and human ocular tissues. PMID:25025426

  1. Effective melanin depigmentation of human and murine ocular tissues: an improved method for paraffin and frozen sections.

    PubMed

    Manicam, Caroline; Pitz, Susanne; Brochhausen, Christoph; Grus, Franz H; Pfeiffer, Norbert; Gericke, Adrian

    2014-01-01

    The removal of excessive melanin pigments that obscure ocular tissue morphology is important to address scientific questions and for differential diagnosis of ocular tumours based on histology. Thus, the goal of the present study was to establish an effective and fast melanin bleaching method for paraffin and frozen mouse and human ocular tissues. Paraffin-embedded and frozen ocular specimens from mice and human donors were subjected to bleaching employing two methods. The first employed potassium permanganate (KMnO4) with oxalic acid, and the second 10% hydrogen peroxide (H2O2). To determine optimal bleaching conditions, depigmentation was carried out at various incubation times. The effect of diluents used for 10% H2O2 was assessed using phosphate-buffered saline (PBS), and deionized water. Three different slide types and two fixatives, which were ice-cold acetone with 80% methanol, and 4% paraformaldehyde (PFA) were used to determine the optimal conditions for better tissue adherence during bleaching. All tissues were stained in hematoxylin and eosin for histological evaluation. Optimal bleaching was achieved using warm 10% H2O2 diluted in PBS at 65°C for 120 minutes. Chromium-gelatin-coated slides prevented tissue detachment. Adherence of cryosections was also improved with post-fixation using 4% PFA and overnight air-drying at RT after cryosectioning. Tissue morphology was preserved under these conditions. Conversely, tissues bleached in KMnO4/oxalic acid demonstrated poor depigmentation with extensive tissue damage. Warm dilute H2O2 at 65°C for 120 minutes rapidly and effectively bleached both cryo- and paraffin sections of murine and human ocular tissues.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. Total laparoscopic hysterectomy in early-stage endometrial cancer using an intrauterine manipulator: is it a bias for frozen section analysis? Case-control study.

    PubMed

    Fanfani, F; Gagliardi, M L; Zannoni, G F; Gallotta, V; Vizzielli, G; Lecca, A; Scambia, G; Fagotti, A

    2011-01-01

    To evaluate whether the systematic use of an intrauterine manipulator influences the accuracy of frozen section analysis in early-stage endometrial cancer. Case-control study (Canadian Task Force classification II-1). Three hundred fourteen consecutive women with early-stage endometrial cancer. Between January 2004 and December 2009, 314 women with early-stage endometrial cancer underwent staging at laparoscopy (case group) or laparotomy (control group). All women in the case group underwent total laparoscopic hysterectomy using an intrauterine manipulator. The positive predictive value of frozen section analysis for myometrial infiltration, histotype, and grade of differentiation was 97.2%, 100%, and 97.2%, respectively. The correct diagnosis rate was of 85.7%. The accuracy of frozen section analysis, rate of correct diagnosis, and rate of tumor vascular invasion did not seem to be significantly modified by systematic use of an intrauterine manipulator for total laparoscopic hysterectomy compared with total abdominal hysterectomy in early-stage endometrial cancer staging. Frozen section analysis of early-stage endometrial cancer is highly accurate, and systematic use of an intrauterine manipulator does not represent a bias for correct evaluation of the specimen. Copyright © 2011 AAGL. Published by Elsevier Inc. All rights reserved.

  7. 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...

  8. 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...

  9. 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...

  10. 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...

  11. 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...

  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. Preoperative incisional and intraoperative frozen section biopsy techniques have comparable accuracy in the diagnosis of benign intraosseous jaw pathology.

    PubMed

    Guthrie, David; Peacock, Zachary S; Sadow, Peter; Dodson, Thomas B; August, Meredith

    2012-11-01

    To compare the accuracy of intraoperative frozen section (FS) and preoperative incisional biopsy (IB) techniques to diagnose benign intraosseous jaw lesions. This is a retrospective cohort study composed of subjects with benign intraosseous jaw lesions. The predictor variable was the technique for establishing a preliminary diagnosis of the lesion, preoperative IB or intraoperative FS. The outcome variable was the accuracy of the biopsy technique when compared with the final histologic diagnosis and was classified as concordant or discordant. The comparative diagnostic accuracy of the techniques was assessed with the χ(2) test. A total of 71 subjects met inclusion criteria. The mean age was 39 years (range, 5 to 85 years), and 58% (41) were male patients. Of the subjects, 20 (28%) underwent IB. In 14 (70%) of these, the results of biopsy agreed with the final diagnosis. 51 (72%) underwent intraoperative FS and in 31 (62%) of these, the results of biopsy agreed with the final diagnosis. The difference in diagnostic accuracy between IB (70%) and FS (61%) was statistically insignificant (P = .48). Sources of biopsy error included sampling error (46%), insufficient epithelial tissue (15%), inflammation (15%), pathologist's experience (8%), and artifact (4%). Preoperative IB and intraoperative FS provide comparable accuracy of diagnosis in patients with benign intraosseous jaw pathology. Sampling error was the most common reason for discordant results. Copyright © 2012 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  14. Establishing an accurate diagnosis of a parotid lump: evaluation of the current biopsy methods - fine needle aspiration cytology, ultrasound-guided core biopsy, and intraoperative frozen section.

    PubMed

    Howlett, D C; Skelton, E; Moody, A B

    2015-09-01

    The optimum technique for histological confirmation of the nature of a parotid mass remains controversial. Fine needle aspiration cytology (FNAC), which has traditionally been used, is associated with high non-diagnostic and false negative rates, and ultrasound (US)-guided core biopsy and frozen section have been explored as alternatives. US-guided core biopsy is more invasive than FNAC, but is safe, well-tolerated, and associated with improved diagnostic performance. Although frozen section offers better specificity than FNAC, it has a number of important drawbacks and cannot be considered as a primary diagnostic tool. US-guided core biopsy should be considered as the initial diagnostic technique of choice, and in units where the accuracy of FNAC is good it can be used when FNAC is equivocal or non-diagnostic. Copyright © 2015 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  15. 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

  16. [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

  17. Pros and cons: cryo-electron microscopic evaluation of block faces versus cryo-sections from frozen-hydrated skin specimens prepared by different techniques.

    PubMed

    Richter, T; Biel, S S; Sattler, M; Wenck, H; Wittern, K-P; Wiesendanger, R; Wepf, R

    2007-02-01

    Over the last two decades, several different preparative techniques have been developed to investigate frozen-hydrated biological samples by electron microscopy. In this article, we describe an alternative approach that allows either ultrastructural investigations of frozen human skin at a resolution better than 15 nm or sample throughput that is sufficiently high enough for quantitative morphological analysis. The specimen preparation method we describe is fast, reproducible, does not require much user experience or elaborate equipment. We compare high-pressure freezing with plunge freezing, and block faces with frozen-hydrated slices (sections), to study variations in cell thickness upon hydration changes. Plunge freezing is optimal for morphological and stereological investigations of structures with low water content. By contrast, high-pressure freezing proved optimal for high-resolution studies and provided the best ultrastructural preservation. A combination of these fast-freezing techniques with cryo-ultramicrotomy yielded well-preserved block faces of the original biological material. Here we show that these block faces did not exhibit any of the artefacts normally associated with cryo-sections, and--after evaporating a heavy metal and carbon onto the surface--are stable enough in the electron beam to provide high-resolution images of large surface areas for statistical analysis in a cryo-SEM (scanning electron microscope). Because the individual preparation steps use only standard equipment and do not require much experience from the experimenter, they are generally more usable, making this approach an interesting alternative to other methods for the ultrastructural investigation of frozen-hydrated material.

  18. Perioperative use of allogenic blood components in live-related donor orthotopic liver transplantation: A cross sectional study.

    PubMed

    Pandey, Prashant; Tiwari, Aseem K; Sharma, Jyoti; Srivastava, Divyajyoti; Dixit, Surbhi; Raina, Vimarsh

    2013-01-01

    In spite of many improvements that have reduced the blood component requirements, substantial numbers of transfusions are still needed in liver transplantation. The objective of the present study was to analyze the perioperative usage of allogenic blood components and predict the preoperative factors as predictors of red cell transfusion in live-related donor liver transplant recipients. The retrospective data on utilization of allogenic blood components were analyzed for a total of 150 liver transplant procedures. The data on utilization of blood components during surgery and till 48 hours of ICU stay was collected from the blood bank record and hospital information system (HIS). Red cell concentrate was commonest blood component used in liver transplant recipient and most of the transfusion took place during surgery. During intraoperative period 92.7% (N = 139) of the cases utilized red cell components with the median number of five whereas in postoperative period only 38% (N = 57) of patients received blood with the median number of one. This study demonstrates that the preoperative hemoglobin and platelet count are the predictors of utilization of red cell concentrates during surgery. There were a total of 11 (7.3%) recipients who didn't receive allogeneic blood transfusion in any form. Utilization of blood components was negligible among organ donors. Our study demonstrates the pattern and predictors of usage of allogeneic blood components in liver transplant recipients at a tertiary healthcare center in India.

  19. 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...

  20. Decline in Frozen Section Diagnosis for Axillary Sentinel Lymph Nodes as a Result of the American College of Surgeons Oncology Group Z0011 Trial.

    PubMed

    Bishop, Julie Anne; Sun, Jihong; Ajkay, Nicolas; Sanders, Mary Ann G

    2016-08-01

    -Results of the American College of Surgeons Oncology Group Z0011 trial showed that patients with early-stage breast cancer and limited sentinel node metastasis treated with breast conservation and systemic therapy did not benefit from axillary lymph node dissection. Subsequently, most pathology departments have likely seen a decrease in frozen section diagnosis of sentinel lymph nodes. -To determine the effect of the Z0011 trial on pathology practice and to examine the utility of intraoperative sentinel lymph node evaluation for this subset of patients. -Pathology reports from cases of primary breast cancer that met Z0011 clinical criteria and were initially treated with lumpectomy and sentinel lymph node biopsy from 2009 to 2015 were collected. Clinicopathologic data were recorded. -Sentinel lymph node biopsies sent for frozen section diagnosis occurred in 22 of 22 cases (100%) in 2009 and 15 of 22 cases (68%) in 2010 during the pre-Z0011 years, and in 3 of 151 cases (2%) collected in 2011 through 2015, considered to be post-Z0011 years. Of the 151 post-Z0011 cases, 28 (19%) had sentinel lymph nodes with metastasis, and 147 (97%) were spared axillary lymph node dissection. -Following Z0011, intraoperative sentinel lymph node evaluation has significantly decreased at our institution. Prior to surgery, all patients had clinically node-negative disease. After sentinel lymph node evaluation, 97% (147 of 151) of the patients were spared axillary lymph node dissection. Therefore, routine frozen section diagnosis for sentinel lymph node biopsies can be avoided in these patients.

  1. Application of scanning electron microscopy to x-ray analysis of frozen- hydrated sections. III. Elemental content of cells in the rat renal papillary tip

    PubMed Central

    1981-01-01

    The electrolyte and water content of cellular and interstitial compartments in the renal papilla of the rat was determined by x-ray microanalysis of frozen-hydrated tissue sections. Papillae from rats on ad libitum water were rapidly frozen in a slush of Freon 12, and sectioned in a cryomicrotome at -30 to -40 degrees C. Frozen 0.5- micrometer sections were mounted on carbon-coated nylon film over a Be grid, transferred cold to the scanning microscope, and maintained at - 175 degrees C during analysis. The scanning transmission mode was used for imaging. Structural preservation was of good quality and allowed identification of tissue compartments. Tissue mass (solutes + water) was determined by continuum radiation from regions of interest. After drying in the SEM, elemental composition of morphologically defined compartments (solutes) was determined by analysis of specific x-rays, and total dry mass by continuum. Na, K, Cl, and H2O contents in collecting-duct cells (CDC), papillary epithelial cells (PEC), and interstitial cells (IC) and space were measured. Cells had lower water content (mean 58.7%) than interstitium (77.5%). Intracellular K concentrations (millimoles per kilogram wet weight) were unremarkable (79-156 mm/kg wet weight); P was markedly higher in cells than in interstitium. S was the same in all compartments. Intracellular Na levels were extremely high (CDC, 344 +/- 127 SD mm/kg wet weight; PEC, 287 +/- 105; IC, 898 +/- 194). Mean interstitial Na was 590 +/- 119 mm/kg wet weight. CI values paralleled those for Na. If this Na is unbound, then these data suggest that renal papillary interstitial cells adapt to their hyperosmotic environment by a Na-uptake process. PMID:7204493

  2. Pulse contour analysis calibrated by Trans-pulmonar thermodilution (Picco Plus(®)) for the perioperative management of a caesarean section in a patient with severe cardiomyopathy.

    PubMed

    Brogly, Nicolas; Schiraldi, Renato; Puertas, Laura; Maggi, Genaro; Yanci, Eduardo Alonso; Maldonado, Ever Hugo Martinez; Arévalo, Emilia Guasch; Rodríguez, Fernando Gilsanz

    2016-01-01

    The delivery of cardiac patients is a challenge for the anaesthesiologist, to whom the welfare of both the mother and the foetus is a main issue. In case of caesarean section, advanced monitoring allows to optimize haemodynamic condition and to improve morbidity and mortality. To describe the use of pulse contour analysis calibrated by Trans-pulmonar thermodilution (Picco Plus(®)) for the perioperative management of a caesarean section in a patient with severe cardiomyopathy. We describe the case of a 28-year-old woman with a congenital heart disease who was submitted to a caesarean section under general anaesthesia for maternal pathology and foetal breech presentation. Intra- and post-operative management was optimized by advanced haemodynamic monitorization obtained by pulse contour wave analysis and thermodilution calibration (Picco Plus(®) monitor). The information about preload, myocardial contractility and postcharge was useful in guiding the fluid therapy and the use of vasoactive drugs. This case report illustrates the importance of advanced haemodynamic monitoring with an acceptably invasive device in obstetric patients with high cardiac risk. The increasing experience in advanced haemodynamic management will probably permit to decrease morbidity and mortality of obstetric patients in the future. Copyright © 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  3. [Pulse contour analysis calibrated by Trans-pulmonar thermodilution (Picco Plus(®)) for the perioperative management of a caesarean section in a patient with severe cardiomyopathy].

    PubMed

    Brogly, Nicolas; Schiraldi, Renato; Puertas, Laura; Maggi, Genaro; Yanci, Eduardo Alonso; Maldonado, Ever Hugo Martinez; Arévalo, Emilia Guasch; Rodríguez, Fernando Gilsanz

    2016-01-01

    The delivery of cardiac patients is a challenge for the anaesthesiologist, to whom the welfare of both the mother and the foetus is a main issue. In case of caesarean section, advanced monitoring allows to optimize haemodynamic condition and to improve morbidity and mortality. To describe the use of pulse contour analysis calibrated by Trans-pulmonar thermodilution (Picco Plus(®)) for the perioperative management of a caesarean section in a patient with severe cardiomyopathy. We describe the case of a 28-year-old woman with a congenital heart disease who was submitted to a caesarean section under general anaesthesia for maternal pathology and foetal breech presentation. Intra- and post-operative management was optimized by advanced haemodynamic monitorization obtained by pulse contour wave analysis and thermodilution calibration (Picco Plus(®) monitor). The information about preload, myocardial contractility and postcharge was useful in guiding the fluid therapy and the use of vasoactive drugs. This case report illustrates the importance of advanced haemodynamic monitoring with an acceptably invasive device in obstetric patients with high cardiac risk. The increasing experience in advanced haemodynamic management will probably permit to decrease morbidity and mortality of obstetric patients in the future. Copyright © 2013 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  4. Multiple Myeloma Presenting as Massive Amyloid Deposition in a Parathyroid Gland Associated with Amyloid Goiter: A Medullary Thyroid Carcinoma Mimic on Intra-operative Frozen Section.

    PubMed

    Hill, Kirk; Diaz, Jason; Hagemann, Ian S; Chernock, Rebecca D

    2017-09-06

    Clinical examples of amyloid deposition in parathyroid glands are exceedingly rare and usually present as an incidental finding in a patient with amyloid goiter. Here, we present the first histologically documented case of parathyroid amyloid deposition that presented as a mass. The patient did not have hyperparathyroidism. The parathyroid gland was submitted for intra-operative frozen section and concern for medullary thyroid carcinoma was raised. An important histologic clue arguing against medullary thyroid carcinoma was the evenly dispersed nature of the amyloid. Histologic perinuclear clearing and parathyroid hormone immunohistochemistry confirmed parathyroid origin on permanent sections. The patient was also found to have associated amyloid goiter. Mass spectrometry of the amyloid showed it to be composed of kappa light chains. On further work-up, the patient was diagnosed with multiple myeloma. Awareness of parathyroid amyloid deposition is important as it is a histologic mimic of medullary thyroid carcinoma, especially on frozen section. Amyloid typing with evaluation for multiple myeloma in any patient with kappa or lambda light chain restriction is also important.

  5. Frozen shoulder.

    PubMed

    Wadsworth, C T

    1986-12-01

    Widespread use of the label "frozen shoulder" as a diagnosis for any stiff and painful shoulder condition has led to its becoming a rather meaningless, catchall term. In addition to confounding both the lay public and health care professionals, this indiscriminate labeling may prevent a patient from receiving appropriate treatment. In this article, I define frozen shoulder and review its pathologic and etiologic factors, epidemiology, natural history, and diagnosis. I present this information in correlation with an examination process to assist physical therapists in identifying suspected cases of frozen shoulder. I also present the current options for treatment, including physical therapy management with physical agents and exercise.

  6. In vivo characterisation of parathyroid lesions by use of gamma probe: comparison with ex vivo count method and frozen section results.

    PubMed

    Ugur, Omer; Kara, Pelin Ozcan; Bozkurt, Murat Fani; Hamaloglu, Erhan; Tezel, Gaye Güler; Salanci, Bilge Volkan; Karabulut, Erdem; Sayek, Iskender

    2006-02-01

    In this study we hypothesized that if timing of gamma probe-guided parathyroidectomy were individualized according to an optimal-time-to-surgery technique, in vivo characterization of parathyroid lesions would be possible. We compared our findings with an ex vivo counting method ("20% rule") and frozen section results. Thirty-five patients who were referred for surgical treatment of hyperparathyroidism were studied. Maximum parathyroid to thyroid sestamibi uptake ratio (UR(max)) was measured by use of preoperative dynamic scintigraphy. The interval between sestamibi injection and UR(max) was defined as the optimal time to surgery. On the day of surgery, the patients received the same dose of sestamibi and were taken to the operating room at UR(max) as determined by preoperative scintigraphy. Intraoperative in vivo gamma probe counts from parathyroid lesions were compared with in vivo contralateral background thyroid counts (in vivo/Bkg) and to ex vivo parathyroid counts relative to postexcision background of the adjacent normal tissue (ex vivo/Bkg). A total of 70 excised lesions were evaluated. In vivo/Bkg counts obtained from parathyroid adenoma were significantly different from parathyroid hyperplasia (z = -3.093, P = 0.002) and other lesions (z = -3.958, P = 0.0001). By receiver operating characteristic curve (ROC) analysis, we found the cutoff value for the in vivo/Bkg counts ratio to be 103% to differentiate parathyroid adenoma from hyperplasia with a sensitivity, specificity, and accuracy of 82.5, 65, and 74.4%, respectively. On the other hand, sensitivity, specificity, and accuracy of the ex vivo/Bkg method to differentiate parathyroid adenoma from hyperplasia with a cutoff value of 34.7 was found to be 70.8%, 60%, and 65.9%, respectively. The difference between the accuracy of these 2 tests was not significant statistically (P = 0.137). Sensitivity of frozen section to differentiate parathyroid adenoma and hyperplasia was 76.2% and 33.3%, respectively

  7. Perioperative warming with a thermal gown prevents maternal temperature loss during elective cesarean section. A randomized clinical trial.

    PubMed

    de Bernardis, Ricardo Caio Gracco; Siaulys, Monica Maria; Vieira, Joaquim Edson; Mathias, Lígia Andrade Silva Telles

    2016-01-01

    Decrease in body temperature is common during general and regional anesthesia. Forced-air warming intraoperative during cesarean section under spinal anesthesia seems not able to prevent it. The hypothesis considers that active warming before the intraoperative period avoids temperature loss during cesarean. Forty healthy pregnant patients undergoing elective cesarean section with spinal anesthesia received active warming from a thermal gown in the preoperative care unit 30min before spinal anesthesia and during surgery (Go, n=20), or no active warming at any time (Ct, n=20). After induction of spinal anesthesia, the thermal gown was replaced over the chest and upper limbs and maintained throughout study. Room temperature, hemoglobin saturation, heart rate, arterial pressure, and tympanic body temperature were registered 30min before (baseline) spinal anesthesia, right after it (time zero) and every 15min thereafter. There was no difference for temperature at baseline, but they were significant throughout the study (p<0.0001; repeated measure ANCOVA). Tympanic temperature baseline was 36.6±0.3°C, measured 36.5±0.3°C at time zero and reached 36.1±0.2°C for gown group, while control group had baseline temperature of 36.4±0.4°C, measured 36.3±0.3°C at time zero and reached 35.4±0.4°C (F=32.53; 95% CI 0.45-0.86; p<0.001). Hemodynamics did not differ throughout the study for both groups of patients. Active warming 30min before spinal anesthesia and during surgery prevented a fall in body temperature in full-term pregnant women during elective cesarean delivery. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  8. [Perioperative warming with a thermal gown prevents maternal temperature loss during elective cesarean section. A randomized clinical trial].

    PubMed

    Bernardis, Ricardo Caio Gracco de; Siaulys, Monica Maria; Vieira, Joaquim Edson; Mathias, Lígia Andrade Silva Telles

    2016-01-01

    Decrease in body temperature is common during general and regional anesthesia. Forced-air warming intraoperative during cesarean section under spinal anesthesia seems not able to prevent it. The hypothesis considers that active warming before the intraoperative period avoids temperature loss during cesarean. Forty healthy pregnant patients undergoing elective cesarean section with spinal anesthesia received active warming from a thermal gown in the preoperative care unit 30min before spinal anesthesia and during surgery (Go, n=20), or no active warming at any time (Ct, n=20). After induction of spinal anesthesia, the thermal gown was replaced over the chest and upper limbs and maintained throughout study. Room temperature, hemoglobin saturation, heart rate, arterial pressure, and tympanic body temperature were registered 30min before (baseline) spinal anesthesia, right after it (time zero) and every 15min thereafter. There was no difference for temperature at baseline, but they were significant throughout the study (p<0.0001; repeated measure ANCOVA). Tympanic temperature baseline was 36.6±0.3°C, measured 36.5±0.3°C at time zero and reached 36.1±0.2°C for gown group, while control group had baseline temperature of 36.4±0.4°C, measured 36.3±0.3°C at time zero and reached 35.4±0.4°C (F=32.53; 95% CI 0.45-0.86; p<0.001). Hemodynamics did not differ throughout the study for both groups of patients. Active warming 30min before spinal anesthesia and during surgery prevented a fall in body temperature in full-term pregnant women during elective cesarean delivery. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  9. 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

  10. 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

  11. [Perioperative nutrition].

    PubMed

    Garretsen, M K; Melis, G C; Richir, M C; Boelens, P G; Vlaanderen, L; van Leeuwen, P A M

    2006-12-16

    Illness is associated with involuntary weight loss, which is often the result of malnutrition. The undernourished surgical patient runs a higher risk of postoperative morbidity and mortality. For this reason, perioperative nutrition is an important part of a patient's therapy. Supplying substrates for wound healing and maintaining existing organic structures are the major goals of nutrition. It is recommended that extremely malnourished patients be fed at least 7 days prior to surgery. It would seem sensible to give a carbohydrate-rich beverage up to 2 hours before surgery, both to decrease preoperative anxiety and to reduce postoperative insulin resistance. The Dutch tradition of fasting patients before surgery is difficult to defend any longer because this policy impairs patients' state of health as a result of which they are not optimally prepared for the surgical induced stress response. The postoperative recovery of all surgical patients can be improved by an early postoperative start of enteric nutrition. When the enteric administration of food turns out to be impossible, total parenteral nutrition can be given to bridge a long period without food.

  12. 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...

  13. 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.

  14. 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.

  15. FIGO stage IIIC endometrial cancer identification among patients with complex atypical hyperplasia, grade 1 and 2 endometrioid endometrial cancer: laparoscopic indocyanine green sentinel lymph node mapping versus frozen section of the uterus, why get around the problem?

    PubMed

    Papadia, Andrea; Gasparri, Maria Luisa; Siegenthaler, Franziska; Imboden, Sara; Mohr, Stefan; Mueller, Michael D

    2017-03-01

    To compare two surgical strategies used to identify lymph node metastases in patients with preoperative diagnosis of complex atypical hyperplasia (CAH), grade 1 and 2 endometrial cancer (EC). Data on patients with preoperative diagnosis of CAH, grade 1 and 2 EC undergoing laparoscopic indocyanine green (ICG) sentinel lymph node (SLN) mapping followed by frozen section of the uterus were collected. When risk factors were identified at frozen section, patients were subjected to a systematic lymphadenectomy. False negative (FN) rates, negative predictive values (NPV), positive predictive values (PPV) and correlation with stage IIIC EC were calculated for the systematic lymphadenectomy based on frozen section of the uterus and for the SLN mapping. Six (9.5%) out of 63 patients had lymph nodal metastases. Based on frozen section of the uterus, 22 (34.9%) and 15 (22.2%) patients underwent a pelvic and a pelvic and paraaortic lymphadenectomy, respectively. Five patients with stage IIIC disease were identified with a FN rate of 16.7% and a NPV and PPV of 97.6 and 27.3%, respectively. Overall and bilateral detection rates of ICG SLN mapping were 100 and 97.6%, respectively; no FN were recorded. The identification of patients with stage IIIC disease with ICG SLN mapping showed a NPV and PPV of 100%. Correlation between indication to lymphadenectomy and stage IIIC disease was poor (κ = 0.244) when based on frozen section of the uterus and excellent (κ = 1) when based on SLN mapping. ICG SLN mapping reduces the number of unnecessary systematic lymphadenectomies and the risk of underdiagnosing patients with metastatic lymph nodes.

  16. 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

  17. [Diagnostic validity of the intraoperative analysis in frozen section of the sentinel lymph node in the surgical management of breast cancer].

    PubMed

    Bañuelos-Andrío, Luis; Rodríguez-Caravaca, Gil; Argüelles-Pintos, Miguel; Mitjavilla-Casanovas, Mercedes

    2014-01-01

    The method for intraoperative sentinel lymph node (SLN) evaluation has still not been established in breast cancer staging. This study has evaluated the diagnostic validity and impact of intraoperative analysis using the frozen section (FS) of SLN. We performed a descriptive study of the diagnostic validity of the FS of the SLN in patients with breast cancer and selective sentinel node biopsy (SSNB) from October-2006 to October-2012. The diagnostic validity indexes were evaluated using sensitivity, specificity, positive and negative predictive values and global value. Gold standard was considered as the final histopathological results of the biopsies. A total of 370 patients were studied. Sensitivity and specificity for detection of metastasis by FS in the SLN were 67% and 100%, respectively. Global diagnostic validity was 95%. There was a correlation between detection of metastasis and tumor size (p<0.05). Twelve of the 15 patients with SLN micro-metastases underwent axillary lymph node dissection (ALND). Metastatic lymph nodes were not found in any of them. Intraoperative FS examination of the SLN is a useful and reliable predictor of axillary lymph node staging in patients with initial stages of breast cancer. FS reduces the need for second interventions, at least for most patients who have breast cancer with identifiable positive SLN and unequivocal evidence of positive lymph node disease. Copyright © 2013 Elsevier España, S.L. and SEMNIM. All rights reserved.

  18. 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.

  19. 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...

  20. 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...

  1. 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...

  2. 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...

  3. 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...

  4. 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...

  5. 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...

  6. 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...

  7. 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...

  8. 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...

  9. 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...

  10. 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...

  11. 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...

  12. 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 by...

  13. 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 by...

  14. 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.

  15. 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.

  16. 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

  17. 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.

  18. Intraoperative frozen section monitoring during nerve-sparing radical prostatectomy: evaluation of partial secondary resection of neurovascular bundles and its effect on oncologic and functional outcome.

    PubMed

    Hatzichristodoulou, Georgios; Wagenpfeil, Stefan; Weirich, Gregor; Autenrieth, Michael; Maurer, Tobias; Thalgott, Mark; Horn, Thomas; Heck, Matthias; Herkommer, Kathleen; Gschwend, Jürgen E; Kübler, Hubert

    2016-02-01

    Intraoperative frozen sections (IFS) of the prostate have demonstrated to be effective in reducing positive surgical margins (PSM) and biochemical recurrence (BCR). The aim of this study was to assess partial secondary resection of neurovascular bundles (NVB) and report for the first time corresponding functional results. A total of 500 consecutive patients were included in this prospective series. All patients underwent open nerve-sparing radical prostatectomy. Intraoperatively, both posterolateral aspects of the prostate were sent for IFS. In case of PSM, additional tissue was partly resected from the prostatic bed along the NVB. BCR was the oncologic endpoint (PSA ≥ 0.2 ng/ml). The impact of IFS on PSM and BCR-free survival, and the effect of secondary partial resection of NVB on continence and erectile function (EF) recovery were analyzed by Kaplan-Meier analyses. Twenty-nine patients were excluded because of neoadjuvant treatment/lymph node positive disease. PSM were detected in 137/471 patients (29.1%). After secondary resection, 127/137 patients (92.7%) converted to definitive negative surgical margins (NSM). Out of 137 patients, ten (7.3%) showed persistent PSM. False-negative rate was 3.3% (11/334). Out of 471 patients, two (0.4%) showed PSM outside the IFS area. Overall, final PSM rate was 4.9% (23/471). Five-year BCR-free survival did not differ significantly in patients with primarily and converted NSM. Continence and EF recovery after 12 months were 95.8 versus 94.3%, and 65.7 versus 56.1%, respectively (all p > 0.05). IFS are highly effective in reducing PSM and avoiding compromised oncologic outcome. Partial secondary resection of the NVB ensures ns status and consequently preserves continence and EF.

  19. 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...

  20. 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...

  1. 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 on...

  2. 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 on...

  3. 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 on...

  4. The value of transvaginal sonography in the preoperative assessment of myometrial invasion in high and low grade endometrial cancer and in comparison to frozen section in grade 1 disease.

    PubMed

    Fishman, A; Altaras, M; Bernheim, J; Cohen, I; Beyth, Y; Tepper, R

    2000-01-01

    To evaluate the diagnostic accuracy of preoperative transvaginal sonography (TVS) in the detection of deep myometrial invasion in endometrial cancer cases classified by the grade of disease, and in comparison to frozen section analysis in grade 1 cases. In a prospective study, 91 patients with confirmed endometrial carcinoma underwent preoperative TVS for evaluation of myoinvasion. Sonographic results were categorized as superficial (less than or equal to 1/2 myometrial depth) and deep invasion (greater than 1/2 myometrial depth). TAH-BSO followed by retroperitoneal lymph node sampling were performed in all patients with grade 2-3 tumors. In patients with grade 1 disease, the surgical specimen was intraoperatively evaluated by frozen section, and lymph node sampling was carried out if deep invasion was determined. The preoperative sonographic findings and the frozen section results were compared to the final histopathology report of myoinvasion. In 77 of the 91 (84.6%) patients, the sonographic assessment of the depth of myoinvasion was in accord with the final histopathologic findings. TVS demonstrated a sensitivity of 87.8% and a specificity of 82.7% in detecting deep invasion in the entire study group (grade 1-3), with positive and negative predictive values (PPV, NPV) of 74.3% and 92.3%, respectively. TVS in grade 1 cases (n=47) showed a sensitivity of 77.7%, a specificity of 79%, PPV of 46.6% and NPV of 93.7%. TVS in cases with grade 2-3 tumors (n=44) showed a sensitivity of 90%, specificity of 91.6%, PPV of 90% and NPV of 91.6%. Thus, the accuracy of TVS in grade 2-3 cases was superior to that achieved in grade 1 cases (91% vs 78.7%; p=.002). The myometrial invasion was assessed by frozen section in 41 out of 47 patients with grade 1 disease and demonstrated a sensitivity of 85.7%, a specificity of 100%, PPV of 100% and NPV of 97.1%. The specificity (100%) and accuracy (97.5%) of the frozen section were found to be superior compared to that of the TVS (79

  5. 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...

  6. 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...

  7. 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 Foods...

  8. 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 Foods...

  9. 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 §...

  10. 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 §...

  11. 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 §...

  12. 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 §...

  13. 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 §...

  14. 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...

  15. 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...

  16. 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...

  17. 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 frozen...

  18. 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...

  19. 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...

  20. 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...

  1. 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...

  2. 21 CFR 135.110 - Ice cream and frozen custard.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 2 2011-04-01 2011-04-01 false Ice cream and frozen custard. 135.110 Section 135.110 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION FROZEN DESSERTS Requirements for Specific Standardized Frozen Desserts § 135...

  3. 21 CFR 135.110 - Ice cream and frozen custard.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 2 2012-04-01 2012-04-01 false Ice cream and frozen custard. 135.110 Section 135.110 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION FROZEN DESSERTS Requirements for Specific Standardized Frozen Desserts § 135...

  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 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION FROZEN DESSERTS Requirements for Specific Standardized Frozen Desserts § 135...

  5. 21 CFR 135.110 - Ice cream and frozen custard.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 2 2013-04-01 2013-04-01 false Ice cream and frozen custard. 135.110 Section 135.110 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION FROZEN DESSERTS Requirements for Specific Standardized Frozen Desserts § 135...

  6. 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.

  7. 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.

  8. 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

  9. 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

  10. Superstitions among perioperative nurses.

    PubMed

    Mandell, David L; Claypool, Margie L; Kay, David J

    2005-05-01

    A descriptive study was conducted using a mailed questionnaire to determine the prevalence of work-related superstitions among perioperative nurses. Data analysis included the two-sample t test for continuous data and the two-sided Fisher's exact test for binary data. Study results indicate that although only 23% of respondents view themselves as "generally superstitious," specific work-related superstitions are widespread. Belief in specific superstitions was not statistically related to age or number of years as a perioperative nurse. An analysis of the literature on medical workplace superstitions helps to elucidate possible underlying explanations for the phenomenon of nursing superstitions.

  11. Perioperative post graduate education.

    PubMed

    Kapnoullas, J

    1997-04-01

    This article describes post-graduate perioperative education in Australia at the Australian Catholic University and St. Vincent's Public Hospital: The Graduate Certificate in Perioperative Practice. The Australian Catholic University operates from eight campuses along the east coast of Australia. There are approximately 9000 students along with 1000 staff. The University consists of major faculties that all have clear relevance to the workplace-namely Arts and Sciences, Education and Health Sciences. Qualifications are offered at Certificate of Doctoral level studies in the areas of business, education, ethics, human movement, management, information systems, music, nursing, religion, social work and theology.

  12. 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

  13. Personality in frozen shoulder

    PubMed Central

    Fleming, A.; Dodman, Sally; Beer, T. C.; Crown, S.

    1976-01-01

    Fleming, A., Dodman, S., Beer, T. C., and Crown, S. (1976).Annals of the Rheumatic Diseases, 35, 456-457. Personality in frozen shoulder. Fifty-six patients with frozen shoulder have had their personality profiles investigated by means of the Middlesex Hospital Questionnaire. Females showed significantly increased somatic anxiety compared with controls. It is suggested that this may be important both to aetiology and treatment. Males and females should be assessed separately in future studies of frozen shoulder. PMID:1234412

  14. Updates in perioperative medicine.

    PubMed

    Dutta, Suparna; Cohn, Steven L; Pfeifer, Kurt J; Slawski, Barbara A; Smetana, Gerald W; Jaffer, Amir K

    2016-03-01

    As our surgical population becomes older and more medically complex, knowledge of the most recent perioperative literature is necessary to optimize perioperative care. We aim to summarize and critique literature published over the past year with the highest potential to impact the clinical practice of perioperative medicine. We reviewed articles published between January 2014 and April 2015, identified via MEDLINE search. The final 10 articles selected were determined by consensus among all authors, with criteria for inclusion including scientific rigor and relevance to perioperative medicine practice. Key findings include: long term β-blockade should be continued prior to surgery, routine screening with postoperative troponin is not recommended, initiation/continuation of aspirin or clonidine in the perioperative period is not beneficial and may increase adverse outcomes, preoperative diagnosis and treatment of obstructive sleep apnea may reduce risk of postoperative cardiovascular complications, new pulmonary risk indices are available that accurately estimate postoperative pulmonary complications, postoperative atrial fibrillation is associated with increased long-term stroke risk, risk scores such as the CHADS2 (Congestive heart failure, Hypertension, Age ≥75 years, Diabetes Mellitus, previous stroke or transient ischemic attack) are superior to the Revised Cardiac Risk Index in predicting adverse postoperative outcomes for patients with nonvalvular atrial fibrillation, and utilization of bridging anticoagulation comes with a much higher risk of bleeding compared to patients who are not bridged. The body of literature reviewed provides important information for clinicians caring for surgical patients across multiple fronts, including preoperative risk assessment, medication management, and postoperative medical care. © 2015 Society of Hospital Medicine.

  15. 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...

  16. 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...

  17. 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...

  18. 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...

  19. Intraoperative Frozen Section of the Prostate Reduces the Risk of Positive Margin Whilst Ensuring Nerve Sparing in Patients with Intermediate and High-Risk Prostate Cancer Undergoing Robotic Radical Prostatectomy: First Reported UK Series.

    PubMed

    Vasdev, Nikhil; Agarwal, Samita; Rai, Bhavan P; Soosainathan, Arany; Shaw, Gregory; Chang, Sebastian; Prasad, Venkat; Mohan-S, Gowrie; Adshead, James M

    2016-05-01

    Nerve sparing during robotic radical prostatectomy (RRP) considerably improves post-operative potency and urinary continence as long as it does not compromise oncological outcome. Excision of the neurovascular bundle (NVB) is often performed in patients with intermediate and high risk prostate cancer to reduce the risk of positive surgical margin raising the risk of urinary incontinence and impotence. We present the first UK series outcomes of such patients who underwent an intra-operative frozen section (IOFS) analysis of the prostate during RRP allowing nerve sparing. We prospectively analysed the data of 40 patients who underwent an IOFS during RRP at our centre from November 2012 until November 2014. Our IOFS technique involved whole lateral circumferential analysis of the prostate during RRP with the corresponding neurovascular tissue. An intrafascial nerve spare was performed and the specimen was removed intra-operatively via an extension of the 12 mm Autosuture™ camera port without undocking robotic arms. It was then painted by the surgeon and sprayed with "Ink Aid" prior to frozen section analysis. The corresponding NVB was excised if the histopathologist found a positive surgical margin on frozen section. Median time to extract the specimen, wound closure and re-establishment of pneumoperitoneum increased the operative time by 8 min. Median blood loss for IOFS was 130 ± 97 ml vs. 90 ± 72 ml (p = NS). IOFS was not associated with major complications or with blood transfusion. PSM decreased significantly from non-IOFS RRP series of 28.7 to 7.8% (p < 0.05). Intra-operative PSM on the prostate specimen was seen in 8/40 margin analysis (20%) leading to an excision of the contra-lateral nerve bundle. On analysis of the nerve bundle on a paraffin embedded block, 6 nerve bundle matched tumor on the specimen whereas 2 NVB were retrospectively removed unnecessarily in our series. All 40 patients have undetectable PSA at a mean follow up of 21.2 months (SD 7

  20. 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

  1. 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.

  2. 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...

  3. Perioperative registered nurses knowledge, attitudes, behaviors, and barriers regarding pressure ulcer prevention in perioperative patients.

    PubMed

    Tallier, Peggy C; Reineke, Patricia R; Asadoorian, Kathy; Choonoo, John G; Campo, Marc; Malmgreen-Wallen, Christine

    2017-08-01

    Hospital acquired pressure ulcers have a detrimental effect on patient quality of life, morbidity, mortality, and cost to the healthcare industry. Little is known about pressure ulcer prevention in perioperative services. The objectives of this study were to describe perioperative registered nurses (RNs) knowledge, attitudes, behaviors, and barriers about pressure ulcer prevention and to determine if knowledge and the availability of a pressure ulcer staging tool are predictors of pressure ulcer prevention behavior. A cross-sectional descriptive pilot study was conducted. Sixty-two perioperative RNs from 10 acute care hospitals participated. Perioperative nurses believed carrying out pressure ulcer prevention strategies is essential to nursing practice but only two-thirds reported conducting pressure ulcer risk assessment on all patients and daily assessment on at risk patients. Results indicated a knowledge deficit regarding assessment and prevention of pressure ulcers as performance on the PUKT (72%) fell below the recommended score of 90%. Results of binary logistic regression indicated that knowledge as measured by the PUKT and availability of a pressure ulcer staging tool were statistically significant (p=0.03) predictors of pressure ulcer prevention behavior. The initial model without the predictor variables, indicated an overall success rate of correct predictions of 64% which increase to 73% when the predictor variables were added to the initial model. Although perioperative nurses believe that pressure ulcer prevention is important, a knowledge deficit exists and there is a need for pressure ulcer prevention education. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Management of perioperative arrhythmias.

    PubMed

    Feeley, T W

    1997-04-01

    Electrocardiography was the first application of electronic monitoring to anesthesia care. The detection of arrhythmias remains the most important use of this technology today. Several predisposing factors tend to emerge when perioperative arrhythmias are evaluated. These are the anesthetic given, the site of surgery, abnormalities of blood gases or electrolytes, tracheal intubation, reflexes such as vagal slowing and the oculocardiac reflex, stimulation of the central nervous system, the presence of preexisting heart disease, and the use of intracardiac devices. In the evaluation of cardiac arrhythmias, several facts need to be determined. The most important is to determine if there is an underlying complication of anesthesia and surgery that may explain the arrhythmia. In addition, it is vital to evaluate the heart rate, the regularity, the number of P waves per QRS, and the configuration of the QRS. The anesthesiologist needs to determine whether the rhythm is dangerous to the patient and whether it requires treatment. Prompt evaluation and management of perioperative arrhythmias reduce anesthetic morbidity and mortality. This article reviews the causes and pharmacological treatment of major abnormalities of atrial and ventricular cardiac arrhythmias occurring in the perioperative period.

  5. 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

  6. [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.

  7. Perioperative Management of Neurological Conditions

    PubMed Central

    Dhallu, Manjeet Singh; Baiomi, Ahmed; Biyyam, Madhavi; Chilimuri, Sridhar

    2017-01-01

    Perioperative care of the patients with neurological diseases can be challenging. Most important consideration is the management and understanding of pathophysiology of these disorders and evaluation of new neurological changes that occur perioperatively. Perioperative generally refers to 3 phases of surgery: preoperative, intraoperative, and postoperative. We have tried to address few commonly encountered neurological conditions in clinical practice, such as delirium, stroke, epilepsy, myasthenia gravis, and Parkinson disease. In this article, we emphasize on early diagnosis and management strategies of neurological disorders in the perioperative period to minimize morbidity and mortality of patients. PMID:28638240

  8. Perioperative pain management.

    PubMed

    Pyati, Srinivas; Gan, Tong J

    2007-01-01

    The under-treatment of postoperative pain has been recognised to delay patient recovery and discharge from hospital. Despite recognition of the importance of effective pain control, up to 70% of patients still complain of moderate to severe pain postoperatively. The mechanistic approach to pain management, based on current understanding of the peripheral and central mechanisms involved in nociceptive transmission, provides newer options for clinicians to manage pain effectively. In this article we review the rationale for a multimodal approach with combinations of analgesics from different classes and different sites of analgesic administration. The pharmacological options of commonly used analgesics, such as opioids, NSAIDs, paracetamol, tramadol and other non-opioid analgesics, and their combinations is discussed. These analgesics have been shown to provide effective pain relief and their combinations demonstrate a reduction in opioid consumption. The basis for using non-opioid analgesic adjuvants is to reduce opioid consumption and consequently alleviate opioid-related adverse effects. We review the evidence on the opioid-sparing effect of ketamine, clonidine, gabapentin and other novel analgesics in perioperative pain management. Most available data support the addition of these adjuvants to routine analgesic techniques to reduce the need for opioids and improve quality of analgesia by their synergistic effect. Local anaesthetic infiltration, epidural and other regional techniques are also used successfully to enhance perioperative analgesia after a variety of surgical procedures. The use of continuous perineural techniques that offer prolonged analgesia with local anaesthetic infusion has been extended to the care of patients beyond hospital discharge. The use of nonpharmacological options such as acupuncture, relaxation, music therapy, hypnosis and transcutaneous nerve stimulation as adjuvants to conventional analgesia should be considered and incorporated to

  9. 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

  10. 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

  11. 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.

  12. Update in perioperative cardiac medicine.

    PubMed

    Cohn, Steven L; Dutta, Suparna; Slawski, Barbara A; Grant, Paul J; Smetana, Gerald W

    2016-10-01

    Recent studies have shed light on preoperative risk assessment, medical therapy to reduce postoperative cardiac complications (beta-blockers, statins, and angiotensin II receptor blockers [ARBs]), perioperative management of patients with coronary stents on antiplatelet therapy, and perioperative bridging anticoagulation. Copyright © 2016 Cleveland Clinic.

  13. 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.

  14. 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.

  15. 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.

  16. Pharmacogenetics in perioperative medicine.

    PubMed

    Cohen, Mindy; Sadhasivam, Senthilkumar; Vinks, Alexander A

    2012-08-01

    This review will discuss the most recent developments in pharmacogenetics of commonly used perioperative medications, new collaboration networks in the field of personalized medicine, and future clinical implications of pharmacogenetics. Evidence now suggests that pharmacogenetics has a role in the effects of analgesic, sedative, beta-blocker, local anesthetic, antiemetic, and obstetric medications. Variants in the μ opioid receptor gene change the analgesic effects of morphine. Additional opioids recently studied include remifentanil, methadone, tramadol, and codeine. Ibuprofen's clearance varies with CYP2C9*3 genotype. Midazolam is primarily metabolized by the CYP3A4/CYP3A5 enzymes. Enzyme induction was found to be about 50% greater with CYP3A5*3 homozygous genotype. Variations in minimum alveolar concentrations of volatile anesthetics and subcutaneous lidocaine efficacy have been attributed in part to melanocortin-1 receptor variants. Metoprolol achieved different effects in patients with CYP2D6 and beta1-receptor polymorphisms. Genetic background of the beta2-receptor contributes to susceptibility for experiencing preterm labor. The Pharmacogenomics Research Network and the Clinical Pharmacogenetics Implementation Consortium are partnerships of researchers who are dedicated to elucidating how the genome contributes to an individual patient's medication responses. In the near future, pharmacogenetic approaches may facilitate personalized perioperative intervention trials.

  17. 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...

  18. 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...

  19. 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.

  20. Canadian guidelines for training in adult perioperative transesophageal echocardiography

    PubMed Central

    Béïque, François; Ali, Mohamed; Hynes, Mark; MacKenzie, Scott; Denault, André; Martineau, André; MacAdams, Charles; Sawchuk, Corey; Hirsch, Kristine; Lampa, Martin; Murphy, Patricia; Honos, Georges; Munt, Bradley; Sanfilippo, Anthony; Duke, Peter

    2006-01-01

    PURPOSE To establish Canadian guidelines for training in adult perioperative transesophageal echocardiography (TEE). METHODS Guidelines were established by the Canadian Perioperative Echocardiography Group with the support of the cardiovascular section of the Canadian Anesthesiologists’ Society in conjunction with the Canadian Society of Echocardiography. Guidelines for training in echocardiography by the American Society of Echocardiography, the American College of Cardiology and the Society of Cardiovascular Anesthesiologists were reviewed, modified and expanded to produce the 2003 Quebec expert consensus for training in perioperative echocardiography. The Quebec expert consensus and the 2005 guidelines for the provision of echocardiography in Canada formed the basis of the Canadian training guidelines in adult perioperative TEE. RESULTS Basic, advanced and director levels of expertise were identified. The total number of echocardiographic examinations to achieve each level of expertise remains unchanged from the 2002 American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists guidelines. The increased proportion of examinations personally performed at basic and advanced levels, as well as the level of autonomy at the basic level suggested by the Quebec expert consensus are retained. These examinations may be performed in a perioperative setting and are not limited to intraoperative TEE. Training ‘on-the-job’, the role of the perioperative TEE examination, the requirements for maintenance of competence and the duration of training are also discussed for each level of training. The components of a TEE report and comprehensive TEE examination are also outlined. CONCLUSION The Canadian guidelines for training in adult perioperative TEE reflect the unique Canadian practice profile in perioperative TEE and address the training requirements to obtain expertise in this field. PMID:17036096

  1. 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.

  2. 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.…

  3. 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

  4. 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).

  5. 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. Copyright © 2016 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  6. 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 ...

  7. 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...

  8. 77 FR 20358 - Certain Frozen Warmwater Shrimp From the Socialist Republic of Vietnam: Final Results of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-04

    ... International Trade Administration Certain Frozen Warmwater Shrimp From the Socialist Republic of Vietnam: Final... order on certain frozen warmwater shrimp (``shrimp'') from the Socialist Republic of Vietnam (``Vietnam..., is listed in the ``Final Results of Review'' section below. \\1\\ See Certain Frozen Warmwater Shrimp...

  9. 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 discharges...

  10. 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 discharges...

  11. 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 discharges...

  12. 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 discharges...

  13. 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.

  14. 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.

  15. 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...

  16. Survival of Microflora in Precooked, Frozen Meals During Frozen Storage,

    DTIC Science & Technology

    FOOD PRESERVATION, *FROZEN FOODS , EXPERIMENTAL DATA, BACTERIA, TEST METHODS, FREEZING, MEALS, MILITARY RESEARCH, TABLES(DATA), YEASTS, STORAGE, FOOD , CULTURES(BIOLOGY), FECES, MICROBIOLOGY, STREPTOCOCCUS, MOLDS(ORGANISMS).

  17. 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).

  18. Perioperative Management of Thyroid Dysfunction

    PubMed Central

    Palace, Marcia Rashelle

    2017-01-01

    Due to the manifold effects of thyroid hormone across virtually all organ systems, the complications associated with thyroid dysfunction are numerous and diverse. The stresses encountered during the perioperative period may exacerbate underlying thyroid disorders, potentially precipitating decompensation and even death. Thus, it is of the utmost importance for the clinician to comprehend the mechanisms by which thyroid disease may complicate surgery and postoperative recovery and to be cognizant of the most effective means of optimizing the status of thyrotoxic and hypothyroid patients perioperatively. This article describes the adverse effects of thyroid dysfunction as they relate to the patient undergoing both thyroid and nonthyroid surgery and recommends treatment approaches aimed at decreasing perioperative risk. PMID:28469454

  19. [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. Copyright © 2010 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.

  20. 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. © The Author 2015. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  1. Clinical forensics for perioperative nurses.

    PubMed

    Muro, G A; Easter, C R

    1994-10-01

    Perioperative nurses frequently care for victims and suspected perpetrators of violent crimes. Nurses often are the first health care providers to assess the trauma patient and collect crucial evidence for future legal action. Informational evidence includes observations about patients' behavior and appearance and documentation of their comments. Nurses also must protect the chain of evidence so that evidence can be admissible in court. To function in this role, perioperative nurses must understand the concepts of clinical forensics, which is the application of the principles and practices of forensic science to questions of law in the investigation of violent crime.

  2. 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

  3. 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

  4. Perioperative Considerations of Herbal Medications.

    PubMed

    Chadha, Ryan M; Egan, Brian J

    2017-09-13

    A considerable portion of the US population uses herbal supplements on a daily basis for their various proposed beneficial effects. However, the over-the-counter nature of these medications and lack of knowledge of adverse effect profiles can have unexpected serious impact on the perioperative course. The growing list of supplements presents a pharmacologic conundrum to the anesthesiologist. To compile a comprehensive list of vitamins, herbals, and supplements used commonly by patients, describe the risks associated with them, and identify recommendations for perioperative management. The current literature on PubMed and Medline was reviewed for the years 2000 through 2016. The reference lists of each selected article were also reviewed for additional sources of information. The review identified 23 herbals and supplements that are commonly used and their perioperative considerations. The management of herbals and supplements is an issue for the anesthesiologist. Although it would be prudent to stop use of most substances a week or more preoperatively, the perioperative physician must be wary of the potential for withdrawal. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  5. Frozen waves: experimental generation.

    PubMed

    Vieira, Tarcio A; Gesualdi, Marcos R R; Zamboni-Rached, Michel

    2012-06-01

    Frozen waves (FWs) are very interesting particular cases of nondiffracting beams whose envelopes are static and whose longitudinal intensity patterns can be chosen a priori. We present here for the first time (that we know of) the experimental generation of FWs. The experimental realization of these FWs was obtained using a holographic setup for the optical reconstruction of computer generated holograms (CGH), based on a 4-f Fourier filtering system and a nematic liquid crystal spatial light modulator (LC-SLM), where FW CGHs were first computationally implemented, and later electronically implemented, on the LC-SLM for optical reconstruction. The experimental results are in agreement with the corresponding theoretical analytical solutions and hold excellent prospects for implementation in scientific and technological applications.

  6. 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.

  7. Perioperative Nurse Leaders and Professionalism.

    PubMed

    Whiteside, Dawn

    2016-08-01

    Professionalism in nursing leadership encompasses key elements that include a common body of knowledge, autonomous practice, self-regulation through education and licensure, a set code of ethics, and a commitment to altruism. Perioperative nurse leaders also must embrace collaboration, vision, accountability, and patient and staff member advocacy based on established ethics, values, and standards of care. Nurse leaders who are committed to professional development through pursuit of higher degrees, application of evidence-based practice, collaboration with colleagues, and certification show a strong commitment to their profession and serve as role models for staff members. This article discusses professionalism in nursing and offers information specific to perioperative nurse leaders. Copyright © 2016 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  8. 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...

  9. 40 CFR 405.70 - Applicability; description of the fluid mix for ice cream and other frozen desserts subcategory.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... fluid 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 provisions...

  10. 40 CFR 405.70 - Applicability; description of the fluid mix for ice cream and other frozen desserts subcategory.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 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 provisions...

  11. 40 CFR 405.70 - Applicability; description of the fluid mix for ice cream and other frozen desserts subcategory.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 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 provisions...

  12. 40 CFR 405.70 - Applicability; description of the fluid mix for ice cream and other frozen desserts subcategory.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 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 provisions...

  13. 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.

  14. The equine frozen semen industry.

    PubMed

    Loomis, P R

    2001-12-03

    Recent acceptance of frozen semen as a method to produce registered foals by two of the worlds largest breed associations, the American Quarter Horse and American Paint Horse, has stimulated new interest in frozen semen technology. This review will: (a) attempt to identify the major impediments to the development of the frozen semen industry, (b) suggest alternative methods for marketing and application of frozen semen, and (c) present the results of a recent study in our laboratory. The objective of which was to compare pregnancy rates of insemination with cooled and frozen semen. Major impediments to the development of the frozen semen industry include 1. Lower fertility with frozen semen as compared to cooled semen for many stallions. 2. Increased costs associated with management of mares for AI with frozen semen using current insemination protocols. 3. Unfavorable marketing practices for frozen semen. Reports of fertility with cooled transported semen in commercial breeding programs indicate seasonal pregnancy rates ranging from 60 to 90%. We compiled data from three commercial transported cooled semen programs in which semen from 16 stallions was used for insemination of 850 mares throughout North America by local veterinarians. During the 1999 and 2000 breeding seasons, first cycle and seasonal pregnancy rates of 59.4 and 74.7% were obtained. During that same period, first cycle and seasonal pregnancy rates of 51.3 and 75.6% were obtained following insemination of 876 mares with frozen semen from 106 different stallions processed by our laboratory and distributed through our commercial distribution program. First cycle and seasonal pregnancy rates were higher for mares bred outside of North America than for mares bred within North America (53.5 and 81.9 versus 49.4 and 65.6%, respectively). Seasonal pregnancy rates were higher presumably because of the better mare management employed for mares bred with exported semen and the fact that some of the domestic

  15. Children's desire for perioperative information.

    PubMed

    Fortier, Michelle A; Chorney, Jill MacLaren; Rony, Rachel Yaffa Zisk; Perret-Karimi, Danielle; Rinehart, Joseph B; Camilon, Felizardo S; Kain, Zeev N

    2009-10-01

    The purpose of this investigation was to identify what perioperative information children want to receive from the medical staff. As a first step, we developed an instrument based on a qualitative study conducted with children in Great Britain, input from a focus group, and input from school children. On the day of surgery, 143 children aged 7-17 yr completed a 40-item assessment of desired surgical information and a measure of anxiety (State-Trait Anxiety Inventory for Children). Parents completed a measure assessing their child's temperament (Emotionality, Activity, Sociability, and Impulsivity Survey) and a measure of their own anxiety (State-Trait Anxiety Inventory). Results indicated that the vast majority of children had a desire for comprehensive information about their surgery, including information about pain and anesthesia, and procedural information and information about potential complications. The most highly endorsed items by children involved information about pain. Children who were more anxious endorsed a stronger desire for pain information and lesser tendency to avoid information. Younger children wanted to know what the perioperative environment would look like more than adolescent children. We conclude that the majority of children aged 7-17 yr who undergo surgery want to be given comprehensive perioperative information and health care providers should ensure adequate information regarding postoperative pain is provided.

  16. Morbid obesity and perioperative complications.

    PubMed

    Tsai, Andrea; Schumann, Roman

    2016-02-01

    Approximately 30% of the general surgical population presents with obesity, and the perioperative implications remain concerning. This review provides recent insights regarding morbid obesity and perioperative complications. Cardiovascular risk including cardiac arrest and myocardial infarction varies by type of surgery and is not always correlated with BMI. Functional status rather than associated comorbidities is an important component for risk assessment of obese patients undergoing noncardiac surgery. Just as for cardiac complications, pulmonary outcomes are influenced by the concurrence of obesity and the metabolic syndrome and/or sleep apnea rather than by BMI alone. New evidence suggests that continuous positive airway pressure treatment before surgery may reduce postoperative complications. Clinical Practice Guidelines for thromboembolic prophylaxis in bariatric patients are available. A comprehensive understanding of the obesity survival paradox has remained elusive. Postoperative surgical infections remain a leading problem related to obesity. Further research and evidence are needed for the development of accepted perioperative pathways to address obesity and related comorbidities including sleep disordered breathing and metabolic syndrome as well as evidence-based strategies to reduce surgical infections. Rather than BMI alone, an improved index for obesity risk assessment is needed.

  17. 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.

  18. [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.

  19. Effects of Perioperative Fluid Replacement Therapy in Lung Transplant Patients.

    PubMed

    Björkbom, Emil; Hämmäinen, Pekka; Schramko, Alexey

    2017-02-01

    Approximately 10 to 25 lung transplant procedures are performed annually in Finland, and 1-year survival has been 95% over the last 10 years. Our aim was to find associations between perioperative fluid replacement therapies and postoperative patient outcomes, with special emphasis on the use of colloids and blood products. We retrospectively evaluated data from 100 patients who underwent lung transplant with cardiopulmonary bypass support in Finland from 2007 to 2013. Outcomes of interest were length of intensive care unit and hospital stays, time in ventilator, use of extracorporeal membrane oxygenation postoperatively, postoperative renal replacement therapy, postoperative graft failure, and 1-year mortality. Of 100 patients, 12 were on extracorporeal membrane oxygenation preoperatively. The 1-year mortality was 5/100 (5%), and the 3-year mortality was 7/100 (7%). Intraoperative fluid balance was positive (4762 a 3018 mL) but fell significantly postoperatively (below +1000 mL on postoperative day 1). During postoperative days 2 to 7, net fluid balance continued decreasing and stayed negative. Intraoperative use of hydroxyethyl starch and fresh frozen plasma were significantly higher in patients who died during follow-up versus those who survived (P < .05). Intraoperative use of fresh frozen plasma, but not red blood cells or platelets, correlated with graft failure (P = .012). Postoperative use of colloids or blood products did not correlate with mortality or graft failure. Patients who were on extracorporeal membrane oxygenation preoperatively stayed longer on ventilators and had longer intensive care unit and hospital stays (P < .001). Eight patients needed postoperative renal replacement therapy. Intraoperative use of fresh frozen plasma and hydroxyethyl starch is associated with increased mortality and graft failure. Postoperative use of colloids and red blood cells did not correlate with patient outcome. Use of extracorporeal membrane oxygenation

  20. Imaging radar observations of frozen Arctic lakes

    NASA Technical Reports Server (NTRS)

    Elachi, C.; Bryan, M. L.; Weeks, W. F.

    1976-01-01

    A synthetic aperture imaging L-band radar flown aboard the NASA CV-990 remotely sensed a number of ice-covered lakes about 48 km northwest of Bethel, Alaska. The image obtained is a high resolution, two-dimensional representation of the surface backscatter cross section, and large differences in backscatter returns are observed: homogeneous low returns, homogeneous high returns and/or low returns near lake borders, and high returns from central areas. It is suggested that a low return indicates that the lake is frozen completely to the bottom, while a high return indicates the presence of fresh water between the ice cover and the lake bed.

  1. Obesity Decreases Perioperative Tissue Oxygenation

    PubMed Central

    Kabon, Barbara; Nagele, Angelika; Reddy, Dayakar; Eagon, Chris; Fleshman, James W.; Sessler, Daniel I.; Kurz, Andrea

    2005-01-01

    Background: Obesity is an important risk factor for surgical site infections. The incidence of surgical wound infections is directly related to tissue perfusion and oxygenation. Fat tissue mass expands without a concomitant increase in blood flow per cell, which might result in a relative hypoperfusion with decreased tissue oxygenation. Consequently, we tested the hypotheses that perioperative tissue oxygen tension is reduced in obese surgical patients. Furthermore, we compared the effect of supplemental oxygen administration on tissue oxygenation in obese and non-obese patients. Methods: Forty-six patients undergoing major abdominal surgery were assigned to one of two groups according to their body mass index (BMI): BMI < 30 kg/m2 (non-obese) and BMI ≥ 30 kg/m2 (obese). Intraoperative oxygen administration was adjusted to arterial oxygen tensions of ≈150 mmHg and ≈300 mmHg in random order. Anesthesia technique and perioperative fluid management were standardized. Subcutaneous tissue oxygen tension was measured with a polarographic electrode positioned within a subcutaneous tonometer in the lateral upper arm during surgery, in the recovery room, and on the first postoperative day. Postoperative tissue oxygen was also measured adjacent to the wound. Data were compared with unpaired two tailed t-tests and Wilcoxon rank-sum tests; P < 0.05 was considered statistically significant. Results: Intraoperative subcutaneous tissue oxygen tension was significantly less in the obese patients at baseline (36 vs. 57 mmHg, P = 0.002) and with supplemental oxygen administration (47 vs. 76 mmHg, P = 0.014). Immediate postoperative tissue oxygen tension was also significantly less in subcutaneous tissue of the upper arm (43 vs. 54 mmHg, P = 0.011) as well as near the incision (42 vs. 62 mmHg, P = 0.012) in obese patients. In contrast, tissue oxygen tension was comparable in each group on the first postoperative morning. Conclusion: Wound and tissue hypoxia were common in obese

  2. 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

  3. Dry Zones Around Frozen Droplets

    NASA Astrophysics Data System (ADS)

    Bisbano, Caitlin; Nath, Saurabh; Boreyko, Jonathan; Nature-Inspired Fluids; Interfaces Team

    2015-11-01

    The saturation pressure of water vapor above supercooled water exceeds that above ice at the same temperature. A frozen droplet will therefore grow by harvesting water vapor from neighboring supercooled condensate, which has recently been demonstrated to be a primary mechanism of in-plane frost growth on hydrophobic surfaces. The underlying physics of this source-sink interaction is still poorly understood. In this work, a deposited water droplet is frozen on a dry hydrophobic surface initially held above the dew point. We demonstrate that when the surface is then cooled beneath the dew point, the frozen droplet harvests nearby water vapor in the air. This results in an annular dry zone that forms between the frozen droplet and the forming supercooled condensation. For a given ambient temperature and humidity, the length of the dry zone varied strongly with surface temperature and weakly with droplet volume. The dependence of the dry zone on surface temperature is due to the fact that the vapor pressure gradients between the ambient and the surface and between the liquid and frozen water are both functions of temperature.

  4. 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).

  5. 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.

  6. Coagulation testing in the perioperative period

    PubMed Central

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

    2014-01-01

    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. PMID:25535418

  7. 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

  8. 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.

  9. 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

  10. 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

  11. 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.

  12. 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

  13. 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...

  14. 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...

  15. 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...

  16. 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...

  17. 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...

  18. 75 FR 44229 - Certain Frozen Warmwater Shrimp from India: Preliminary Results of Antidumping Duty Changed...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-28

    ... International Trade Administration (A-533-840) Certain Frozen Warmwater Shrimp from India: Preliminary Results... warmwater shrimp (shrimp) from India pursuant to section 751(b) of the Tariff Act of 1930, as amended (the... Frozen Warmwater Shrimp From India: Initiation of Antidumping Duty Changed Circumstances Review, 75 FR...

  19. 7 CFR 52.812 - Score sheet for frozen red tart pitted cherries.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 2 2010-01-01 2010-01-01 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 of...

  20. 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 of...

  1. 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 of...

  2. Pulse Transmission through Frozen Silt,

    DTIC Science & Technology

    1984-07-01

    THROUGH FROZEN SILT 6. PERFORMING ORG. REPORT NUMBER 7. AUTHOR(s) 8. CONTRACT OR GRANT NUMBER(e) Steven A. Arcone 9. PERFORMING ORGANIZATION NAME AND...SECURITY CLASSIFICATION OF THIS PAGE (When Dots Entered) PREFACE This report was prepared by Dr. Steven A. Arcone , Research Geophysicist, Snow and Ice...GRA&I A w ,.,.TAB L u :,nnr-ane’ed n --." ~~~i f teation--- - ! i . Avaii and/orC in I+ PULSE TRANSMISSION THROUGH FROZEN SILT Steven A. Arcone

  3. 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 Section 864.9145 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES HEMATOLOGY AND PATHOLOGY DEVICES Products Used In Establishments That...

  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, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Frozen concentrate for colored lemonade. 146.126 Section 146.126 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION CANNED FRUIT JUICES Requirements for Specific Standardized Canned...

  6. 21 CFR 146.120 - Frozen concentrate for lemonade.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 2 2012-04-01 2012-04-01 false Frozen concentrate for lemonade. 146.120 Section 146.120 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION CANNED FRUIT JUICES Requirements for Specific Standardized Canned...

  7. 21 CFR 146.120 - Frozen concentrate for 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 lemonade. 146.120 Section 146.120 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION CANNED FRUIT JUICES Requirements for Specific Standardized Canned...

  8. 21 CFR 146.120 - Frozen concentrate for lemonade.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Frozen concentrate for lemonade. 146.120 Section 146.120 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION CANNED FRUIT JUICES Requirements for Specific Standardized Canned...

  9. 21 CFR 146.120 - Frozen concentrate for lemonade.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 2 2011-04-01 2011-04-01 false Frozen concentrate for lemonade. 146.120 Section 146.120 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION CANNED FRUIT JUICES Requirements for Specific Standardized Canned...

  10. A survey evaluating surgeons' peri-operative usage of acetyl-salicylic acid (ASA) and their willingness to enroll their patients in a perioperative ASA randomized controlled trial.

    PubMed

    Hiralal, Rajesh; Guyatt, Gordon; Bhandari, Mohit; Cook, Deborah; Berwanger, Otavio; De Beer, Justin; Cina, Claudio; Buckley, Norm; Villar, Juan Carlos; Montori, Victor; Marcaccio, Michael; Paul, James; Whiteacre, Laura; Devereaux, P J

    2010-12-01

    Major cardiovascular complications associated with noncardiac surgery represent a substantial population health problem for which there are no established efficacious and safe prophylactic interventions. Acetyl-salicylic acid (ASA) represents a promising intervention. The objective of this study was to determine surgeons' perioperative usage of ASA, and if they would enroll their patients in a perioperative ASA randomized controlled trial (RCT). Cross-sectional survey of all practicing Canadian general, orthopedic, and vascular surgeons. Our mailed, self-administered survey asked surgeons to consider only their patients who were at risk of a major perioperative cardiovascular complication. The response rate was 906/1854 (49%). For patients taking ASA chronically, there was marked variability regarding ASA continuation prior to surgery amongst the general and orthopedic surgeons, whereas 76% of vascular surgeons continued ASA in 81-100% of their patients. For patients not taking ASA chronically, approaches to starting ASA prior to surgery were variable amongst the vascular surgeons, whereas 70% of general and 82% of orthopaedic surgeons did not start ASA. For patients taking ASA chronically, 73% of general surgeons, 70% of orthopaedic surgeons, and 36% of vascular surgeons would allow at least 40% of their patients to participate in a perioperative RCT comparing stopping versus continuing ASA. For patients not taking ASA chronically, most general (76%), orthopaedic (67%), and vascular (51%) surgeons would allow at least 40% of their patients to participate in a perioperative RCT comparing starting ASA versus placebo. This national survey demonstrates that perioperative ASA usage as reported by surgeons is variable, identifying the need for, and community interest in, a large perioperative ASA trial.

  11. 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.

  12. Controversies in Pediatric Perioperative Airways.

    PubMed

    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.

  13. 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

  14. Atelectasis in the perioperative patient.

    PubMed

    Duggan, Michelle; Kavanagh, Brian P

    2007-02-01

    To report the impact of atelectasis on perioperative outcomes. Atelectasis occurs in the dependent parts of the lungs of most patients who are anesthetized. Development of atelectasis is associated with decreased lung compliance, impairment of oxygenation, increased pulmonary vascular resistance and development of lung injury. Here, we examine the etiology, contributing factors, consequences, diagnosis and treatment of atelectasis. Atelectasis describes the state of absent air in alveoli attributable to collapse, but recent findings suggest that alveoli are filled with foam and fluid. It is now known that atelectasis plays an important role beyond abnormal gas exchange and that prevention or reversal of atelectasis in some populations of postoperative patients may improve outcome. Atelectasis in the presence of preexisting lung disease or limited cardiopulmonary reserve may have significant consequences. Increasing understanding of the underlying nature of atelectasis and its contribution to acute lung injury will improve our approach to the prevention and management of atelectasis.

  15. [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.

  16. [Perioperative Management of PD Patients].

    PubMed

    Reichmann, H

    2016-07-01

    Both patients and caregivers but also treating physicians are concerned about complications along with surgical interventions. A major problem is abrupt cessation of anti-Parkinson medication, which leads to manifold disturbances, sometimes even to an akinetic crisis. There are several means to guarantee continuous dopaminergic stimulation even in patients that are not allowed to take medication orally before they undergo surgery. Amongst others rectally applied levodopa, amantadine infusions, and especially the use of a rotigotine patch are good means to overcome oral intake. Perioperative management is important due to the fact that in Germany alone each year more than 10 000 PD patients undergo surgery. Main reasons for this are fractures, but also elective interventions. Further emergency situations that cause treatment as an inpatient are psychosis, motoric disability, but also pneumonia and cardiovascular disturbances. In contrast PD patients suffer less often from cancer. © Georg Thieme Verlag KG Stuttgart · New York.

  17. Perioperative Management of Antithrombotic Therapy

    PubMed Central

    Douketis, James D.; Spyropoulos, Alex C.; Spencer, Frederick A.; Mayr, Michael; Jaffer, Amir K.; Eckman, Mark H.; Dunn, Andrew S.

    2012-01-01

    Background: This guideline addresses the management of patients who are receiving anticoagulant or antiplatelet therapy and require an elective surgery or procedure. Methods: The methods herein follow those discussed in the Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines. Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines article of this supplement. Results: In patients requiring vitamin K antagonist (VKA) interruption before surgery, we recommend stopping VKAs 5 days before surgery instead of a shorter time before surgery (Grade 1B). In patients with a mechanical heart valve, atrial fibrillation, or VTE at high risk for thromboembolism, we suggest bridging anticoagulation instead of no bridging during VKA interruption (Grade 2C); in patients at low risk, we suggest no bridging instead of bridging (Grade 2C). In patients who require a dental procedure, we suggest continuing VKAs with an oral prohemostatic agent or stopping VKAs 2 to 3 days before the procedure instead of alternative strategies (Grade 2C). In moderate- to high-risk patients who are receiving acetylsalicylic acid (ASA) and require noncardiac surgery, we suggest continuing ASA around the time of surgery instead of stopping ASA 7 to 10 days before surgery (Grade 2C). In patients with a coronary stent who require surgery, we recommend deferring surgery > 6 weeks after bare-metal stent placement and > 6 months after drug-eluting stent placement instead of undertaking surgery within these time periods (Grade 1C); in patients requiring surgery within 6 weeks of bare-metal stent placement or within 6 months of drug-eluting stent placement, we suggest continuing antiplatelet therapy perioperatively instead of stopping therapy 7 to 10 days before surgery (Grade 2C). Conclusions: Perioperative antithrombotic management is based on risk assessment for thromboembolism and

  18. Spinal Anaesthesia and Perioperative Anxiety

    PubMed Central

    Mıngır, Tarkan; Ervatan, Zekeriya; Turgut, Namigar

    2014-01-01

    Objective Anxiety is a pathological condition with a feeling of fear accompanied by somatic symptoms due to hyperactivity of the autonomic nervous system. In this study, we aimed to compare perioperative anxiety status and the effects of age, gender, educational status, and The American Society of Anesthesiologists physical status classification (ASA) score on perioperative anxiety in patients undergoing elective surgery under spinal anaesthesia. Methods After IRB approval and signed informed consent, 100 healthy patients undergoing elective surgery under spinal anaesthesia were enrolled. The demographic data of patients and ASA scores were recorded. After spinal anaesthesia, State Trait Anxiety Inventory (STAI) and anxiety levels were measured. Results The mean anxiety score in patients undergoing surgery under spinal anaesthesia indicate the presence of an intermediate level of anxiety (44.58±19.06). A statistically significant positive correlation was found between anxiety scores and age of patients with increased age (p<0.01). Statistically significant differences were found between anxiety scores of patients according to gender, and women’s anxiety scores were found to be significantly higher than in men (p<0.05). Anxiety scores did not differ significantly between education levels. A statistically significant difference was found between anxiety scores regarding ASA scores (p<0.05). Evaluation of patients revealed that the anxiety score of patients with ASA score 1 was significantly higher than the anxiety score of patients with ASA score 2. There was no significant difference between anxiety score of patients with ASA scores 2 and 3. Conclusion There is a mid-level anxiety, associated more with advanced age, female gender, and low ASA score, in patients undergoing elective surgery under spinal anaesthesia. PMID:27366419

  19. 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.

  20. 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…

  1. 'Frozen finger' in anal fissures.

    PubMed

    Chintamani; Tandon, Megha; Khandelwal, Rohan

    2009-10-01

    Acute anal fissures are usually managed by various invasive and non-invasive modalities ranging from simple lifestyle changes to chemical and surgical sphincterotomies. Frozen finger, prepared using a water-filled ordinary rubber glove, was successfully used in one hundred patients, thus providing a cost-effective and simple solution to the problem.

  2. 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…

  3. 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.

  4. Perioperative anticoagulation and renal disease: an update.

    PubMed

    Dutta, Suparna; Jaffer, Amir K; Slawski, Barbara A; Pfeifer, Kurt J; Smetana, Gerald W; Cohn, Steven L

    2014-12-01

    As our surgical population becomes older and increasingly medically complex, knowledge of the most recent perioperative literature can provide guidance for physicians across multiple specialties caring for the surgical patient. Common issues many clinicians encounter in the perioperative period relate to anticoagulation and renal disease. This article identifies gaps in knowledge for the fields of perioperative anticoagulation, acute kidney injury, and chronic kidney disease and highlights recently published studies on these topics that attempt to fill these gaps and help clinicians provide excellent care for their patients.

  5. 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.

  6. [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.

  7. 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.

  8. 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...

  9. 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...

  10. 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...

  11. 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...

  12. [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.

  13. [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.

  14. 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.

  15. 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.

  16. 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.

  17. Perioperative mischief: the price of academic misconduct.

    PubMed

    Chopra, Vineet; Eagle, Kim A

    2012-10-01

    Recent allegations of fraud committed by one of the most prolific researchers in perioperative medicine, Don Poldermans, have left many clinicians in a state of disbelief. With over 500 peer-reviewed publications, Poldermans heavily influenced the clinical practice of perioperative beta-blockers and statins in noncardiac surgery, shaping guidelines and national policies on the use of these treatments. The effects of fraud in perioperative medicine are particularly caustic owing to a profound domino effect. Many investigators devoted their academic careers to following the footsteps of investigators such as Poldermans. Similarly, funding agencies supported this line of enquiry, incurring significant cost and expense. Most importantly, hundreds of patients were exposed to treatments that may have been harmful in an effort to advance this research agenda. How should perioperative clinicians utilize beta blockade now that a considerable portion of the literature is enshrouded in uncertainty? In this brief review, we reiterate and emphasize basic principles about the indications and administration of perioperative beta blockade. Because research misconduct in perioperative medicine can be so damaging, we present strategies to prevent such events in the future. Without such reform, fraud in research may very well continue. The price for such misconduct is simply too great to pay. Copyright © 2012 Elsevier Inc. All rights reserved.

  18. [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.

  19. Perioperative Assessment of Myocardial Deformation

    PubMed Central

    Duncan, Andra E.; Alfirevic, Andrej; Sessler, Daniel I.; Popovic, Zoran B.; Thomas, James D.

    2014-01-01

    Evaluation of left ventricular performance improves risk assessment and guides anesthetic decisions. However, the most common echocardiographic measure of myocardial function, the left ventricular ejection fraction (LVEF), has important limitations. LVEF is limited by subjective interpretation which reduces accuracy and reproducibility, and LVEF assesses global function without characterizing regional myocardial abnormalities. An alternative objective echocardiographic measure of myocardial function is thus needed. Myocardial deformation analysis, which performs quantitative assessment of global and regional myocardial function, may be useful for perioperative care of surgical patients. Myocardial deformation analysis evaluates left ventricular mechanics by quantifying strain and strain rate. Strain describes percent change in myocardial length in the longitudinal (from base to apex) and circumferential (encircling the short-axis of the ventricle) direction and change in thickness in the radial direction. Segmental strain describes regional myocardial function. Strain is a negative number when the ventricle shortens longitudinally or circumferentially and is positive with radial thickening. Reference values for normal longitudinal strain from a recent meta-analysis using transthoracic echocardiography are (mean ± SD) −19.7 ± 0.4%, while radial and circumferential strain are 47.3 ± 1.9 and −23.3 ± 0.7%, respectively. The speed of myocardial deformation is also important and is characterized by strain rate. Longitudinal systolic strain rate in healthy subjects averages −1.10 ± 0.16 sec−1. Assessment of myocardial deformation requires consideration of both strain (change in deformation), which correlates with LVEF, and strain rate (speed of deformation), which correlates with rate of rise of left ventricular pressure (dP/dt). Myocardial deformation analysis also evaluates ventricular relaxation, twist, and untwist, providing new and noninvasive methods to

  20. 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.

  1. 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.

  2. Acidity of frozen electrolyte solutions.

    PubMed

    Robinson, Carmen; Boxe, C S; Guzman, M I; Colussi, A J; Hoffmann, M R

    2006-04-20

    Ice is selectively intolerant to impurities. A preponderance of implanted anions or cations generates electrical imbalances in ice grown from electrolyte solutions. Since the excess charges are ultimately neutralized via interfacial (H(+)/HO(-)) transport, the acidity of the unfrozen portion can change significantly and permanently. This insufficiently recognized phenomenon should critically affect rates and equilibria in frozen media. Here we report the effective (19)F NMR chemical shift of 3-fluorobenzoic acid as in situ probe of the acidity of extensively frozen electrolyte solutions. The sign and magnitude of the acidity changes associated with freezing are largely determined by specific ion combinations, but depend also on solute concentration and/or the extent of supercooling. NaCl solutions become more basic, those of (NH(4))(2)SO(4) or Na(2)SO(4) become more acidic, while solutions of the 2-(N-morpholino)ethanesulfonic acid zwitterion barely change their acidity upon freezing. We discuss how acidity scales based on solid-state NMR measurements could be used to assess the degree of ionization of weak acids and bases in frozen media.

  3. 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.

  4. 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

  5. Perioperatively acquired disorders of coagulation

    PubMed Central

    Grottke, Oliver; Fries, Dietmar; Nascimento, Bartolomeu

    2015-01-01

    Purpose of review To provide an overview of acquired coagulopathies that can occur in various perioperative clinical settings. Also described are coagulation disturbances linked to antithrombotic medications and currently available strategies to reverse their antithrombotic effects in situations of severe hemorrhage. Recent findings Recent studies highlight the link between low fibrinogen and decreased fibrin polymerization in the development of acquired coagulopathy. Particularly, fibrin(ogen) deficits are observable after cardiopulmonary bypass in cardiac surgery, on arrival at the emergency room in trauma patients, and with ongoing bleeding after child birth. Regarding antithrombotic therapy, although new oral anticoagulants offer the possibility of efficacy and relative safety compared with vitamin K antagonists, reversal of their anticoagulant effect with nonspecific agents, including prothrombin complex concentrate, has provided conflicting results. Specific antidotes, currently being developed, are not yet licensed for clinical use, but initial results are promising. Summary Targeted hemostatic therapy aims to correct coagulopathies in specific clinical settings, and reduce the need for allogeneic transfusions, thus preventing massive transfusion and its deleterious outcomes. Although there are specific guidelines for reversing anticoagulation in patients treated with antiplatelet agents or warfarin, there is currently little evidence to advocate comprehensive recommendations to treat drug-induced coagulopathy associated with new oral anticoagulants. PMID:25734869

  6. Clinical pearls in perioperative medicine.

    PubMed

    Mauck, Karen F; Litin, Scott C; Bundrick, John B

    2014-02-01

    At the 2001 annual meeting of the American College of Physicians (ACP), a new and innovative teaching format, the "Clinical Pearls" session, was introduced. Clinical Pearls sessions were designed to teach physicians using clinical cases. The session format involves specialty speakers presenting a number of short cases to a physician audience. Each case is followed by a multiple-choice question, answered by each attendee using an electronic audience-response system. After a summary of the answer distribution is shown, the correct answer is displayed and the speaker discusses important teaching points and clarifies why one answer is most clinically appropriate. Each case presentation ends with 1 or 2 "Clinical Pearls," defined as a practical teaching point, supported by the literature, and generally not well known to most internists. The Clinical Pearls sessions are consistently one the most popular and well attended sessions at the American College of Physicians' national meeting each year. Herein, we present the Clinical Pearls in Perioperative Medicine, presented at the ACP National Meeting in San Francisco, California, April 11-13, 2013.

  7. Perioperative pharmacology in morbid obesity.

    PubMed

    Lemmens, Hendrikus J m

    2010-08-01

    Morbid obesity alters drug dose requirement and time course of drug response. In addition, morbid obesity's impact on many organ systems decreases the margin of safety of anesthetic drugs. Consequently, incorrect dosing will increase the rate of perioperative complications. In this review, we will discuss factors that affect the pharmacokinetics and pharmacodynamics of anesthetic agents in the obese population, we specify certain dosing scalars, and we relate our current knowledge of obesity's effects on the clinical pharmacology of anesthetic drugs. A morbidly obese individual's increased cardiac output requires administration of higher drug doses than would be required for a standard-size person to attain the same peak-plasma concentration. Lean body weight (LBW) is highly correlated with the increased cardiac output, more so than fat mass or other variables. For most drugs, clearance increases nonlinearly with total body weight but linearly with LBW. Morbid obesity has no clinically significant impact on the uptake of the inhalation anesthetics isoflurane, sevoflurane, and desflurane when used in routine clinical practice. Total body weight dosing of neuromuscular blocking agents will result in a prolonged effect. For the induction dose of hypnotics and the initial dose of other drugs that have a fast onset of effect, cardiac output or LBW are relevant dosing scalars. For maintenance dosing, LBW seems to be a more appropriate dosing scalar than total body weight.

  8. 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

  9. Perioperative stroke risk in nonvascular surgery.

    PubMed

    Macellari, Federica; Paciaroni, Maurizio; Agnelli, Giancarlo; Caso, Valeria

    2012-01-01

    Perioperative stroke is an ischemic or hemorrhagic cerebrovascular accident that can arise intraoperatively or from 3 to 30 days after surgery. This relatively rare complication deserves attention because of its high mortality and serious disability, the latter of which can lead to prolonged hospital stay as well as discharge to long-term care facilities. The aim of this article was to review the literature on perioperative stroke in general surgery, excluding carotid and cardiac surgeries because these have already been thoroughly investigated in previous papers. A search strategy was designed to identify all relevant studies on perioperative stroke in the English language. This search was restricted to papers published up to December 5, 2011. Studies were initially identified from the Medline/PubMed database, EMBASE and the Cochrane Database using the search terms 'surgery', 'perioperative stroke', 'risk factors', 'anticoagulation treatment' and 'antiplatelet treatment'. The incidence of perioperative stroke among patients who undergo nonvascular surgery is reported to be about 0.08-0.7%. This depends on the type and complexity of the surgical procedure along with patient risk factors. The reported perioperative mortality is 18-26%. One of the main issues is the management of patients taking anticoagulant or antiplatelet drugs, as the risk of bleeding has to be counterbalanced with the risk of arterial thrombosis due to discontinuation. Additionally, the presence of symptomatic carotid stenosis should be taken into account in the risk evaluation. To date, current guidelines are incomplete regarding the management of patients with vascular disease undergoing nonvascular surgery. It is recommended to stop oral anticoagulation approximately 5 days before major surgery to adequately allow the INR to normalize, and at the same time subcutaneous low-molecular-weight heparin or intravenous unfractionated heparin should be started. Regarding new anticoagulants

  10. 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

  11. Perioperative and transfusion outcomes in women undergoing cesarean hysterectomy for abnormal placentation

    PubMed Central

    Brookfield, Kathleen F.; Goodnough, Lawrence T.; Lyell, Deirdre J.; Butwick, Alexander J.

    2013-01-01

    Background Women with placenta increta (PI) and placenta percreta (PP) are at high risk of obstetric hemorrhage, however the severity of hemorrhage and perioperative morbidity may differ according to the degree of placental invasion. We sought to compare blood component usage and perioperative morbidity between women with PI vs. PP undergoing CH (Cesarean hysterectomy). Study Design and Methods We identified 77 women who underwent CH for PI or PP from the NICHD MFMU Network Cesarean registry, which sourced data from 19 centers from 1999–2002. We examined demographic, obstetric and surgical data, and rates of transfusion and perioperative morbidity. We performed statistical tests for between-group analyses; P<0.05 as statistically significant. Results Rates of intraoperative or postoperative red blood cell (RBC) transfusion were similar between groups (PI=84% vs. PP=88%; P=0.7). We observed no between-group differences in rates of fresh frozen plasma (FFP) transfusion (intraoperative FFP: PI=30% vs. PP=41%; P=0.3; postoperative FFP: PI=28% vs. PP=18%; P=0.4) or platelet (PLT) transfusion (intraoperative PLTs: PI=14% vs. PP=29%; P=0.2; postoperative PLTs: PI=9% vs. PP=9%; P=1.0). Among the morbidities, a higher proportion of PP women underwent cystotomy (PI=14% vs. PP=38%, P=0.02) and postoperative mechanical ventilation (PI=14% vs. PP=35%; P=0.03). Conclusion Rates of intraoperative RBC, FFP and PLT transfusion are similar for PI and PP women, and perioperative outcomes are worse for PP women. We suggest the same mobilization transfusion medicine support for both groups, including blood-ordering (type and crossmatch for CH), and availability of emergency blood protocols including fibrinogen-containing preparations. PMID:24188691

  12. Risk Factors and Clinical Outcomes Associated with Perioperative Transfusion-associated Circulatory Overload.

    PubMed

    Clifford, Leanne; Jia, Qing; Subramanian, Arun; Yadav, Hemang; Schroeder, Darrell R; Kor, Daryl J

    2017-03-01

    Transfusion-associated circulatory overload remains underappreciated in the perioperative environment. The authors aimed to characterize risk factors for perioperative transfusion-associated circulatory overload and better understand its impact on patient-important outcomes. In this case-control study, 163 adults undergoing noncardiac surgery who developed perioperative transfusion-associated circulatory overload were matched with 726 transfused controls who did not develop respiratory complications. Univariate and multivariable logistic regression analyses were used to evaluate potential risk factors for transfusion-associated circulatory overload. The need for postoperative mechanical ventilation, lengths of intensive care unit and hospital stay, and mortality were compared. For this cohort, the mean age was 71 yr and 56% were men. Multivariable analysis revealed the following independent predictors of transfusion-associated circulatory overload: emergency surgery, chronic kidney disease, left ventricular dysfunction, previous β-adrenergic receptor antagonist use, isolated fresh frozen plasma transfusion (vs. isolated erythrocyte transfusion), mixed product transfusion (vs. isolated erythrocyte transfusion), and increasing intraoperative fluid administration. Patients who developed transfusion-associated circulatory overload were more likely to require postoperative mechanical ventilation (73 vs. 33%; P < 0.001) and experienced prolonged intensive care unit (11.1 vs. 6.5 days; P < 0.001) and hospital lengths of stay (19.9 vs. 9.6 days; P < 0.001). Survival was significantly reduced (P < 0.001) in transfusion recipients who developed transfusion-associated circulatory overload (1-yr survival 72 vs. 84%). Perioperative transfusion-associated circulatory overload was associated with a protracted hospital course and increased mortality. Efforts to minimize the incidence of transfusion-associated circulatory overload should focus on the judicious use of

  13. 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.

  14. 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.

  15. 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.

  16. [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.

  17. 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.

  18. 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.

  19. 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. Copyright © 2017 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  20. Role of the Perioperative Surgical Home in Optimizing the Perioperative Use of Opioids.

    PubMed

    Vetter, Thomas R; Kain, Zeev N

    2017-07-24

    Several federal agencies have recently noted that the United States is in the midst of an unprecedented "opioid epidemic," with an increasing number of opioid-related overdoses and deaths. Providers currently face 3 population-level, public health challenges in providing optimal perioperative pain care: (1) the continued lack of overall improvement in the excessive incidence of inadequately treated postoperative pain, (2) minimizing or preventing postoperative opioid-related side effects, and (3) addressing current opioid prescribing patterns, and the accompanying problematic surge in prescription opioid diversion, misuse, abuse, addiction, and overdose. In the Perioperative Surgical Home model, anesthesiologists and other pain medicine specialists are uniquely qualified and positioned to develop, implement, and coordinate a comprehensive perioperative analgesic plan, which begins with the formal preoperative patient assessment and continues throughout the postdischarge, convalescence period. The scope and practice of pain management within the Perioperative Surgical Home should thus (a) expand to include routine preoperative patient-level pain-risk stratification (including the chronic use of opioid and nonopioid analgesics), (b) address the multitude of biopsychosocial factors that contribute to interpatient pain variability, and (c) extend and be well coordinated across all 4 phases of the surgical pain experience (preoperative, intraoperative, postoperative, and postdischarge). Specifically, safe and effective perioperative pain management should include a plan of care that is tailored to the individual patient's underlying disease(s), presence of a chronic pain condition and preoperative use of opioids, and the specific surgical procedure- with evidence-based, multimodal analgesic regimens being applied in the vast majority of cases. An iteratively evolutionary component of an existing institutional Perioperative Surgical Home program can be an integrated

  1. 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.

  2. Interpreting Neutron Probe Readings In Frozen Soil

    Treesearch

    Richard S. Sartz

    1969-01-01

    Several factors associated with soil freezing complicate the interpretation of neutron probe readings in frozen soil. Temperature is unimportant, but the effect of vertical resolution must be considered. Because of the possibility of both gains and losses of water at the same depth during a period of measurement, interpreting changes in the water content of frozen...

  3. Pine pollens frozen five years produce seed

    Treesearch

    R.Z. Callaham; R.J. Steinhoff

    1966-01-01

    Deep-freezing of pine pollen offers a means of prolonging its storage life. Early work showed that pollen could be frozen without losing its viability. A study was started in 1958 at the Institute of Forest Genetics at Placerville to determine how long frozen pollen of several pines would remain viable. This paper reports in vitro germination and in vivo seed...

  4. A review on frozen shoulder.

    PubMed

    Wong, P L; Tan, H C

    2010-09-01

    Of all the joints in the human body, the shoulder has the greatest range of motion. This allows complex movements and functions to be carried out, and is of vital importance to the activities of daily living and work. Any restriction or pain that involves the joint puts a huge amount of strain on patients, especially those who are in their most productive years of life. Frozen shoulder, a frequently encountered disorder of the shoulder, has been well recognised since the early 1900s. Although benign, it has great impact on the quality of life of patients. This article aims to provide an overview of the nature and the widely accepted management of this condition based on other studies.

  5. 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.

  6. 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.

  7. Perioperative temperature control: Survey on current practices.

    PubMed

    Brogly, N; Alsina, E; de Celis, I; Huercio, I; Dominguez, A; Gilsanz, F

    2016-04-01

    Prevention of perioperative hypothermia decreases morbidity and mortality, as well as hospital costs. This study was conducted to evaluate the level of implementation of protocols in 3 tertiary Spanish University Hospitals. A survey among anaesthesiologists assessed estimated importance and clinical practice in terms of prevention of perioperative hypothermia. Results were compared depending on their experience. P<.05 was considered significant. A total of 116 anaesthesiologists answered the survey, of whom 48 (41.3%) were residents, 32 (27.6%) were staff with less than 10 years of experience, and 36 (31.1%) staff with 10 years or more of experience, In a 0-10 importance scale, prevention of hypothermia was scored 7.49±1,79, with no difference between groups (P=.58). Younger staff were more concerned of the end surgery temperature than other colleagues (P=.02). The most usual practice was a combination warming the intravenous fluids and an electric blanket (55%). Only 20% of the anaesthesiologists monitored temperature intra-operatively, even though 75% considered it an important parameter. No unit had a written protocol for prevention of perioperative hypothermia. Despite the absence of prevention protocols, the anaesthesiologists were aware of the importance maintaining a normal peri-operative temperature, but this awareness is still not enough to influence their perioperative management to diagnose and prevent hypothermia. A harmonisation of practice at local, regional and national level could improve this practice in the future. Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  8. 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.

  9. Perioperative nurses' perceptions of caring practices.

    PubMed

    McNamara, S A

    1995-02-01

    This study was designed to determine how caring is practiced in perioperative nursing. The theory of nursing by M. Jean Watson, RN, PhD, FAAN, provided the conceptual framework for the study. The researcher used a qualitative, descriptive methodology to analyze data collected in audiotaped interviews with five perioperative nurses and used standard qualitative research procedures for transcribing and analyzing the interview data. The five study participants identified their perceptions of caring behaviors with conscious and unconscious patients in the preoperative, intraoperative, and postoperative periods. They described the essential structure of caring as the establishment of a human care relationship and provision of a supportive, protective, and/or corrective psychological, physical, and spiritual environment.

  10. 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.

  11. Perioperative Research Fellowship: Planning, Implementation, Experience

    PubMed Central

    Memtsoudis, Stavros G; Mazumdar, Madhu; Stundner, Ottokar; Hargett, Mary J.

    2014-01-01

    Perioperative outcomes research has gained widespread interest and is viewed as increasingly important among different specialties, including anesthesiology. Outcome research studies serve to help in the adjustment of risk, allocation of resources, and formulation of hypotheses to guide future research. Pursuing high quality research projects requires familiarity with a wide range of research methodologies, and concepts are ideally learned in a dedicated setting. Skills associated with the use of these methodologies as well as with scientific publishing in general, however, are increasingly challenging to acquire. This article is intended to describe the curriculum and implementation of the Perioperative Medicine and Regional Anesthesia Research Fellowship at the Hospital for Special Surgery. We also propose a methodology to evaluate the success of a research fellowship curriculum. PMID:24942850

  12. Using games to provide interactive perioperative education.

    PubMed

    Carifa, Linda; Janiszewski Goodin, Heather

    2011-10-01

    Perioperative nurses must use critical thinking and sound clinical judgment to meet their patients' needs safely and effectively. This requires the integration and continual updating of large amounts of detailed clinical information. Innovative education strategies are designed to make teaching and learning more interesting and interactive, especially for the presentation of complex subject material. One interactive educational strategy is the use of games. Educational games can foster collaboration and critical thinking among peers and associates. An example of this was the Perioperative QuizBowl: Evidence-Based Practice presented at the annual AORN Congress from 2003 to 2010, which was used to teach and reinforce evidence-based practice in a fun, competitive way. Although AORN no longer presents this offering, the QuizBowl format demonstrates how educational games can support clinical practice. Copyright © 2011 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  13. Information literacy: implications for perioperative nurses.

    PubMed

    Byrne, Michelle M

    2011-02-01

    The concept of information literacy may be new to some perioperative nurses; however, embracing this concept will help nurses identify situations that necessitate gaining more information, locate and access information sources, evaluate and analyze data, and cite information in compliance with copyright and fair use laws. The culture of health care is continually changing as a result of new technology and new methods to improve patient care, and this creates an information explosion. Perioperative educators should add information literacy as a strategic goal for obtaining Magnet status because it is foundational to evidence-based practice. Administrators also should advocate to obtain resources that will enable nurses to access information that addresses current patient care issues.

  14. 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.

  15. [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.

  16. 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.

  17. 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.

  18. Perioperative delirium and its relationship to dementia

    PubMed Central

    Silverstein, Jeffrey H.; Deiner, Stacie G.

    2013-01-01

    A number of serious clinical cognitive syndromes occur following surgery and anesthesia. Postoperative delirium is a behavioral syndrome that occurs in the perioperative period. It is diagnosed through observation and characterized by a fluctuating loss of orientation and confusion. A distinct syndrome that requires formalized neurocognitive testing is frequently referred to as postoperative cognitive dysfunction (POCD). There are serious concerns as to whether either postoperative delirium or postoperative cognitive dysfunction lead to dementia. These concerns are reviewed in this article. PMID:23220565

  19. Perioperative considerations in infantile neuroaxonal dystrophy.

    PubMed

    Sinskey, Jina L; Holzman, Robert S

    2017-03-01

    Infantile neuroaxonal dystrophy is a rare neurological disorder that is universally fatal with life expectancy under 10 years. A 10-year-old boy with infantile neuroaxonal dystrophy and severe neuromuscular scoliosis underwent posterior spinal fusion following halo traction. He was successfully extubated to bilevel positive airway pressure on postoperative day 3 and discharged home on postoperative day 11. Infantile neuroaxonal dystrophy presents several perioperative challenges including concerns for difficult intubation and respiratory dysfunction. © 2017 John Wiley & Sons Ltd.

  20. The perioperative management of patients with left ventricular assist devices undergoing noncardiac surgery.

    PubMed

    Barbara, David W; Wetzel, David R; Pulido, Juan N; Pershing, Bryan S; Park, Soon J; Stulak, John M; Zietlow, Scott P; Morris, David S; Boilson, Barry A; Mauermann, William J

    2013-07-01

    To describe the perioperative management of patients with left ventricular assist devices (LVADs) who require general anesthesia while undergoing noncardiac surgery (NCS) at a single, large tertiary referral center. Electronic medical records from September 2, 2005, through May 31, 2012, were retrospectively reviewed to evaluate the perioperative management and outcomes in LVAD patients undergoing NCS. Patients were included only if they required a general anesthetic and had previously been discharged from the hospital after initial LVAD implantation. Thirty-three patients with LVADs underwent general anesthesia for 67 noncardiac operations. The mean ± SD time from LVAD implantation to NCS was 317 ± 349 days. All but 1 patient had axial flow LVADs. Anticoagulation or antiplatelet agents were present within 7 days before NCS in 49 procedures (73%) and reversed in 32 of 49 (65%). No perioperative thrombotic complications related to anticoagulation or antiplatelet reversal were noted. Red blood cell, fresh frozen plasma, and platelet transfusions were administered during 10, 6, and 4 operations, respectively. The only intraoperative complication was surgical bleeding. Postoperative complications were present in 12 patients after NCS and were mainly composed of bleeding. Three patients died within 30 days of NCS, with the causes of death not attributed to NCS. Patients with LVAD safely underwent NCS in a multidisciplinary setting that included preoperative optimization by cardiologists familiar with LVADs when feasible. Anticoagulation or antiplatelet agents were present preoperatively in most patients with LVADs and were safely reversed when necessary for NCS. The relatively high occurrence of postoperative bleeding is consistent with previous series. Copyright © 2013 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  1. Obstructive sleep apnoea in children: perioperative considerations.

    PubMed

    Patino, M; Sadhasivam, S; Mahmoud, M

    2013-12-01

    Obstructive sleep apnoea (OSA) has become a major public health concern as its incidence and severity have increased in tandem with the obesity epidemic. In children, OSA is now recognized as a common disorder and can be associated with significant morbidity. OSA belongs to a spectrum of diagnoses known as sleep-related breathing disorders in which the airway is completely (apnoea) or partially (hypopnoea) occluded during sleep despite continued respiratory efforts. This airway obstruction can cause abnormal gas exchange leading to hypoxaemia, hypercapnia, sleep fragmentation, and their attendant physiological and behavioural consequences. The degrees of hypercapnia, hypoxaemia, and upper airway airflow reduction are the primary factors determining the severity of OSA. In young children, adenotonsillar hypertrophy is the most common anatomical abnormality associated with OSA, and adenotonsillectomy is, therefore, the most common surgical intervention. Perioperative complications associated with adenotonsillectomy are more common in children with severe OSA. A thorough understanding of the pathophysiology of OSA, careful and complete preoperative assessment, meticulous intraoperative and postoperative management, and early recognition of potential perioperative complications are essential to optimization of outcomes. The safe anaesthetic management of a child with OSA requires an anaesthetic technique tailored to the underlying aetiology and severity of OSA and the surgical procedure. This review focuses on the epidemiology, pathogenesis, and diagnosis of OSA, and the state-of-the-art and future directions in the perioperative management of children with OSA.

  2. Metabolic syndrome and insulin resistance: perioperative considerations.

    PubMed

    Bagry, Hema S; Raghavendran, Sreekrishna; Carli, Franco

    2008-03-01

    Metabolic syndrome represents a constellation of risk factors associated with increased incidence of cardiovascular disease and progression to diabetes mellitus. Insulin resistance, a state of decreased biologic response to physiologic concentrations of insulin, is a key component of this syndrome and seems to be the result of a primary defect at the skeletal muscle glucose transporter. Acute illness and the perioperative period are characterized by a state of insulin resistance that manifests as hyperglycemia and leads to various other metabolic and biochemical alterations that adversely affect end organ function. Hyperglycemia in acutely ill patients adversely affects outcome. Achieving euglycemia seems beneficial in certain clinical situations, but considerable disagreement exists regarding the target blood sugar levels, the duration of therapy, and the modality. Pharmacotherapy, exercise, and nutrition to improve insulin sensitivity seem promising but require further evaluation to confirm their efficacy for perioperative risk reduction. This review discusses the pathophysiology and the clinical implications of metabolic syndrome and insulin resistance in the acutely ill patient with an emphasis on perioperative modulation strategies.

  3. 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.

  4. [Perioperative managment of laparoscopic sleeve gastrectomy].

    PubMed

    Chang, Xu-sheng; Yin, Kai; Wang, Xin; Zhuo, Guang-zuan; Ding, Dan; Guo, Xiang; Zheng, Cheng-zhu

    2013-10-01

    To summarize the surgical technique and perioperative management of laparoscopic sleeve gastrectomy (LSG). A total of 57 morbid obesity patients undergoing LSG surgery from May 2010 to December 2012 were enrolled in the study, whose clinical data in perioperative period were analyzed retrospectively. These patients had more than 1 year of follow-up. All the patients received preoperative preparation and postoperative management, and postoperative excess weight loss(EWL%) and improvement of preoperative complications was evaluated. All the cases completed the operation under laparoscopy, except 1 case because of the abdominal extensive adhesion. The average operation time was(102.0±15.2) min and the mean intraoperative blood loss (132.3±45.6) ml. Of 2 postoperative hemorrhage patients, 1 case received conservative treatment, and another one underwent laparoscopic exploration. The EWL% at 3 months, 6 months and 1 year after procedure was (54.9±13.8)%, (79.0±23.6)% and (106.9±25.1)% respectively. The preoperative complications were improved in some degree. There were no operative death, and anastomotic leak, anastomotic stenosis, or surgical site infection occurred. LSG is a safe and effective surgical technique, whose safety and efficacy may be increased by improving the perioperative management.

  5. 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

  6. 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

  7. Noninvasive respiratory support in the perioperative period.

    PubMed

    Cereda, Maurizio; Neligan, Patrick J; Reed, Amy J

    2013-04-01

    Pulmonary complications ranging from atelectasis to acute respiratory failure are common causes of poor perioperative outcomes. As the surgical population becomes increasingly at risk for pulmonary dysfunction due to increasing age and weight, development of an approach toward respiratory compromise in these patients is becoming ever more important. Given the utility of noninvasive respiratory support (NRS) in acute respiratory failure, it is likewise likely to also be important in the perioperative period. NRS is evaluated from preoperative risk assessment to its use in prevention and treatment of acute respiratory failure. Data supporting intraoperative use of NRS including preinduction continuous positive airway pressure and postextubation NRS for high-risk individuals and surgeries are examined. Timing and duration of NRS is also addressed. Finally, NRS is proposed for treatment for postoperative acute respiratory failure as an alternative to invasive rescue maneuvers. Noninvasive respiratory support should be considered an important adjunct in perioperative pulmonary care. Usage should be individually tailored in regard to timing and application modality specific to patient and surgical circumstances. More studies are needed, however, to determine the relationship demonstrated between short-term improvements in lung function and long-term outcomes.

  8. Perioperative management of severe anorexia nervosa.

    PubMed

    Hirose, K; Hirose, M; Tanaka, K; Kawahito, S; Tamaki, T; Oshita, S

    2014-02-01

    As the prevalence of anorexia nervosa (AN) increased, surgery in severe AN patients also increased in the 2000s. We experienced a surgical case of a patient with severe AN, showing an extremely low BMI of 8.6 kg m(-2). We investigated the problems associated with this case and propose criteria to manage severe AN. We endeavour to report on the perioperative management of rare and severe symptoms and surgical indications of severely malnourished patients. All published reports were identified through comprehensive searches using PubMed, BioMedLib, and the Japan Medical Abstracts Society with the following terms and keywords: 'anorexia nervosa', 'eating disorder', 'hypoglycaemia', 'leucocytopaenia', 'gelatinous bone marrow', 'surgery', and 'operation'. In cases of AN with a BMI under 13 kg m(-2), marked hypoglycaemia, leucocytopaenia <3.0×10(9) litre(-1), or both, potentially fatal complications frequently occur. Accordingly, patients need strict nutritional support to avoid re-feeding syndrome until surgery. During the course of anaesthesia, careless loading of glucose or catecholamine may lead to disturbance of electrolytes or fatal arrhythmia. Intensive care and early feeding as soon as possible after surgery are important to prevent surgical site infection. Although not many perioperative cases of AN have been reported, clinicians must be aware of the danger and the causes of mortality in critical cases. Thus, the decision to undertake surgery must be taken carefully and close perioperative coordination among physicians, surgeons, psychiatrists, anaesthesiologists, and intensivists is essential.

  9. Children’s Desire for Perioperative Information

    PubMed Central

    Fortier, Michelle A.; Chorney, Jill MacLaren; Rony, Rachel Yaffa Zisk; Perret-Karimi, Danielle; Rinehart, Joseph B.; Camilon, Felizardo S.; Kain, Zeev N.

    2010-01-01

    Background The purpose of this investigation was to identify what perioperative information children want to be given by the medical staff. Methods As a first step we developed an instrument based on a qualitative study conducted with children in Great Britain, input from a focus group, and input from school children. On the day of surgery, 143 children aged 7-17 years old completed a 40-item assessment of desired surgical information and a measure of anxiety (STAIC). Parents completed a measure assessing their child’s temperament (EASI), and a measure of their own anxiety (STAI). Results Results indicated that the vast majority of children had a desire for comprehensive information about their surgery, including information about pain and anesthesia, as well as procedural information and information about potential complications. The most highly endorsed items by children involved information about pain. Children who were more anxious endorsed a stronger desire for pain information and lesser tendency to avoid information. Younger children wanted to know what the perioperative environment would look like more than adolescent children. Conclusions We conclude that the majority of children aged 7-17 years old who undergo surgery want to be given comprehensive perioperative information and healthcare providers should ensure adequate information regarding postoperative pain is provided. PMID:19762736

  10. 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)

  11. Defective Reduction in Frozen Pie Manufacturing Process

    NASA Astrophysics Data System (ADS)

    Nooted, Oranuch; Tangjitsitcharoen, Somkiat

    2017-06-01

    The frozen pie production has a lot of defects resulting in high production cost. Failure mode and effect analysis (FMEA) technique has been applied to improve the frozen pie process. Pareto chart is also used to determine the major defects of frozen pie. There are 3 main processes that cause the defects which are the 1st freezing to glazing process, the forming process, and the folding process. The Risk Priority Number (RPN) obtained from FMEA is analyzed to reduce the defects. If RPN of each cause exceeds 45, the process will be considered to be improved and selected for the corrective and preventive actions. The results showed that RPN values decreased after the correction. Therefore, the implementation of FMEA technique can help to improve the performance of frozen pie process and reduce the defects approximately 51.9%.

  12. 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)

  13. 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.

  14. Management of chickenpox with frozen mother's milk.

    PubMed

    Verd, Sergio; López, Esther

    2012-08-01

    If a mother has contracted chickenpox, the antibodies in her milk confer immunity against chickenpox to her breastfed babies. This passive immunization may avoid or spare the breastfed babies' symptoms of chickenpox. It is hypothesized that frozen breast milk may shorten chickenpox duration because specific antibodies against varicella zoster have been detected in human milk and they are resistant to digestion and are stable in frozen milk. The clinical outcomes of chickenpox in a 9-year-old boy and his father on frozen breast milk are reported. The study comprised a varicella-vaccine-refusing family attending a private office of pediatrics. The boy presented with a crusted varicella rash. The medical history revealed premature cessation of the typical varicella rash on day 3. It was coincidental with a supply of frozen human milk by his mother. Next, the father (41 years old) of this patient contracted chickenpox: he was on frozen breast milk from day 2, and no new pox emerged thereafter. The rash spread and numbered 50 to 150 lesions on day 2. Instead, the typical rash was expected to appear in three successive crops of lesions throughout the first week. The disease usually numbers approximately 250-500 lesions in unvaccinated healthy persons. Frozen breast milk may shorten chickenpox duration.

  15. [Scientific ethics and frozen embryos].

    PubMed

    Valenzuela, C Y

    2001-05-01

    Scientific Ethics is the theory and praxis of decisions. Philosophical Ethics is presented as the theory and praxis of the good. As the good differs among cultures, Philosophical Ethics is dependent on the endo-cultural good conception. The decision (included that one of adhesion or not to a world vision) depends on neuro-psychic specific factors: i) cognitive factors that include mostly the knowledge of the alternatives and their consequences and the ideological or religious conception of good in relation to the alternatives; ii) affective factors that make alternatives pleasant, unpleasant or neutral, attractive, repulsive or neutral; iii) emotional factors that associate to alternatives anger, peace or neutrality, sadness, happiness or neutrality; iv) value factors that assign importance, triviality or neutrality to alternatives, or assign them significance, irrelevancy or neutrality. There are unspecific factors such as the psychic energy, desire or others. Mixed factors such as attitude, motivation, intention and others. Scientific Ethics deals with the mind as a materio-energetic process which is different from the soul, eggs and embryos of any species are full individuals of that species, because, they have initiated a copy of their genome that specify, give autonomy and define them as individuals. For Scientific Ethics to leave frozen embryos like that for ever, to defrost and get rid of them or to use their cells for science are synonymous of killing them. To defrost them to use their cells as stem cells for somatic cell therapy or to implant them into uteri to continue their development is to maintain alive their cells, but only the implantation allows their maintenance as individuals, thus, being the only compatible with the Christian ethics. The compatibility of these alternatives with other ethics is discussed.

  16. Perioperative fellowship curricula in anesthesiology: a systematic review.

    PubMed

    Gharapetian, Angineh; Chung, Frances; Wong, David; Wong, Jean

    2015-04-01

    Perioperative medicine is emerging as a unique area of medical practice. Anesthesiology graduates are particularly well suited for this role given their training. The purpose of this systematic review is to summarize the various fellowships being offered in perioperative medicine and the scope of clinical perioperative practice that currently exists. The common areas of competency covered in these perioperative medicine fellowships are also identified. On July 28, 2014, we conducted a search of the literature from January 1, 1946, to July 28, 2014 through MEDLINE®, EMBASE™ and the World Wide Web for definitions of perioperative medicine and for curricula for fellowships in perioperative care throughout the world. Currently, seven institutions offer postgraduate fellowships in perioperative medicine, including two Canadian universities (University of Manitoba and University of Toronto), two American universities (Stanford University and University of California, Irvine), two Australian institutions (University of Western Australia, and the Alfred Hospital), and one New Zealand site (North Shore Hospital). Apart from fellowships, we also identified other postgraduate training routes. Graduate master's programs in perioperative medicine were identified in the United Kingdom and in Australia. A new intensive five-day perioperative medicine course was also identified. The scope of the curricula of the fellowships, the main focus of our review, is not uniform, although common elements emerged, including a research component and exposure to pain medicine. There is a paucity of published literature on what perioperative care entails as well as what perioperative fellowship curricula should include. While we suggest certain areas of focus to include, the subspecialty of perioperative medicine would benefit from a cohesive and consensus-based curriculum to which academic fellowships could adhere.

  17. 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

  18. [Improving patient safety in perioperative care for major surgeries].

    PubMed

    Horváth, Alexandra; Reusz, Géza; Gál, János; Csomós, Akos

    2012-09-16

    The Helsinki Declaration was created and signed by the European Board of Anaesthesiology (EBA) and the European Society of Anaesthesiology (ESA). It was initiated in June 2010, and it implies a European consensus on those medical practices which improve patient safety and provide higher quality perioperative care. Authors focus on four elements of this initiative, which can be easily implemented, and provide almost instant benefit: use of preoperative checklist, prevention of perioperative infections, goal-directed fluid therapy and perioperative nutrition. The literature review emphasizes that well organized perioperative care plays the most important role in improving patient safety.

  19. 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

  20. Can a Total Knee Arthroplasty Perioperative Surgical Home Close the Gap Between Primary and Revision TKA Outcomes?

    PubMed

    Iwuchukwu, Chijioke; Wright, David; Sofine, Anna; Schwarzkopf, Ran

    Given the steady increase in the number of primary and revision total knee arthroplasties (TKAs) performed in the United States, we wanted to determine if an evidence-based TKA perioperative surgical home could close the perioperative morbidity gap between primary and revision TKAs. We conducted a prospective cross-sectional cohort study comparing outcomes of patients who had primary TKA (n = 235) with outcomes of patients who had revision TKA (n = 50). We measured several perioperative outcomes: length of stay, discharge disposition, 30-day readmission rate, and 30-day reoperation rate. Mean length of stay was 2.55 days for primary TKA and 2.92 days for revision TKA (P = .061). Eighty (34%) of the 235 primary TKA patients and 21 (41%) of the 51 revision TKA patients were discharged to a subacute nursing facility (P = .123). One primary TKA patient (0.4%) and 2 revision TKA patients (4%) were readmitted within 30 days after surgery (P = .081). None of the primary TKAs and 2 (4%) of the revision TKAs underwent reoperation (P = .993). There was no difference in perioperative outcomes between the primary and revision TKA groups in our Total Joint Replacement Perioperative Surgical Home (TJR-PSH) cohort. Advances in multidisciplinary co-management of TKA patients are highlighted in the TJR-PSH. The similarity in primary and revision TKA outcomes has significant implications regarding costs and potential increased patient satisfaction.

  1. [Perioperative interstitial brachytherapy for recurrent keloid scars].

    PubMed

    Rio, E; Bardet, E; Peuvrel, P; Martinet, L; Perrot, P; Baraer, F; Loirat, Y; Sartre, J-Y; Malard, O; Ferron, C; Dreno, B

    2010-01-01

    Evaluation of the results of perioperative interstitial brachytherapy with low dose-rate (LDR) Ir-192 in the treatment of keloid scars. We performed a retrospective analysis of 73 histologically confirmed keloids (from 58 patients) resistant to medicosurgical treated by surgical excision plus early perioperative brachytherapy. All lesions were initially symptomatic. Local control was evaluated by clinical evaluation. Functional and cosmetic results were assessed in terms of patient responses to a self-administered questionnaire. Median age was 28 years (range 13-71 years). Scars were located as follows: 37% on the face, 32% on the trunk or abdomen, 16% on the neck, and 15% on the arms or legs. The mean delay before loading was four hours (range, 1-6h). The median dose was 20Gy (range, 15-40Gy). Sixty-four scars (from 53 patients) were evaluated. Local control was 86% (follow-up, 44.5 months; range, 14-150 months). All relapses occurred early - within 2 years posttreatment. At 20 months, survival without recurrence was significantly lower when treated lengths were more than 6cm long. The rate was 100% for treated scars below 4.5cm in length, 95% (95% CI: 55-96) for those 4.5-6cm long, and 75% (95% CI: 56-88) beyond 6cm (p=0.038). Of the 35 scars (28 patients) whose results were reassessed, six remained symptomatic and the esthetic results were considered to be good in 51% (18/35) and average in 37% (13/35) (median follow-up, 70 months; range, 16-181 months). Early perioperative LDR brachytherapy delivering 20Gy at 5mm reduced the rate of recurrent keloids resistant to other treatments and gave good functional results. 2009 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

  2. 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

  3. Perioperative Management Center (PERIO) for Neurosurgical Patients.

    PubMed

    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

    2016-09-15

    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.

  4. 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

  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. Pulmonary atelectasis: a pathogenic perioperative entity.

    PubMed

    Duggan, Michelle; Kavanagh, Brian P

    2005-04-01

    Atelectasis occurs in the dependent parts of the lungs of most patients who are anesthetized. Development of atelectasis is associated with decreased lung compliance, impairment of oxygenation, increased pulmonary vascular resistance, and development of lung injury. The adverse effects of atelectasis persist into the postoperative period and can impact patient recovery. This review article focuses on the causes, nature, and diagnosis of atelectasis. The authors discuss the effects and implications of atelectasis in the perioperative period and illustrate how preventive measures may impact outcome. In addition, they examine the impact of atelectasis and its prevention in acute lung injury.

  7. Perioperative delirium and its relationship to dementia.

    PubMed

    Silverstein, Jeffrey H; Deiner, Stacie G

    2013-06-03

    A number of serious clinical cognitive syndromes occur following surgery and anesthesia. Postoperative delirium is a behavioral syndrome that occurs in the perioperative period. It is diagnosed through observation and characterized by a fluctuating loss of orientation and confusion. A distinct syndrome that requires formalized neurocognitive testing is frequently referred to as postoperative cognitive dysfunction (POCD). There are serious concerns as to whether either postoperative delirium or postoperative cognitive dysfunction leads to dementia. These concerns are reviewed in this article. Copyright © 2012 Elsevier Inc. All rights reserved.

  8. 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

  9. 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.

  10. 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

  11. 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.

  12. 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

  13. Fall Speeds of Freezing and Frozen Raindrops

    NASA Astrophysics Data System (ADS)

    Flynn, A. M.; Rahman, K. M.; Testik, F. Y.

    2016-12-01

    In this study, we investigated the fall speeds of freezing and frozen raindrops through field observations. While there have been many studies on the fall speed of warm raindrops (i.e. raindrops that are in liquid state during fall and after impact on a surface), yielding a number of parameterizations to predict the terminal fall speed of warm raindrops, such studies are limited for freezing and frozen raindrops. Moreover, the parameterizations developed for predicting the terminal fall speeds of warm raindrops are not applicable to freezing and frozen raindrops. The information on freezing and frozen raindrop fall speeds has important meteorological applications: for example, identification of precipitation type and radar retrieval of precipitation rates during such events. In this study, field data was collected using a new instrument called the High-speed Optical Disdrometer (HOD) that we recently developed. This data provided valuable insights into fall speeds of freezing and frozen raindrops, which will be discussed in our presentation. This material is based upon work supported by the National Science Foundation under Grants No. AGS-1144846 and AGS-1612681.

  14. The perioperative management of patients with coronary artery stents: surveying the clinical stakeholders and arriving at a consensus regarding optimal care.

    PubMed

    Vetter, Thomas R; Boudreaux, Arthur M; Papapietro, Silvio E; Smith, Perry W; Taylor, Benjamin B; Porterfield, John R

    2012-10-01

    The perioperative management of patients with a coronary artery stent is a major patient safety issue currently confronting clinicians. Surgery on a patient on antiplatelet therapy creates the following dilemma: is it better to withdraw the drugs and reduce the hemorrhagic risk or to maintain them and reduce the risk of a myocardial ischemic event? An electronic survey was used to sample a cross-section of local clinicians regarding the perioperative management of patients with an indwelling coronary artery stent. The reiterative Consensus-Oriented Decision-Making model was applied by an institutional task force with representation from anesthesiology, cardiology, primary care medicine, and surgery. Significant disagreement existed among the multidisciplinary survey respondents regarding various aspects of the perioperative management of patients with indwelling coronary artery stents. We clarified the perioperative risk factors for coronary stent thrombosis and an alternate process for immediate access to a cardiac catheterization laboratory at our institution. Copyright © 2012 Elsevier Inc. All rights reserved.

  15. 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

  16. 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.

  17. Perioperative management of pheochromocytoma: the heart of the issue.

    PubMed

    Shen, J; Yu, R

    2013-03-01

    Pheochromocytoma is an endocrine tumor derived from the adrenal medulla and paraganglia. Pheochromocytoma presents with a wide spectrum of symptoms, from a silent adrenal mass to cardiac arrest. Perioperative management of pheochromocytoma is critical for preventing perioperative cardiovascular complications. Traditionally, perioperative management focuses on blood pressure control, which has generated considerable controversy. In this review, we suggest that perioperative management should focus more on treating subclinical and clinical pheochromocytoma-induced cardiomyopathy. We first describe the natural history of pheochromocytoma and illustrate that cardiomyopathy is present to various degrees in patients with pheochromocytoma. We then classify pheochromocytomas into 3 groups according to the risks of developing clinical cardiomyopathy. After going over perioperative physiological changes, we propose that the need for preoperative preparation depends on the risk level of the pheochromocytoma. We present the regimens for perioperative management, emphasizing that the goals of perioperative management should extend beyond blood pressure control and include improvement of cardiac function. Perioperative management in unique clinical situations is also discussed.

  18. Reduce--recycle--reuse: guidelines for promoting perioperative waste management.

    PubMed

    Laustsen, Gary

    2007-04-01

    The perioperative environment generates large amounts of waste, which negatively affects local and global ecosystems. To manage this waste health care facility leaders must focus on identifying correctable issues, work with relevant stakeholders to promote solutions, and adopt systematic procedural changes. Nurses and managers can moderate negative environmental effects by promoting reduction, recycling, and reuse of materials in the perioperative setting.

  19. 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.

  20. Soil organic matter mineralization in frozen soils

    NASA Astrophysics Data System (ADS)

    Harrysson Drotz, S.; Sparrman, T.; Schleucher, J.; Nilsson, M.; Öquist, M. G.

    2009-12-01

    Boreal forest soils are frozen for a large part of the year and soil organic matter mineralization during this period has been shown to significantly influence the C balance of boreal forest ecosystems. Mineralization proceeds through heterotrophic microbial activity, but the understanding of the environmental controls regulating soil organic matter mineralization under frozen conditions is poor. Through a series of investigations we have addressed this issue in order to elucidate to what extent a range of environmental factors control mineralization processes in frozen soils and also the microbial communities potential to oxidize organic substrates and grow under such conditions. The unfrozen water content in the frozen soils was shown to be an integral control on the temperature response of biogenic CO2 production across the freezing point of bulk soil water. We found that osmotic potential was an important contributor to the total water potential and, hence, the unfrozen water content of frozen soil. From being low and negligible in an unfrozen soil, the osmotic potential was found to contribute up to 70% of the total water potential in frozen soil, greatly influencing the volume of liquid water. The specific factors of how soil organic matter composition affected the unfrozen water content and CO2 production of frozen soil were studied by CP-MAS NMR. We concluded that abundance of aromatics and recalcitrant compounds showed a significant positive correlation with unfrozen water content and these were also the major soil organic fractions that similarly correlated with the microbial CO2 production of the frozen soils. Thus, the hierarchy of environmental factors controlling SOM mineralization changes as soils freeze and environmental controls elucidated from studies of unfrozen systems can not be added on frozen conditions. We have also investigated the potential activity of soil microbial communities under frozen conditions in order to elucidate temperature

  1. Preference mapping of frozen and fresh raspberries.

    PubMed

    Villamor, R R; Daniels, C H; Moore, P P; Ross, C F

    2013-06-01

    The purpose of the study was to identify key sensory attributes that influence consumer liking for frozen and fresh red raspberries using preference mapping. Sensory profiling of different raspberry cultivars and selections from the Washington State Univ. and Oregon State Univ. breeding programs was carried out using a trained panel (frozen, n = 12 and fresh, n = 10). In addition, a subset of frozen and fresh raspberries of each cultivar was assessed by consumers for sensory acceptability (n = 105 and n = 100, respectively). Based on overall hedonic ratings, cluster analysis identified 3 clusters of frozen raspberry consumers from day 1 (41% "nondistinguishers," 34% "likers," and 25% "nonlikers") and day 2 (41% "group 1 likers," 26% "nonlikers," and 34% and 33% group 2 likers"). For fresh raspberry consumers, 2 clusters were detected from day 1 (54% "likers" and 46% nondistinguishers") and day 2 (54% "group 1 likers" and 46% "group 2 likers"). Preference mapping was applied on the descriptive sensory and acceptability of clustered consumer data. Partial least squares regression results showed that liking of frozen raspberries was driven by high raspberry flavor, firmness, and sweetness. Conversely, disliking of frozen raspberries was related to high sour and aftertaste intensity. In the case of fresh raspberries, high color uniformity, raspberry aroma, raspberry flavor, floral aroma, green flavor, bitter, astringency, and aftertaste increased the acceptability, whereas high color intensity and green aroma were associated with negative drivers of liking. The information obtained in this study can be a useful guide for breeders in the selection of characteristics for growing superior quality raspberries. © 2013 Institute of Food Technologists®

  2. 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

  3. 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).

  4. [Cost accounting of a geriatric perioperative unit].

    PubMed

    Boddaert, Jacques; Barondeau, Marie-Laure; Khiami, Frédéric; Nion, Nathalie; Frandji, Didier; Riou, Bruno

    2015-01-01

    Hip fracture management in a dedicated geriatric perioperative unit improves long-term mortality. In this "we report the" health economics evaluation of this geriatric perioperative care unit (UPOG). This study was conducted in 2011. Direct expenditures were obtained from the Assistance Publique-Hopitaux de Paris database, indirect expenditures from the hospital cost accounting,and financial incomes from the PMSI Pilot programme. Emergency department incomes and expenditures were estimated together with additional incomes related to orthopaedic surgery. We estimated expenditures related to operating room (OR) activities in the framework of several models, one with an emergency OR open 24h/24, and one with a standard OR. Lastly, we compared incomes/expenditures according to regular paramedical staff or according to the paramedical staff that would appear to be necessary to ensure patient care. 253 patients were admitted to the UPOG during the study J215 (84%) of whom underwent surgery. The income statement was positive for both an emergency OR (+741,000 Euros) and a standard OR ( +490,000 Euros) and remained positive when paramedical staff was increased (+629,000 and +156,000 Euros, respectively). The UPOG income statement shows a positive result regardless of the model used, emergency 24h/24 OR or standard OR, and even when paramedical staff is increased

  5. 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.

  6. Vasoplegic syndrome: An update on perioperative considerations.

    PubMed

    Liu, Henry; Yu, Ling; Yang, Longqiu; Green, Michael S

    2017-08-01

    Vasoplegic syndrome (VS) is increasingly recognized as an important clinical entity in perioperative medicine. VS is characterized by significant arterial hypotension, normal or high cardiac output, low systemic vascular resistance, and increased requirements for intravenous volume and vasopressors. Tremendous variations exist regarding incidence reported in the literature and management at different institutions; and the incidence of VS is likely significantly higher than many anesthesiologists believe. Thus the aims of this article are to review the pertinent aspects related to VS and alert clinical anesthesiologists to this under-recognized yet very challenging clinical condition. The potential risk factors include blood transfusion, cardiopulmonary bypass, organ transplantation, trauma and sepsis, and use of specific medications such as angiotensin-converting enzyme inhibitors, Angiotensin-II antagonist, heparin, amiodarone, aprotinin, and protamine. The pathogenesis of VS may have several mechanistic pathways, overproduction of inducible nitric oxide, activation of ATP-dependent K channels, vasopressin V1A-receptor down-regulation, and nuclear factor-κB activation. Current management strategies include intravenous administration of volume and catecholamines, vasopressin, methylene blue and high dose hydroxocobalamin. Other treatment could include ATP-sensitive K channel blocker, nuclear factor-κB inhibitor, indigo carmine, and hyperbaric oxygen therapy. VS is still associated with significantly increased perioperative morbidity and mortality. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Perioperative Interventions to Reduce Chronic Postsurgical Pain

    PubMed Central

    Carroll, Ian; Hah, Jennifer; Mackey, Sean; Ottestad, Einar; Kong, Jiang Ti; Lahidji, Sam; Tawfik, Vivianne; Younger, Jarred; Curtin, Catherine

    2016-01-01

    Approximately 10% of patients following a variety of surgeries develop chronic postsurgical pain. Reducing chronic postoperative pain is especially important to reconstructive surgeons because common operations such as breast and limb reconstruction have even higher risk for developing chronic postsurgical pain. Animal studies of posttraumatic nerve injury pain demonstrate that there is a critical time frame before and immediately after nerve injury in which specific interventions can reduce the incidence and intensity of chronic neuropathic pain behaviors–so called “preventative analgesia.” In animal models, perineural local anesthetic, systemic intravenous local anesthetic, perineural clonidine, systemic gabapentin, systemic tricyclic antidepressants, and minocycline have each been shown to reduce pain behaviors days to weeks after treatment. The translation of this work to humans also suggests that brief perioperative interventions may protect patients from developing new chronic postsurgical pain. Recent clinical trial data show that there is an opportunity during the perioperative period to dramatically reduce the incidence and severity of chronic postsurgical pain. The surgeon, working with the anesthesiologist, has the ability to modify both early and chronic postoperative pain by implementing an evidence-based preventative analgesia plan. PMID:23463498

  8. [Perioperative approach of patient with takotsubo syndrome].

    PubMed

    Barros, Joana; Gomes, Diana; Caramelo, Susana; Pereira, Marta

    Takotsubo cardiomyopathy (TCM) is a stress-induced cardiomyopathy. It is characterized by an acute onset of symptoms and electrocardiographic abnormalities mimicking an acute coronary syndrome in the absence of obstructive coronary artery disease. Any anesthetic-surgical event corresponds to a stressful situation, so the anesthetic management of patients with TCM requires special care throughout the perioperative period. We describe the anesthetic management of a patient with a confirmed diagnosis of TCM undergoing segmental colectomy. Female patient, 55 years old, ASA III, with history of takotsubo syndrome diagnosed 2 years ago, scheduled for segmental colectomy. The patient, without other changes in preoperative evaluation, underwent general anesthesia associated with lumbar epidural and remained hemodynamically stable during the 2hours of surgery. After a brief stay in the Post-Anesthesia Care Unit, she was transferred to the Intermediate Care Unit (IMCU), with epidural analgesia for postoperative period. TCM is a rare disease which true pathophysiology remains unclear, as well as the most appropriate anesthetic-surgical strategy. In this case, through a preventive approach, with close monitoring and the lowest possible stimulus, all the perioperative period was uneventful. Because it is a rare disease, this report could help to raise awareness about TCM. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  9. 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.

  10. 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.

  11. [Perioperative coagulation management controlled by thrombelastography. Clinical implementation illustrated by reference to a case of acquired coagulopathy following aortic stab injury].

    PubMed

    Grashey, R; Mathonia, P; Mutschler, W; Heindl, B

    2007-03-01

    Uncontrolled bleeding is one of the main reasons for a lethal outcome of severe trauma. Loss, consumption and dilution of clotting factors and platelets induce a complex acquired coagulopathy. Beside surgical control of bleeding, early and precise coagulation therapy is essential for successful treatment. We report on a patient whose life-threatening bleeding and perioperative coagulopathy after a knife injury to the aorta was successfully treated by surgical control of the bleeding and subsequent targeted coagulation therapy with factor concentrates and fresh-frozen plasma. The coagulopathy was diagnosed and managed by means of bed-side thrombelastography.

  12. 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.

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

    USDA-ARS?s Scientific Manuscript database

    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...

  14. 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...

  15. 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...

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

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Frozen concentrate for artificially sweetened lemonade. 146.121 Section 146.121 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION CANNED FRUIT JUICES Requirements for Specific...

  17. 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 REGULATIONS...

  18. 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 REGULATIONS...

  19. 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.

  20. 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.

  1. Frozen water waves over rough topographical bottoms.

    PubMed

    Chen, Liang-Shan; Ye, Zhen

    2004-09-01

    The propagation of surface water waves over rough topographical bottoms is investigated by the multiple scattering theory. It is shown that the waves can be localized spatially through the process of multiple scattering and wave interference, a peculiar wave phenomenon which has been previously discussed for frozen light in optical systems [Nature 390, 661 (1997)

  2. Sewage Effluent Infiltrates Frozen Forest Soil

    Treesearch

    Alfred Ray Harris

    1976-01-01

    Secondarily treated sewage effluent, applied at the rate of 1 and 2 inches per week, infiltrated a frozen Sparta sand soil forested with jack pine and scrub oak. Maximum frost depth in treated plots averaged 60 cm and in check plots averages 35 cm. Nitrogen was mobile with some accumulation. Phosphorus was absorbed.

  3. 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)

  4. 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...

  5. Pharmacogenomics of opioids and perioperative pain management.

    PubMed

    Sadhasivam, Senthilkumar; Chidambaran, Vidya

    2012-11-01

    Inadequate pain relief and adverse effects from analgesics remain common in children and adults during the perioperative period. Opioids are the most commonly used analgesics in children and adults to treat perioperative pain. Narrow therapeutic index and a large interpatient variability in response to opioids are clinically significant, with inadequate pain relief at one end of the spectrum and serious side effects, such as respiratory depression and excessive sedation due to relative overdosing, at the other end. Personalizing analgesia during the perioperative period attempts to maximize pain relief while minimizing adverse events from therapy. While various factors influence response to treatment among surgical patients, age, sex, race and pharmacogenetic differences appear to play major roles in predicting outcome. Genetic factors include a subset of genes that modulate the proteins involved in pain perception, pain pathway, analgesic metabolism (pharmacokinetics), transport and receptor signaling (pharmacodynamics). While results from adult genetic studies can provide direction for pediatric studies, they have limited direct applicability, as children's genetic predispositions to analgesic response may be influenced by developmental and behavioral components, altered sensitivity to analgesics and variation in gene-expression patterns. We have reviewed the available evidence on improving and personalizing pain management with opioids and the significance of individualizing analgesia, in order to maximize analgesic effect with minimal adverse effects with opioids. While the early evidence on individual genotype associations with pain, analgesia and opioid adverse outcome are promising, the large amount of conflicting data in the literature suggests that there is a need for larger and more robust studies with appropriate population stratification and consideration of nongenetic and other genetic risk factors. Although the clinical evidence and the prospect of

  6. A review of perioperative anaphylaxis at a Singapore tertiary hospital.

    PubMed

    Chen, Xuanxuan; Thong, Sze Ying; Chong, Yong Yeow; Ng, Shin Yi

    2016-03-01

    Perioperative anaphylaxis is an anaesthetic emergency, but its incidence is not well described in the local literature. This retrospective study aims to look at a group of patients who had perioperative anaphylaxis in our institution. We conducted a retrospective review of electronic databases and clinical case sheets, and identified 34 patients who had possible perioperative anaphylaxis during anaesthesia in our institution between 1 January 2007 and 30 April 2012. After reviewing clinical and biochemical data, we found that 16 out of 151,876 patients who underwent surgery had confirmed perioperative anaphylaxis, an incidence of 1:10,000. Neuromuscular blockers were identified as the most common causative agent for perioperative anaphylaxis. The offending agent could not be identified in seven patients. To the best of our knowledge, this is the first study in Southeast Asia on the incidence of perioperative anaphylaxis. Having a preoperative history of allergy did not seem to predispose patients to the subsequent development of perioperative anaphylaxis. Copyright: © Singapore Medical Association.

  7. A review of perioperative anaphylaxis at a Singapore tertiary hospital

    PubMed Central

    Chen, Xuanxuan; Thong, Sze Ying; Chong, Yong Yeow; Ng, Shin Yi

    2016-01-01

    INTRODUCTION Perioperative anaphylaxis is an anaesthetic emergency, but its incidence is not well described in the local literature. This retrospective study aims to look at a group of patients who had perioperative anaphylaxis in our institution. METHODS We conducted a retrospective review of electronic databases and clinical case sheets, and identified 34 patients who had possible perioperative anaphylaxis during anaesthesia in our institution between 1 January 2007 and 30 April 2012. RESULTS After reviewing clinical and biochemical data, we found that 16 out of 151,876 patients who underwent surgery had confirmed perioperative anaphylaxis, an incidence of 1:10,000. Neuromuscular blockers were identified as the most common causative agent for perioperative anaphylaxis. The offending agent could not be identified in seven patients. CONCLUSION To the best of our knowledge, this is the first study in Southeast Asia on the incidence of perioperative anaphylaxis. Having a preoperative history of allergy did not seem to predispose patients to the subsequent development of perioperative anaphylaxis. PMID:26996282

  8. 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

  9. 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

  10. 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. Copyright © 2011 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  11. 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.

  12. 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.

  13. [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.

  14. [Perioperative medical complications in orthognathic surgery].

    PubMed

    Carry, P Y; Dubost, J; Roche, C; Baud, A V; Breton, P; Freidel, M; Gueugniaud, P Y

    2001-02-01

    To describe per and postoperative medical complications. Prospective, observational study. Between July and December 1999, 59 patients scheduled for programmed orthognathic surgery were included. Anaesthetic and surgical procedures were standardised including patient information and training of surgical ward' nurses. During perioperative periods (in operative and recovery theater and in surgical ward), all the events were qualified on an anaesthetic spreadsheet for a qualitative analysis (description of events and treatment procedures). Two main complications were described 1) one atelectasia due to blood inhalation during the recovery period and 2) local sepsis in surgical ward. These two events were medically treated and recovered. No need of blood transfusion or stay in ICU were noted. Anaesthetic and surgical cooperation is associated with poor morbidity of this functional surgery performed in young subjects.

  15. 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.

  16. [Perioperative blood glucose levels in children].

    PubMed

    Aono, J; Ueda, W; Hirakawa, M

    1992-12-01

    The perioperative blood glucose (BG) level may represent autonomic responses to various stresses by anesthesia and surgery. We studied the effects of regional blocks combined with general anesthesia on the BG response in pediatric patients. We could not find any significant differences in BG levels between blocked and non-blocked patients. However, BG levels of the children who had been hysterical or crying during the induction of anesthesia were significantly higher than those of the children who had been calm or sleeping. Forty healthy children, aged 1-3 yrs who were scheduled for elective urological surgery were studied. Anesthesia was induced with halothane in oxygen. The anesthesiologist recorded the children's attitude before and during the induction of anesthesia, and described as "calm or asleep (Calm-group), and hysterical or crying (Crying-group)". Patients were assigned randomly to two groups as follow; Group A (n = 20): receiving nerve blocks, Group B (n = 20): without the blocks. The anesthesia was maintained with 1-2.5% halothane in oxygen required to maintain the hemodynamic parameters within 10% of baseline value before surgery. Both groups received lactated-Ringer's solution during the study period. The venous BG levels were determined 5 times, i.e. immediately after asleep, 5, 15, 30 minutes after skin incision and at the conclusion of surgery. BG levels were compared between groups using Mann-Whitney Test. There was no significant difference in BG levels between Group A and B throughout the study period. But BG values of Crying-group (n = 9) were significantly higher than those of Calm-group (n = 31) during perioperative period.(ABSTRACT TRUNCATED AT 250 WORDS)

  17. Perioperative chemotherapy and hepatic resection for resectable colorectal liver metastases.

    PubMed

    Beppu, Toru; Sakamoto, Yasuo; Hayashi, Hiromitsu; Baba, Hideo

    2015-02-01

    The role of perioperative chemotherapy in the management of initially resectable colorectal liver metastases (CRLM) is still unclear. The EPOC trial [the European Organization for Research and Treatment of Cancer (EORTC) 40983] is an important study that declares perioperative chemotherapy as the standard of care for patients with resectable CRLM, and the strategy is widely accepted in western countries. Compared with surgery alone, perioperative FOLFOX therapy significantly increased progression-free survival (PFS) in eligible patients or those with resected CRLM. Overall survival (OS) data from the EPOC trial were recently published in The Lancet Oncology, 2013. Here, we discussed the findings and recommendations from the EORTC 40983 trial.

  18. 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.

  19. The pharmaco-economics of peri-operative statin therapy.

    PubMed

    Biccard, B M; Sear, J W; Foëx, P

    2005-11-01

    We analysed the pharmaco-economics of the prospective peri-operative studies of statin administration for major elective vascular surgery, using the NHS reference costs for 2004. This analysis suggests that peri-operative statin therapy for patients undergoing vascular surgery may present the most cost-effective use of statin therapy yet described, with a number-needed-to-treat of 15 and almost 60% of the total cost of atorvastatin therapy recovered through a reduction in peri-operative adverse events.

  20. Perioperative chemotherapy and hepatic resection for resectable colorectal liver metastases

    PubMed Central

    Sakamoto, Yasuo; Hayashi, Hiromitsu; Baba, Hideo

    2015-01-01

    The role of perioperative chemotherapy in the management of initially resectable colorectal liver metastases (CRLM) is still unclear. The EPOC trial [the European Organization for Research and Treatment of Cancer (EORTC) 40983] is an important study that declares perioperative chemotherapy as the standard of care for patients with resectable CRLM, and the strategy is widely accepted in western countries. Compared with surgery alone, perioperative FOLFOX therapy significantly increased progression-free survival (PFS) in eligible patients or those with resected CRLM. Overall survival (OS) data from the EPOC trial were recently published in The Lancet Oncology, 2013. Here, we discussed the findings and recommendations from the EORTC 40983 trial. PMID:25713806

  1. 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 Federal...

  2. 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 for...

  3. 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 for...

  4. 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 Federal...

  5. 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...

  6. 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...

  7. 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...

  8. 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...

  9. 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...

  10. 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...

  11. Frozen O2 layer revealed by neutron reflectometry

    DOE PAGES

    Steffen, A.; Glavic, A.; Holderer, O.; ...

    2016-05-27

    We investigated a 63 thick film originating from frozen air on a solid substrate via neutron reflectometry. Furthermore, the experiment shows that neutron reflectometry allows performing chemical surface analysis by quantifying the composition of this frozen layer and identifies the film to be frozen oxygen.

  12. 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.

  13. Health Care Costs and the Perioperative Surgical Home: A Survey Study.

    PubMed

    Raphael, Darren R; Cannesson, Maxime; Rinehart, Joseph; Kain, Zeev N

    2015-11-01

    The perceptions of anesthesiologists of US health care finance reform are germane to informing the future of our specialty. For this reason, we sought to assess anesthesiologists' views of their own importance in cost-reduction strategies. In addition, respondents were asked a series of questions related to the Perioperative Surgical Home. A cross-sectional survey was sent through email to 6000 randomly chosen active members of the American Society of Anesthesiologists. Respondents were asked to indicate what level of responsibility they perceive stakeholders to have in reducing the cost of health care and perioperative care delivery. Respondents were then asked to describe their relative enthusiasm for cost-reduction strategies. To validate the primary outcome, we took advantage of the American Society of Anesthesiologists' recent focus on the Perioperative Surgical Home to ask a series of related questions as comparators. Thirty-eight percent (95% confidence interval, 35-42) of respondents indicated that physicians bear "major responsibility" for cost reduction, 58% (55-61) indicated that physicians bear "some responsibility," and 4%, only a small fraction (0.7-7.5) indicated that physicians bear "no responsibility." Respondents also indicated that other entities listed bear "major responsibility" for cost reduction including hospitals (57% [54-61]) and insurance companies (54% [51-57]). Comparator data from questions not designed to directly measure the primary outcome are reported, including questions about the Perioperative Surgical Home. US anesthesiologists surveyed perceive other stakeholders, such as hospitals and insurance companies, as having a major responsibility in cost reduction. Furthermore, they are not enthusiastic about substantial financial reform such as cuts to Medicare payments.

  14. 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

  15. Frozen shoulder and the Big Five personality traits.

    PubMed

    Debeer, Philippe; Franssens, Fien; Roosen, Isabelle; Dankaerts, Wim; Claes, Laurence

    2014-02-01

    In the past, several studies have suggested the existence of a "periarthritic personality" in patients with frozen shoulder. We conducted a study to determine differences in personality traits in patients with primary and secondary frozen shoulders. We prospectively evaluated 118 patients (84 women and 34 men; mean age, 53.8 years; SD 7.56) with a frozen shoulder. Of these patients, 48 had an idiopathic frozen shoulder and 70 had a secondary frozen shoulder. Personality traits were determined by the NEO Five-Factor Inventory (NEO-FFI) scale. This questionnaire measures the 5 major personality traits and is based on the norms determined in a neutral test situation for 2415 controls. Compared with healthy controls, no differences in personality traits were found in patients with primary and secondary frozen shoulder, except for Conscientiousness and Extraversion, for which patients with secondary frozen shoulder scored significantly higher than healthy controls. Patients with primary frozen shoulder scored significantly higher on Openness to Experience than did patients with secondary frozen shoulder; on the other 4 Big Five personality traits, no significant differences were found between patients with primary and secondary frozen shoulder. More specifically, patients with idiopathic frozen shoulder did not score higher on the trait Neuroticism as would be expected from previous publications. Our study results do not indicate that patients with an idiopathic frozen shoulder have a specific personality compared with healthy controls. Only a few differences were found in personality traits when the entire frozen shoulder group was compared with healthy controls and between patients with primary and secondary frozen shoulders. The results of this study suggest that these differences are not sufficient to speak about a specific "frozen shoulder personality." Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights

  16. Using unfixed, frozen tissues to study natural mucin distribution.

    PubMed

    Cohen, Miriam; Varki, Nissi M; Jankowski, Mark D; Gagneux, Pascal

    2012-09-21

    layer, and thus permits the study of the numerous roles of mucins in epithelial biology. As this method requires minimal processing of the tissue, the tissue is preserved in a more natural state. Therefore frozen tissues sections do not require any additional processing prior to staining and can be readily analyzed using immunohistochemistry methods. We demonstrate the preservation of micrometers-thick secreted mucus layer in frozen colon samples. This layer is drastically reduced when the same tissues are embedded in paraffin. We also demonstrate immunofluorescence staining of glycan epitopes presented on mucins using plant lectins. The advantage of this approach is that it does not require the use of special fixatives and allows utilizing frozen tissues that may already be preserved in the laboratory.

  17. Using Unfixed, Frozen Tissues to Study Natural Mucin Distribution

    PubMed Central

    Cohen, Miriam; Varki, Nissi M.; Jankowski, Mark D.; Gagneux, Pascal

    2012-01-01

    thus permits the study of the numerous roles of mucins in epithelial biology. As this method requires minimal processing of the tissue, the tissue is preserved in a more natural state. Therefore frozen tissues sections do not require any additional processing prior to staining and can be readily analyzed using immunohistochemistry methods. We demonstrate the preservation of micrometers-thick secreted mucus layer in frozen colon samples. This layer is drastically reduced when the same tissues are embedded in paraffin. We also demonstrate immunofluorescence staining of glycan epitopes presented on mucins using plant lectins. The advantage of this approach is that it does not require the use of special fixatives and allows utilizing frozen tissues that may already be preserved in the laboratory. PMID:23023050

  18. Perioperative care of head and neck free flap patients.

    PubMed

    Kinzinger, Michael R; Bewley, Arnaud F

    2017-10-01

    This article reviews the recent literature on the perioperative care of head and neck surgical patients undergoing free tissue transfer. As the overall success of head and neck free flaps has plateaued above 95%, recent literature on perioperative flap management has focused on minimizing complications, length of stay, and cost of treatment. Current areas of research include preoperative risk stratification, preoperative and postoperative nutrition, intraoperative fluid management, postoperative level of care, postoperative antibiotic prophylaxis, defining the impact of comorbidities, and developing comprehensive evidence-based perioperative care protocols. Rates of complications for head and neck free flap surgery remain stubbornly high. Optimization of perioperative nutrition, antibiotics, fluid management, and the establishment of structured pathways has the potential to decrease these complication rates. However, more research is needed into defining and implementing optimal comprehensive care regimens for this complex patient population.

  19. [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.

  20. 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.

  1. [When is a perioperative glucocorticoid stress-dose regime indicated?].

    PubMed

    van Rossum, E F C Liesbeth; Feelders, R A Richard

    2015-01-01

    To avoid a life-threatening crisis due to adrenal insufficiency during or after surgery, extra glucocorticoids are often administered perioperatively to patients already taking them. However, this type of supplementation also has a downside, e.g. complications such as fluid retention, hyperglycaemia, psychiatric disturbances, infection and delayed wound healing. In patients with primary or central adrenal insufficiency their daily hydrocortisone substitution should be supplemented perioperatively depending on the type of surgery. Also, suppression of the pituitary-adrenal function may occur in patients being treated with exogenous glucocorticoids for other diseases and this may justify perioperative supplemental glucocorticoid administration. However, the extent of adrenal suppression in response to exogenous glucocorticoids is heterogeneous. This can be explained by differences in glucocorticoid type and dosage, treatment duration, mode of administration, as well as an individual's glucocorticoid sensitivity and metabolism of glucocorticoids. In this article we provide suggestions as to which patients should or should not be perioperatively supplemented with glucocorticoids.

  2. [Aspects of perioperative care in patients with diabetes].

    PubMed

    Pestel, G; Closhen, D; Zimmermann, A; Werner, C; Weber, M M

    2013-01-01

    Diabetes is a common disease in Germany. Due to diabetes-associated end-organ disease, such as large and small vessel disease and neuropathy, diabetic patients require more intense anesthesia care during the perioperative phase. An in-depth and comprehensive medical history focusing on hemodynamic alterations, gastroparesis, neuropathy and stiff joint syndrome is a cornerstone of perioperative care and may affect outcome of diabetes patients more than specific anesthetic medications or the anesthetic procedure. Intraoperative anesthetic care needs to focus on preservation of hemodynamic stability, perioperative infection control and maintenance of glucose homeostasis. Whereas some years ago strict glucose control by aggressive insulin therapy was adamantly advocated, the results of recent studies have put the risk of such therapeutic algorithms into perspective. Therefore, optimized perioperative care of diabetic patients consists of setting a predefined targeted blood glucose level, evidence-based therapeutic approaches to reach that goal and finally adequate and continuous monitoring and amendment of the therapeutic approach if required.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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.

  8. 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. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  9. Excellence in perioperative management: establishing a culture of safety.

    PubMed

    Steelman, Victoria M

    2014-07-01

    TeamSTEPPS is a powerful, evidence-based tool available to perioperative leaders to promote patient safety. The program improves communication and develops highly effective teams that optimize the use of information, people, and resources; resolve conflicts; improve information sharing; eliminate barriers to quality and safety; and achieve positive patient outcomes. TeamSTEPPS is one available tool that perioperative leaders should consider using in support of our pursuit of excellence.

  10. 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.

  11. Perioperative Considerations in Crohn Disease and Ulcerative Colitis

    PubMed Central

    Nickerson, T. Paul; Merchea, Amit

    2016-01-01

    The management of inflammatory bowel disease (IBD) is medically and surgically complex. Numerous patient- and disease-oriented factors must be considered in treating patients with IBD, including nutritional replenishment/support, effect of immunosuppressive medications, extent of resection, and use of proximal diversion. Perioperative planning and optimization of the patient is imperative to ensuring favorable outcomes and limiting morbidity. These perioperative considerations in Crohn disease and ulcerative colitis are reviewed here. PMID:27247531

  12. 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.

  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. Cutting Frozen Ground with Disc Saws

    DTIC Science & Technology

    1975-06-01

    a (actor ot 5. taking a depth widtli ratio toi the uncut nbs ol 2. Axle torces on the cutter wheel depend on the design ol the cutting teeth and on...position. If the shoulder of the cutting tool behind the cutting edge is exactly tangential, it will grind against uncut material and...AD-A012 114 CUTTING FROZEN GROUND UITH DISC SAWS Mai colm Mel lor Cold Regions Research and Engineering Laboratory Hanover, New

  15. 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.

  16. 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

  17. 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.

  18. 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.

  19. 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.

  20. 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.