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Sample records for perioperative frozen section

  1. Perioperative coagulation management--fresh frozen plasma.

    PubMed

    Kor, Daryl J; Stubbs, James R; Gajic, Ognjen

    2010-03-01

    Clinical studies support the use of perioperative fresh frozen plasma (FFP) in patients who are actively bleeding with multiple coagulation factor deficiencies and for the prevention of dilutional coagulopathy in patients with major trauma and/or massive haemorrhage. In these settings, current FFP dosing recommendations may be inadequate. However, a substantial proportion of FFP is transfused in non-bleeding patients with mild elevations in coagulation screening tests. This practice is not supported by the literature, is unlikely to be of benefit and unnecessarily exposes patients to the risks of FFP. The role of FFP in reversing the effects of warfarin anticoagulation is dependent on the clinical context and availability of alternative agents. Although FFP is commonly transfused in patients with liver disease, this practice needs broad reconsideration. Adverse effects of FFP include febrile and allergic reactions, transfusion-associated circulatory overload and transfusion-related acute lung injury. The latter is the most serious complication, being less common with the preferential use of non-alloimmunised, male-donor predominant plasma. FP24 and thawed plasma are alternatives to FFP with similar indications for administration. Both provide an opportunity for increasing the safe plasma donor pool. Although prothrombin complex concentrates and factor VIIa may be used as alternatives to FFP in a variety of specific clinical contexts, additional study is needed.

  2. [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.

  3. Accuracy of frozen section diagnosis of parotid lesions.

    PubMed

    Miller, R H; Calcaterra, T C; Paglia, D E

    1979-01-01

    The accuracy of frozen section diagnosis was analyzed in a review of 132 parotid lesions. Of 107 benign lesions, 93% were correctly diagnosed on frozen section analysis, but of 25 malignant lesions, only 9 frozen sections were accurately interpreted. This study points out the difficulty encountered in using the frozen section technique when dealing with malignant parotid lesions and the importance of the surgeon's active participation in the analysis.

  4. Accuracy of frozen-section diagnosis in salivary gland neoplasms.

    PubMed

    Rigual, N R; Milley, P; Loré, J M; Kaufman, S

    1986-01-01

    A retrospective review of 100 patients with major or minor salivary gland neoplasms was conducted to ascertain the accuracy and effect on therapy of frozen-section diagnosis. Of these patients, 23% had malignant and 77% benign neoplasms. Twelve patients benefited by further surgery during the initial operation, and no treatment delay occurred as a result of frozen-section diagnosis. There were four incorrect diagnoses of clinical significance, two false positives (benign tumor called malignant on frozen section) and two false negatives (malignant tumor called benign on frozen section). The accuracy of frozen section for specific pathologic diagnosis was 92%. No unnecessary radical surgery was performed. Frozen-section diagnosis of salivary gland neoplasms in our institution was found to be accurate and useful.

  5. [Ovarian tumours--accuracy of frozen section diagnosis].

    PubMed

    Ivanov, S; Ivanov, S; Khadzhiolov, N

    2005-01-01

    A retrospective study of 450 ovarian biopsy results were examined for the period of 1998 till 2004 to evaluate the accuracy of frozen section diagnosis. In addition to this we performed a review of the literature for all previous studies in this field in order to study the accuracy rates of the different clinics throughout the world. The histhopathological results of the frozen section diagnosis were equal with the diagnosis of the paraffin blocks in 90%. The sensitivity rates for benign, malignant and borderline tumours, were 96%, 84% and 60% respectively. We had 10 patients (2,1%) false-positive results (overdiagnosed) and 26 (5,2%) false-negative results (underdiagnosed) in frozen section examinations. Frozen section examination of mucinous tumours showed hogher underdiagnosis--18%. The review of the literature showed that there is no significant difference in accuracy rates of frozen section diagnosis for benign and malignant ovarian tumours in relation with time. We found low accuracy rates for borderline tumours which was similar with most of the foreign publications. However the accuracy of the frozen section diagnosis is bettering with the time. As a result of this we conclude that the accuracy rates of the frozen section diagnosis for evaluation of the malignant and benign tumours is quite enough for correct diagnosis. Since accuracy rates for borderline ovarian tumours are low we have to take care and attention of improvement in this field.

  6. Preparation of slides for microscopy from frozen tissue sections.

    PubMed

    Bachman, Julia

    2013-01-01

    Freezing tissue is a convenient method for long-term storage. In addition, sectioning tissue under frozen conditions or embedded within a frozen matrix allows for stabilization of tissue during the sectioning process. This is advantageous for small and/or delicate tissue (e.g., rodent brains younger than postnatal day 7) and tissue that will be sectioned very thin (usually <150 μm).

  7. Accuracy of frozen section in the evaluation of salivary tumors.

    PubMed

    Heller, K S; Attie, J N; Dubner, S

    1993-10-01

    The records of 333 patients who underwent surgery were reviewed to document the accuracy of frozen section in the evaluation of salivary gland tumors. Frozen sections were obtained in 310 patients. The final pathologic diagnoses included 210 benign tumors and 45 malignancies. The sensitivity for the detection of malignancy was 69%, and the specificity was 96%. The specific accuracy to correctly identify the type of malignancy present was only 51%. In four patients, a false-positive diagnosis of malignancy was made. Frozen section was much more accurate in the evaluation of benign salivary tumors. Forty-three of 45 Warthin's tumors were correctly identified by frozen section. Two tumors thought to be Warthin's tumors on frozen section proved to be low-grade mucoepidermoid carcinomas. One tumor reported to be a benign mixed tumor was actually a malignant mixed tumor. In this series of patients, frozen section proved to be no more accurate in the evaluation of salivary tumors than what has been reported in the literature for fine-needle aspiration biopsy.

  8. Accuracy of frozen section diagnosis of the salivary gland.

    PubMed

    Gnepp, D R; Rader, W R; Cramer, S F; Cook, L L; Sciubba, J

    1987-04-01

    Three hundred and one salivary gland lesions (162 benign, 72 malignant, and 67 benign non-neoplastic) of 677 cases were evaluated by use of intraoperative frozen sections by 66 pathologists. In seven patients, the diagnosis was deferred for permanent sections. In four cases (1.3%), the diagnosis at permanent section changed from one category of benign tumor to another, and in five cases (1.7%), from one category of malignant tumor to another. In four tumors, a frozen section diagnosis of benign was changed to malignant on permanent sectioning; all four involved acinic cell carcinomas. Only two tumors were incorrectly diagnosed as malignant. We conclude that diagnoses of most salivary gland lesions based on frozen section examination are reliable and accurate. However, the literature does indicate that caution should be exercised when malignant tumors are dealt with.

  9. Segmental infarction of the testis: can frozen sections avoid orchidectomy?

    PubMed

    Pacella, E; Grillo, F; Lapetina, C; Cabiddu, F; Auriati, L; Tunesi, G; Mastracci, L

    2015-03-01

    Segmental infarction (SI) of the testis is a rare condition that can masquerade as a mass lesion, thus requiring exclusion of tumour. If clinical exams do not exclude a neoplastic lesion with certainty, orchidectomy is usually performed. A case of SI of the testis is presented; the use of frozen section of the enucleated mass demonstrated the ischaemic nature of the lesion, so avoiding orchidectomy. The 8 year follow-up was uneventful. The use of frozen section in SI could permit the selection of cases in which testicular-sparing surgery should be considered.

  10. Fine needle aspiration and frozen section of salivary gland lesions.

    PubMed

    Cross, D L; Gansler, T S; Morris, R C

    1990-03-01

    This report examines the role of fine needle aspiration (FNA) and frozen section (FS) examination in the management of salivary gland lesions, and is based on a review of 58 cases. FNA specimens were first classified as nonneoplastic, or as benign or malignant neoplasms. Identification of specific morphologic type of neoplastic lesions was attempted. Overall accuracy for assigning cases was 86%. Specific accuracy (histologic type of neoplasms predicted by FNA) was 72%. No inflammatory lesion was incorrectly diagnosed as neoplasm. Eight patients with histologically documented neoplasm had aspirates classified as nonneoplastic because the sample obtained was not representative. These data indicate that FNA is a highly specific method for identifying benign and malignant neoplasms. Applications of salivary gland FNA include (1) identification of nonneoplastic lesions that may respond to nonsurgical management, (2) identification of neoplasms that represent lymph node metastases rather than primary lesions of the salivary gland, (3) preliminary identification of lymphomas, and (4) preliminary separation of benign and malignant neoplasms.

  11. 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.

  12. Accuracy of frozen-section analysis in the diagnosis of ovarian tumors: a systematic quantitative review.

    PubMed

    Medeiros, L R; Rosa, D D; Edelweiss, M I; Stein, A T; Bozzetti, M C; Zelmanowicz, A; Pohlmann, P R; Meurer, L; Carballo, M T

    2005-01-01

    A quantitative systematic review was performed to estimate the diagnostic accuracy of frozen sections in ovarian tumors. Studies that compared frozen sections and paraffin sections within subjects for diagnosis of ovarian tumors were included. Fourteen primary studies were analyzed, which included 3 659 women. For benign ovarian vs borderline/malignant tumor cases, the occurrence of a positive frozen-section result for benignity (pooled likelihood ratio [LR], 8.7; 95% confidence interval [CI], 7.3-10.4) and posttest probability for benign diagnosis was 95% (95% CI, 94-96%). A positive frozen-section result for malignant vs benign diagnosis (pooled LR, 303; 95% CI, 101-605) increased the probability of ovarian cancer to 98% (95% CI, 97-99%). In borderline vs benign ovarian tumor cases, a positive frozen-section result (pooled LR, 69; 95% CI, 45-106) increased the probability of borderline tumors to 79% (95% CI, 71-85%). In borderline vs malignant ovarian tumor cases, a positive frozen-section result (pooled LR, 18; 95% CI, 13-26) increased the probability of borderline tumors to 51% (95% CI, 42-60%). We conclude that diagnostic accuracy rates for frozen-section analysis is high for malignant and benign ovarian tumors, but the accuracy rates in borderline tumors remain relatively low.

  13. Evaluation of the value of frozen tissue section used as "gold standard" for immunohistochemistry.

    PubMed

    Shi, Shan-Rong; Liu, Cheng; Pootrakul, Llana; Tang, Laurie; Young, Andrew; Chen, Ryan; Cote, Richard J; Taylor, Clive R

    2008-03-01

    To examine the use of acetone- or ethanol-fixed frozen tissue sections as the "gold standard" for immunohistochemical analysis, we evaluated frozen sections with various conditions of fixation and antigen retrieval (AR). Fresh human tissues were frozen in OCT. An adjacent tissue block was fixed in 10% neutral buffered formalin (NBF) and paraffin embedded (FFPE). Frozen sections were fixed by 6 protocols: acetone, ethanol, NBF (2 durations), and NBF + calcium chloride (2 durations). AR was used for all NBF-fixed sections. More than half of the antibodies (16/26 [62%]) showed immunohistochemical results indistinguishable between acetone- and NBF-fixed sections; 8 (31%) showed better immunohistochemical signals following NBF and AR; 2 gave better immunohistochemical results for acetone-fixed sections. Most cytoplasmic proteins (10/13) showed comparable immunohistochemical signals between acetone- and NBF-fixed sections. For nuclear proteins, NBF-fixed sections gave better immunohistochemical signals than did acetone-fixed sections. In most cases, NBF yielded stronger signals with less background and better morphology. The data do not support the use of acetone-fixed frozen tissue sections as the gold standard for immunohistochemical analysis. In evaluating new antibodies, a combination of acetone- and NBF-fixed frozen sections should be used, although in practice, FFPE tissue sections may serve as the standard for most antigens for immunohistochemical analysis.

  14. 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

  15. 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.

  16. Frozen section as a diagnostic test for major salivary gland tumors.

    PubMed

    Mostaan, Leila V; Yazdani, Nasrin; Madani, Seyed Ziaodin; Borghei, Hasty; Mortazavi, Shabnam; Ojani, Leila; Mokhtari, Zahra

    2012-01-01

    Major salivary gland tumors are uncommon and the exact nature of these tumors is not obvious. This study was carried out to compare the histological results of intraoperative frozen sections against those of permanent reports for major salivary glands masses. One hundred thirty-nine patients with major salivary gland masses who were candidates for surgery underwent an intraoperative frozen section biopsy. A permanent histological examination was then performed for definite diagnosis and its result was compared with that of the frozen section. Sensitivity, specificity, accuracy and the positive and negative predictive values were analyzed. The frozen section had 98.4% sensitivity, 87% specificity, 97.1% accuracy, 98.4% positive predictive value and 87% negative predictive value in differentiating between non-neoplastic and neoplastic lesions. In addition, the frozen section's identification of a mass as either benign or malignant showed 98% sensitivity, 100% specificity, 99.2% accuracy, 100% positive predictive value and 99% negative predictive value. Based on the current study's findings, it can be suggested that the frozen section is considerably accurate in the diagnosis of malignant versus benign lesions of major salivary glands, regardless of the exact histopathological type of the malignant tumors.

  17. 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

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

    PubMed Central

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

    1988-01-01

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

  19. 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

  20. Paratesticular fibrous pseudotumour: Intraoperative frozen section analysis can help prevent unnecessary orchiectomy

    PubMed Central

    DeCoste, Ryan C.; Carter, Michael D.; Bagnell, Scott; Merrimen, Jennifer

    2015-01-01

    Paratesticular fibrous pseudotumours are rare intrascrotal lesions, most frequently affecting the testicular tunics. They are benign in nature; however, their pathogenesis is not completely understood. Presenting features are similar to testicular malignancy, which may result in unnecessary radical surgery. It has been suggested that additional diagnostic imaging combined with frozen section analysis may help prevent orchiectomy in these patients. We describe a case of paratesticular fibrous pseudotumour in a 40-year-old male treated with testicle-sparing surgery aided by intraoperative frozen section analysis. PMID:26664509

  1. Tumors of the salivary glands. Comparison of frozen-section diagnosis with final pathologic diagnosis.

    PubMed

    Wheelis, R F; Yarington, C T

    1984-02-01

    Of the 256 cases of salivary gland tumors subjected to frozen-section diagnosis, the error rate in diagnosis for malignant disease was one of four cases, and in benign disease, it was one of ten cases. Six of the 52 malignant tumors were erroneously labeled as benign, while four of the 204 benign tumors were diagnosed as malignant neoplasms. The occurrence of concurrent benign and malignant disease, nonneoplastic alterations of salivary gland tissue, and sampling errors militated against total reliance on frozen-section diagnosis in the management of salivary gland neoplasms.

  2. Quantification of sarcomere length distribution in whole muscle frozen sections.

    PubMed

    O'Connor, Shawn M; Cheng, Elton J; Young, Kevin W; Ward, Samuel R; Lieber, Richard L

    2016-05-15

    Laser diffraction (LD) is a valuable tool for measuring sarcomere length (Ls), a major determinant of muscle function. However, this method relies on few measurements per sample that are often extrapolated to whole muscle properties. Currently it is not possible to measure Ls throughout an entire muscle and determine how Ls varies at this scale. To address this issue, we developed an actuated LD scanner for sampling large numbers of sarcomeres in thick whole muscle longitudinal sections. Sections of high optical quality and fixation were produced from tibialis anterior and extensor digitorum longus muscles of Sprague-Dawley rats (N=6). Scans produced two-dimensional Ls maps, capturing >85% of the muscle area per section. Individual Ls measures generated by automatic LD and bright-field microscopy showed excellent agreement over a large Ls range (ICC>0.93). Two-dimensional maps also revealed prominent regional Ls variations across muscles. PMID:26994184

  3. Cytodiagnosis of 112 salivary gland lesions. Correlation with histologic and frozen section diagnosis.

    PubMed

    Chan, M K; McGuire, L J; King, W; Li, A K; Lee, J C

    1992-01-01

    Aspirates of 112 cases of salivary gland lesions with histologic correlation were reviewed. Fifty-five cases (49%) had frozen sections made. The 112 cases included 76 cases of benign lesions (31 cases of pleomorphic adenoma, 19 of Warthin's tumor and 26 of nonneoplastic lesions), 22 of primary salivary gland malignancy and 14 of metastatic malignant lesions. The overall accuracy in diagnosing benign and malignant lesions was 95%. The accuracy in diagnosing the exact category of neoplastic lesions was 70%. The diagnostic sensitivity for malignant lesions was 86% and the specificity, 99%. There was one false positive, in which a pleomorphic adenoma was diagnosed as small cell carcinoma. Five false-negative cases were encountered that were due to underdiagnosis of mucoepidermoid carcinoma and adenoid cystic carcinoma. The smears were reviewed, and the diagnostic pitfalls are discussed. A comparison of the cytodiagnosis and frozen section diagnosis was made. In frozen sections there were two false negatives, and two diagnoses were deferred. The overall diagnostic accuracy was 91%. The accuracy in diagnosing the exact category of neoplastic disease was 77%. The diagnostic sensitivity for malignant disease was 70% and specificity, 100%. Frozen section, however, did supplement the fine needle aspiration diagnosis in 13 cases.

  4. 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

  5. Diagnostic accuracy of remote frozen sections compared with paraffin-embedded sections: a telepathology project in Austria

    NASA Astrophysics Data System (ADS)

    Moser, Patrizia; Soegner, Peter I.; Stadlmann, Sonja; Jacobs, Jan; Mikuz, Gregor

    2000-04-01

    The purpose of the present study was to evaluate the diagnostic accuracy of remote frozen sections examined by telepathology. The gold standard was the diagnosis made using direct examination of paraffin-embedded sections. A consecutive series of 134 frozen-section cases were examined by six qualified pathologists. We used the Zeiss telepathology system with robot microscopy, which allowed different magnifications and fields of view to be chosen. The wide-area network used the TCP/IP protocol. The diagnosis made on the frozen sections was compared with the final diagnosis in the paraffin-embedded sections. Times were recorded for each telepathology session, as well as the users comments on usability and software, and on any communication problems which occurred. In addition, we evaluated the importance of the macroscopic sampling of the surgical specimen, applied to each type of tissue. The diagnostic evaluation showed complete agreement in approximately 80% of cases, in 20% diagnosis was not possible due to insufficient quality of the slides. The median time for the telemedicine diagnosis was 14 min 30 sec.

  6. Practical issues related to uterine pathology: staging, frozen section, artifacts, and Lynch syndrome.

    PubMed

    Soslow, Robert A

    2016-01-01

    This review covers three areas in endometrial tumor pathology: International Federation of Gynecology and Obstetrics (FIGO) staging, the use of frozen section, and Lynch syndrome. The section on FIGO staging will emphasize problems that practicing pathologists often confront, such as measuring the depth of myometrial invasion, assessing for the presence of cervical stromal invasion, detecting low-volume lymph node metastases, and recognizing synchronous endometrial and ovarian tumors and artifacts. The frozen section portion of this review will focus on the performance characteristics of intraoperative examination of the uterus to determine tumor grade and depth of myometrial invasion, including suggestions for alternative methods. The last portion of this review will provide an overview of Lynch syndrome and a discussion of the rationale and methods of screening for Lynch syndrome.

  7. Practical issues related to uterine pathology: staging, frozen section, artifacts, and Lynch syndrome.

    PubMed

    Soslow, Robert A

    2016-01-01

    This review covers three areas in endometrial tumor pathology: International Federation of Gynecology and Obstetrics (FIGO) staging, the use of frozen section, and Lynch syndrome. The section on FIGO staging will emphasize problems that practicing pathologists often confront, such as measuring the depth of myometrial invasion, assessing for the presence of cervical stromal invasion, detecting low-volume lymph node metastases, and recognizing synchronous endometrial and ovarian tumors and artifacts. The frozen section portion of this review will focus on the performance characteristics of intraoperative examination of the uterus to determine tumor grade and depth of myometrial invasion, including suggestions for alternative methods. The last portion of this review will provide an overview of Lynch syndrome and a discussion of the rationale and methods of screening for Lynch syndrome. PMID:26715174

  8. Diagnostic accuracy of intraoperative consultation (frozen section) in borderline ovarian tumours and factors associated with misdiagnosis.

    PubMed

    Basaran, D; Salman, M C; Calis, P; Ozek, A; Ozgul, N; Usubütün, A; Yuce, K

    2014-07-01

    The objective of our study was to evaluate the accuracy of frozen section (FS) in borderline ovarian tumours (BOT) and to define the factors associated with misdiagnosis during FS evaluation. We performed a retrospective review of patients who underwent exploratory laparotomy for an adnexal mass, from January 2007 to July 2012, at a tertiary oncology centre in Turkey. Patients with a diagnosis of BOT either in FS or in permanent pathology were identified. Agreement between FS diagnosis and permanent histology was observed in 37/59 patients (62.7%), which gave a sensitivity and a positive predictive value of 71.2% and 84.1%, respectively. In patients with a diagnosis of BOT by frozen section only (n = 44), the diagnosis was consistent with permanent histopathology in 37/44 patients (84.1%). Frozen section interpreted a malignant tumour as BOT (under-diagnosis) in 6/44 (13.6%) of cases and interpreted a benign lesion as BOT (over-diagnosis) in 1/44 (2.3%) of cases. Slide review of discrepant cases revealed that major pathological causes of under-diagnosis were misinterpretation and sampling errors. Univariate analysis showed that presence of bilateral tumour and positive peritoneal cytology were associated with under-diagnosis. We concluded that, despite significant risk of under-diagnosis, FS analysis is an accurate method for intraoperative diagnosis of BOTs.

  9. Errors, limitations, and pitfalls in the diagnosis of central and peripheral nervous system lesions in intraoperative cytology and frozen sections

    PubMed Central

    Chand, Priyanka; Amit, Sonal; Gupta, Raghvendra; Agarwal, Asha

    2016-01-01

    Context: Intraoperative cytology and frozen section play an important role in the diagnosis of neurosurgical specimens. There are limitations in both these procedures but understanding the errors and pitfalls may help in increasing the diagnostic yield. Aims: To find the diagnostic accuracy of intraoperative cytology and frozen section for central and peripheral nervous system (PNS) lesions and analyze the errors, pitfalls, and limitations in these procedures. Settings and Design: Eighty cases were included in this prospective study in a span of 1.5 years. Materials and Methods: The crush preparations and the frozen sections were stained with hematoxylin and eosin method. The diagnosis of crush smears and the frozen sections were compared with the diagnosis in the paraffin section, which was considered as the gold standard. Statistical Analyses Used: Diagnostic accuracy, sensitivity, and specificity. Results: The diagnostic accuracy of crush smears was 91.25% with a sensitivity of 95.5% and specificity of 100%. In the frozen sections, the overall diagnostic accuracy was 95%, sensitivity was 96.8%, and specificity was 100%. The categories of pitfalls noted in this study were categorization of spindle cell lesions, differentiation of oligodendroglioma from astrocytoma in frozen sections, differentiation of coagulative tumor necrosis of glioblastoma multiforme (GBM) from the caseous necrosis of tuberculosis, grading of gliomas in frozen section, and differentiation of the normal granular cells of the cerebellum from the lymphocytes in cytological smears. Conclusions: Crush smear and frozen section are complimentary procedures. When both are used together, the diagnostic yield is substantially increased. PMID:27279685

  10. Fine-needle aspiration of salivary gland lesions. Comparison with frozen sections and histologic findings.

    PubMed

    Layfield, L J; Tan, P; Glasgow, B J

    1987-04-01

    The results of 171 salivary gland fine-needle aspirates, with subsequent histologic correlation, were compared with those from previous head and neck series and analyzed for diagnostic accuracy. Cytologically, 118 cases were diagnosed as benign; 51, malignant; and two, insufficient for diagnosis. The false-negative rate was 4.7%, and the false-positive rate was 3.5%. Pleomorphic adenoma, mucoepidermoid carcinoma, chronic sialadenitis, and malignant lymphoma were the lesions most frequently misdiagnosed. Corresponding frozen sections (available in 38 cases) showed an exact correlation with the final surgical pathologic diagnosis in 58% of the cases, with no false-positive diagnoses but an 11% false-negative rate.

  11. 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.

  12. 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. PMID:27649947

  13. Perioperative analgesic effects of intravenous paracetamol: Preemptive versus preventive analgesia in elective cesarean section

    PubMed Central

    Hassan, Hossam Ibrahim Eldesuky Ali

    2014-01-01

    Background: Cesarean section (CS) is the one of the most common surgical procedure in women. There is preoperative stress effect before the delivery of the baby as (intubation and skin incision). There is acute postoperative pain, which may be progressed to chronic pain. All these perioperative stress effects need for various approach of treatment, which including systemic and neuraxial analgesia. The different analgesia modalities may affect and impair early interaction between mother and infant. Preemptive intravenous (I.V.) paracetamol (before induction) may reduce stress response before the delivery of the baby, intraoperative opioids and postoperative pain. Objectives: The aim of this study to compare between the administration of I.V. paracetamol as: Preemptive analgesia (preoperative) and preventive analgesia (at the end of surgery) as regards of hemodynamic, pain control, duration of analgesia, cumulative doses of intraoperative opioids and their related side-effects and to compare between two different protocols of postoperative analgesia and their cumulative doses. Patients and Methods: Sixty patients undergoing elective CS were randomly enrolled in this study and divided into two groups of 30 patients each. Group I: i.V. paracetamol 1 g (100 ml) was given 30 min before induction of anesthesia. Group II: i.V. paracetamol 1 g (100 ml) was given 30 min before the end of surgery. Heart rate, systolic blood pressure, diastolic blood pressure, and peripheral oxygen saturation were recorded. Postoperative pain was assessed by visual analog score. Postoperative pethidine was given by two different protocols: group I: 0.5 mg/kg was divided into 0.25 mg/kg intramuscular and 0.25 mg/kg I.V. Group II was given pethidine 0.5 mg/kg I.V. Doses of intraoperative fentanyl, postoperative pethidine, duration of paracetamol analgesic time, time to next analgesia, and side-effects of opioid were noted and compared. Result: Preemptive group had hemodynamic stability

  14. 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. PMID:16348731

  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. 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.

  18. 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.

  19. Salivary gland tumors. Fine-needle aspiration vs frozen-section diagnosis.

    PubMed

    Cohen, M B; Ljung, B M; Boles, R

    1986-08-01

    We examined the relative accuracy of fine-needle aspiration biopsy (FNAB) and frozen section (FS) in the diagnosis of salivary gland tumors; FNAB completely and accurately diagnosed 35 (88%) of 40 cases, including ten (100%) of ten nonneoplastic lesions, 20 (87%) of 23 benign, and five (71%) of seven malignant tumors. No complications were encountered with this procedure. These results compare favorably with previously published reports. Twenty-one of 40 tumors diagnosed by FNAB and FS at surgery. Sixteen (76%) of 21 of these were correctly diagnosed by FNAB, and 15 (71%) of 21 by FS. Cystic lesions gave the most diagnostic difficulties both on FNAB and FS. Worldwide, FNAB has been demonstrated to be a cost-effective, accurate, and safe procedure. Furthermore, the use of FNAB allows for better preoperative management and overall treatment planning.

  20. 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.

  1. Diagnostic Accuracy of Frozen Section of Central Nervous System Lesions: A 10-Year Study

    PubMed Central

    KHODDAMI, Maliheh; AKBARZADEH, Ali; MORDAI, Afshin; BIDARI - ZEREHPOUSH, Farahnaz; ALIPOUR, Hamid; SAMADZADEH, Sara; ALIPOUR, Bijan

    2015-01-01

    Objective Definitive diagnosis of the central nervous system (CNS) lesions is unknown prior to histopathological examination. To determine the method and the endpoint for surgery, intraoperative evaluation of the lesion helps the surgeon. In this study, the diagnostic accuracy and pitfalls of using frozen section (FS) of CNS lesions is determined. Materials & Methods In this retrospective study, we analyzed the results of FS and permanent diagnoses of all CNS lesions by reviewing reports from 3 general hospitals between March 2001 and March 2011. Results 273 cases were reviewed and patients with an age range from 3 to 77 years of age were considered. 166 (60.4%) had complete concordance between FS and permanent section diagnosis, 83 (30.2%) had partial concordance, and 24 cases (9.5%) were discordant. Considering the concordant and partially concordant cases, the accuracy rate was 99.5%, sensitivity was 91.4%, specificity was 99.7%, and positive and negative predictive values were 88.4% and 99.8%, respectively. Conclusion Our results show high sensitivity and specificity of FS diagnosis in the evaluation of CNS lesions. A Kappa agreement score of 0.88 shows high concordance for FS results with permanent section. Pathologist’s misinterpretation, small biopsy samples (not representative of the entire tumor), suboptimal slides, and inadequate information about tumor location and radiologic findings appear to be the major causes for these discrepancies indicated from our study. PMID:25767535

  2. The diagnostic properties of frozen sections in suspected intracranial tumors: A study of 578 consecutive cases

    PubMed Central

    Tofte, Kathrine; Berger, Cathrine; Torp, Sverre Helge; Solheim, Ole

    2014-01-01

    Background: Intraoperative frozen section (FS) diagnostics is an important diagnostic tool in neurosurgery, but agreement with final histopathology diagnoses may vary. In the present study we assess the diagnostic properties of intraoperative FSs in suspected intracranial tumors. Methods: Retrospective single-center review of consecutive patients with suspected intracranial brain tumors from January 2008 to December 2012. We included all cases were both an intraoperative FS and a formalin-fixed paraffin-embedded (FFPE) section had been acquired. Agreement with final diagnosis, sensitivity, specificity, and predictive values were explored. Time between date of surgery and first final diagnosis based on FFPE section, whether the patients had undergone previous brain surgery and/or prior cerebral radiotherapy were also registered. Results: Agreement between FS diagnoses and final FFPE section diagnoses was seen in 504/558 (90.3%), while there was lack of agreement in 54/558 (9.7%). In 20 cases, agreement was not classifiable. Agreement was lower in low-grade gliomas (82.5%) than in high-grade gliomas (93.2%). Agreement between FS and FFPE was significantly higher in primary operations (92.1%) than in re-do operations (81.5%) (P = 0.001). Sensitivity of FS ranged from 30.8% in lymphomas to 94.6% in meningiomas. Conclusions: Intraoperative FS diagnoses demonstrate high diagnostic accuracy. However, agreement varies among histopathological entities and is lower in low-grade tumors than in high-grade tumors. Sensitivity for diagnosing CNS lymphomas is low. A variable degree of reservation is always necessary when interpreting and communicating FS diagnoses. PMID:25593754

  3. Interactions between actin and myosin filaments in skeletal muscle visualized in frozen-hydrated thin sections.

    PubMed

    Trus, B L; Steven, A C; McDowall, A W; Unser, M; Dubochet, J; Podolsky, R J

    1989-04-01

    For the purpose of determining net interactions between actin and myosin filaments in muscle cells, perhaps the single most informative view of the myofilament lattice is its averaged axial projection. We have studied frozen-hydrated transverse thin sections with the goal of obtaining axial projections that are not subject to the limitations of conventional thin sectioning (suspect preservation of native structure) or of equatorial x-ray diffraction analysis (lack of experimental phases). In principle, good preservation of native structure may be achieved with fast freezing, followed by low-dose electron imaging of unstained vitrified cryosections. In practice, however, cryosections undergo large-scale distortions, including irreversible compression; furthermore, phase contrast imaging results in a nonlinear relationship between the projected density of the specimen and the optical density of the micrograph. To overcome these limitations, we have devised methods of image restoration and generalized correlation averaging, and applied them to cryosections of rabbit psoas fibers in both the relaxed and rigor states. Thus visualized, myosin filaments appear thicker than actin filaments by a much smaller margin than in conventional thin sections, and particularly so for rigor muscle. This may result from a significant fraction of the myosin S1-cross-bridges averaging out in projection and thus contributing only to the baseline of projected density. Entering rigor incurs a loss of density from an annulus around the myosin filament, with a compensating accumulation of density around the actin filament. This redistribution of mass represents attachment of the fraction of cross-bridges that are visible above background. Myosin filaments in the "nonoverlap" zone appear to broaden on entering rigor, suggesting that on deprivation of ATP, cross-bridges in situ move outwards even without actin in their immediate proximity.

  4. Fine needle aspiration cytology and frozen section in the diagnosis of malignant parotid tumours.

    PubMed

    Fakhry, N; Santini, L; Lagier, A; Dessi, P; Giovanni, A

    2014-07-01

    The aim of this study was to determine the value of fine needle aspiration cytology (FNAC) and frozen section (FS) in the diagnosis of malignant parotid tumours. One hundred and thirty-eight patients who underwent FNAC and FS of a parotid tumour between 2006 and 2011 were analyzed retrospectively. The sensitivity, specificity, and positive and negative predictive values of FNAC and FS were determined using final histological diagnosis as the gold standard. Of the 138 tumours assessed in our study, 30 were malignant and 108 benign. For FNAC, the sensitivity was 73%, specificity 87%, positive predictive value 61%, and negative predictive value 90%. For FS, the sensitivity was 80%, specificity 98%, positive predictive value 92%, and negative predictive value 94%. Four false-negative results by FNAC were corrected by FS, and surgery was completed. Two false-positive results were identified by both FNAC and FS. FNAC is an important examination that provides valuable information for the preoperative diagnostic work-up and alerts the surgeon to the possible presence of malignancy. However, FNAC cannot be used alone, and FS has a very important place in the intraoperative management of parotid tumours.

  5. Application of scanning electron microscopy to x-ray analysis of frozen- hydrated sections. I. Specimen handling techniques

    PubMed Central

    1981-01-01

    X-ray microanalysis of frozen-hydrated tissue sections permits direct quantitative analysis of diffusible elements in defined cellular compartments. Because the sections are hydrated, elemental concentrations can be defined as wet-weight mass fractions. Use of these techniques should also permit determination of water fraction in cellular compartments. Reliable preparative techniques provide flat, smooth, 0.5 micrometers-thick sections with little elemental and morphological disruption. The specimen support and transfer system described permits hydrated sections to be transferred to the scanning electron microscope cold stage for examination and analysis without contamination or water loss and without introduction of extraneous x- ray radiation. PMID:7204491

  6. 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

  7. The influence of immunohistochemistry on mRNA recovery from microdissected frozen and formalin-fixed, paraffin-embedded sections.

    PubMed

    Gjerdrum, Lise Mette; Abrahamsen, Helene N; Villegas, Berta; Sorensen, Boe S; Schmidt, Henrik; Hamilton-Dutoit, Stephen J

    2004-12-01

    Laser-assisted microdissection (LAM) is now widely used to obtain specific cell populations from heterogeneous tissues. A major disadvantage of LAM is poor tissue morphology during microscopy, in part because coverslips are not used. Immunohistochemical labeling can improve identification of target cells but may affect the subsequent analysis of the microdissected tissue. We studied the effect of immunohistochemistry (IHC) on mRNA recovery from labeled cells after microdissection from both frozen and formalin-fixed, paraffin-embedded (FFPE) sections, using Melan-A and Ki-67 staining in lymph nodes with metastatic melanoma as a model. We developed rapid protocols for immunostaining in an attempt to limit loss of mRNA during procedures. A sensitive real-time quantitative reverse transcription-PCR was used to measure mRNA. We found a marked decrease in the mRNA yield from 500 microdissected cells from frozen and paraffin sections after immunostaining for both markers. Recovery of mRNA decreased by up to 89%, comparing the immunostained with the routinely stained sections. Interestingly, the ratio between mRNA for the two markers was similar in all stains, indicating that immunostained sections may be used for mRNA analysis. We also investigated the effect of storing membrane-mounted sections for microdissection under different conditions. Slides mounted with paraffin sections could be stored at room temperature for up to 90 days with no significant decrease in mRNA recovery.

  8. Accuracy of intraoperative frozen section diagnosis in head and neck surgery: experience at a university medical center.

    PubMed

    Gandour-Edwards, R F; Donald, P J; Wiese, D A

    1993-01-01

    We performed 2,210 intraoperative frozen sections on 258 patients from the Otolaryngology-Head and Neck Surgery Service in 1990 and 1991. Surgery involved a wide variety of benign and malignant lesions. Techniques included biopsies for diagnosis, simple excision, thyroid and salivary gland surgeries, lymph node biopsies, composite resections with radical neck dissections, laryngectomies, and skull base surgeries. During the 2-year period, 1,947 (88.1%) sections were requested for evaluation of surgical margins, 258 (11.7%) for diagnosis, and five (0.2%) cases for tissue identification. There was disagreement between the frozen section and permanent section in 46 (2.1%) cases, and the deferral diagnosis rate was 0.8%. Disagreements were the result of sampling errors in 33 and interpretive errors in 13 cases. There were six (0.3%) false-negative diagnosis of malignancy and four (0.2%) false-positive diagnoses of malignancy. Three of these had an impact on patient care as discussed. We recommend careful sampling and sectioning of small biopsies and the need for vigilant communication between surgeon and pathologist.

  9. Freezing without Ice Crystal Damage: Semithin and Ultrathin Frozen Sections of Ethanol-Infiltrated Tissue for Microscopy, with Applications to Immunocytochemistry

    NASA Astrophysics Data System (ADS)

    Christensen, A. Kent; Lowry, Terry B.

    1995-10-01

    Ethanol (ethyl alcohol) has long been a standard reagent used in preparing tissues for light and electron microscopy. After fixation, tissues are usually dehydrated with ethanol before being embedded in paraffin or plastic. In this study we show that the ethanol-infiltrated tissue can be frozen and sectioned directly without embedding. When tissue impregnated with ethanol is cooled below about [minus sign]117°C with liquid nitrogen, the ethanol solidifies without appreciable crystallization. The frozen tissue can then be sectioned in a commercial cryoultramicrotome that is set at [minus sign]155 to [minus sign]170°C to produce semithin frozen sections (0.5 to 3 [mu]m thick) for light microscopy or ultrathin frozen sections (50 to 100 nm thick) for electron microscopy. Sections are picked up and mounted on glass slides or EM grids by means that are in current use for ice ultrathin frozen sectioning. Because there is no apparent freezing damage, the morphology in these ethanol frozen sections of unembedded tissue appears generally quite good, often resembling that obtained by conventional EM techniques. Examples are provided that illustrate the use of this material for immunocytochemistry at the light and electron microscope levels.

  10. A simple method for fixation and microdissection of frozen fresh tissue sections for molecular cytogenetic analysis of cancers.

    PubMed

    Huang, Q; Sacks, P G; Mo, J; McCormick, S A; Iacob, C E; Guo, L; Schaefer, S; Schantz, S P

    2005-01-01

    Microdissection has been widely used for procuring DNA from specific microscopic regions of formalin fixed, paraffin embedded tissue sections. We have developed a method for fixation and microdissection of frozen fresh biopsy tissue sections. Five micrometer frozen fresh tissue sections were fixed with ethanol and stored at room temperature. Well defined regions from hematoxylin and eosin (H & E) stained or unstained sections were briefly steamed and microdissected using a needle. The dissected tissue was digested with proteinase K and DNA was isolated. Whole genome amplifications were obtained by degenerate oligonucleotide primed polymerase chain reaction (DOP-PCR) from these samples. The reliability of this technique was demonstrated by comparing conventional comparative genomic hybridization (CGH) with DOP-PCR-CGH. The advantages of this method are that frozen fresh sections can be fixed easily and stored for more than 4 years, it is easy to microdissect and pick-up very minute regions (0.1 mm(2)), and it is rapid; microdissection and purification can be accomplished within 3 h. Using DNA from microdissected sections, DOP-PCR-CGH revealed genetic abnormalities more accurately than conventional CGH. Although this novel method was demonstrated using DOP-PCR-CGH, we believe that it will be useful for other genetic analyses of specific small regions and cell populations. We also observed whether storage time, H & E staining and crude DNA extracts affected the quality of amplified DNA. DNA integrity was maintained for at least 49 months in ethanol fixed sections that were stored at room temperature, but DNA was gradually degraded after one month if the ethanol fixed sections had been H & E stained and stored. When crude DNA extracts from H & E stained sections were used, the size of the DOP-PCR product was reduced. Our study suggests that ethanol fixed tissue sections may be stored at room temperature for at least 4 years without DNA degradation, the H & E stains may

  11. 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.

  12. Affinity imaging mass spectrometry (AIMS): high-throughput screening for specific small molecule interactions with frozen tissue sections.

    PubMed

    Yoshimi, T; Kawabata, S; Taira, S; Okuno, A; Mikawa, R; Murayama, S; Tanaka, K; Takikawa, O

    2015-11-01

    A novel screening system, using affinity imaging mass spectrometry (AIMS), has been developed to identify protein aggregates or organ structures in unfixed human tissue. Frozen tissue sections are positioned on small (millimetre-scale) stainless steel chips and incubated with an extensive library of small molecules. Candidate molecules showing specific affinity for the tissue section are identified by imaging mass spectrometry (IMS). As an example application, we screened over a thousand compounds against Alzheimer's disease (AD) brain tissue and identified several compounds with high affinity for AD brain sections containing tau deposits compared to age-matched controls. It should also be possible to use AIMS to isolate chemical compounds with affinity for tissue structures or components that have been extensively modified by events such as oxidation, phosphorylation, acetylation, aggregation, racemization or truncation, for example, due to aging. It may also be applicable to biomarker screening programs. PMID:26365298

  13. A cryoprotection method that facilitates cutting frozen sections of whole monkey brains for histological and histochemical processing without freezing artifact.

    PubMed

    Rosene, D L; Roy, N J; Davis, B J

    1986-10-01

    Cutting frozen sections of large (greater than 60 cc) blocks of monkey brain using the conventional procedures of infiltration with 30% sucrose as a cryoprotectant before freezing with pulverized dry ice often produces unacceptable levels of freezing artifact (FA) caused by displacement of tissue by ice crystals. Experiments investigating FA utilized perfusion-fixed brains from 46 monkeys and spanned combinations of cryoprotectants (glycerol, sucrose), freezing methods (dry ice or -75 degrees C isopentane), and fixatives (10% formalin, Karnovsky's or Timm's). The effects were evaluated by rating of FA severity in frozen sections of whole monkey brains. Minor FA appears as enlarged capillaries, more serious FA as large vacuoles, and both first appear midway between the periphery and center of the block. Stronger fixatives increased the severity of freezing artifact. The best method for eliminating FA was graded infiltration with up to 20% glycerol and 2% DMSO (in buffer or fixative), followed by rapid freezing in -75 degrees C isopentane. Although using a glycerol-DMSO infiltration before conventional freezing with pulverized dry ice or using conventional sucrose infiltration before freezing in isopentane gave better results than sucrose infiltration and dry-ice freezing, only the combination of glycerol-DMSO infiltration and freezing in isopentane produced consistently excellent results and virtually eliminated freezing artifact. To determine the effect of freezing with dry ice or isopentane on the rate of cooling in large blocks of CNS tissue, thermocouples were embedded in an 80-cc block of albumin-gelatin and frozen with the two methods. The rate of cooling (-3.5 degrees C/min) was twice as fast using isopentane.

  14. 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. PMID:26358710

  15. 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

  16. 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

  17. 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.

  18. 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.

  19. Use of the frozen section 'jelly-roll' technique to aid in the diagnosis of bullous congenital ichthyosiform erythroderma (epidermolytic hyperkeratosis).

    PubMed

    Galler, Blake; Bowen, Casey; Arnold, Jason; Kobayashi, Todd; Dalton, Scott R

    2016-05-01

    Frozen section is a valuable tool that is often underutilized in the setting of in-patient dermatology. Traditionally, frozen section has been used in dermatology to diagnose toxic epidermal necrolysis, with some additional utility in staphylococcal scalded skin syndrome in the new born period. We report a newborn female with ruptured bullae on the face, chest, back and extremities with a clinical differential diagnosis that included staphylococcal scalded skin, bullous congenital ichthyosiform erythroderma/epidermolytic hyperkeratosis and epidermolysis bullosa. A thin detached skin sample ('jelly-roll') taken from a ruptured bulla on the abdomen was prepared for frozen section analysis. Characteristic findings of epidermolytic hyperkeratosis were seen which included hyperkeratosis with granular layer degeneration, vacuolization and eosinophilic globules. The 'jelly-roll' technique can be used for quick diagnosis with minimal trauma to the patient. Epidermolytic hyperkeratosis was subsequently confirmed by a biopsy fixed in formalin and by genetic testing. A novel missense mutation in KRT1 (I479N) was identified. Herein, we discuss the use of the frozen section 'jelly roll' technique for rapid diagnosis in a case of bullous congenital ichthyosis erythroderma/epidermolytic hyperkeratosis. PMID:26969483

  20. Use of the frozen section 'jelly-roll' technique to aid in the diagnosis of bullous congenital ichthyosiform erythroderma (epidermolytic hyperkeratosis).

    PubMed

    Galler, Blake; Bowen, Casey; Arnold, Jason; Kobayashi, Todd; Dalton, Scott R

    2016-05-01

    Frozen section is a valuable tool that is often underutilized in the setting of in-patient dermatology. Traditionally, frozen section has been used in dermatology to diagnose toxic epidermal necrolysis, with some additional utility in staphylococcal scalded skin syndrome in the new born period. We report a newborn female with ruptured bullae on the face, chest, back and extremities with a clinical differential diagnosis that included staphylococcal scalded skin, bullous congenital ichthyosiform erythroderma/epidermolytic hyperkeratosis and epidermolysis bullosa. A thin detached skin sample ('jelly-roll') taken from a ruptured bulla on the abdomen was prepared for frozen section analysis. Characteristic findings of epidermolytic hyperkeratosis were seen which included hyperkeratosis with granular layer degeneration, vacuolization and eosinophilic globules. The 'jelly-roll' technique can be used for quick diagnosis with minimal trauma to the patient. Epidermolytic hyperkeratosis was subsequently confirmed by a biopsy fixed in formalin and by genetic testing. A novel missense mutation in KRT1 (I479N) was identified. Herein, we discuss the use of the frozen section 'jelly roll' technique for rapid diagnosis in a case of bullous congenital ichthyosis erythroderma/epidermolytic hyperkeratosis.

  1. Visualizing Oxazine 4 nerve-specific fluorescence ex vivo in frozen tissue sections

    NASA Astrophysics Data System (ADS)

    Barth, Connor W.; Gibbs, Summer L.

    2016-03-01

    Nerve damage plagues surgical outcomes and remains a major burden for patients, surgeons, and the healthcare system. Fluorescence image-guided surgery using nerve specific small molecule fluorophores offers a solution to diminish surgical nerve damage through improved intraoperative nerve identification and visualization. Oxazine 4 has shown superior nerve specificity in initial testing in vivo, while exhibiting a red shifted excitation and emission spectra compared to other nerve-specific fluorophores. However, Oxazine 4 does not exhibit near-infrared (NIR) excitation and emission, which would be ideal to improve penetration depth and nerve signal to background ratios for in vivo imaging. Successful development of a NIR nerve-specific fluorophore will require understanding of the molecular target of fluorophore nerve specificity. While previous small molecule nerve-specific fluorophores have demonstrated excellent ex vivo nerve specificity, Oxazine 4 ex vivo nerve specific fluorescence has been difficult to visualize. In the present study, we examined each step of the ex vivo fluorescence microscopy sample preparation procedure to discover how in vivo nerve-specific fluorescence is changed during ex vivo tissue sample preparation. Through step-by-step examination we found that Oxazine 4 fluorescence was significantly diminished by washing and mounting tissue sections for microscopy. A method to preserve Oxazine 4 nerve specific fluorescence ex vivo was determined, which can be utilized for visualization by fluorescence microscopy.

  2. [Perioperative tachyarrhythmia].

    PubMed

    David, I

    2002-07-01

    Sudden onset of tachyarrhythmias in an operating theatre or an intensive care unit can be a frustrating experience for an attending physician and sometimes even for his patient, not only because of severity of patient's clinical state, but also for the mental stress loaded on him by collaborating surgeons. From that reason, a diagnosis and treatment of such condition should be intensive, simple, effective and safe for the patient. Increased activity of sympathoadrenal system is the main pathophysiological condition in the pathogenesis of perioperative arrhythmias that can provoke sinus tachycardia followed with a transient myocardial ischaemia and other deleterious effects. Sympathetic nervous system stability plays an important role in the prevention and treatment of perioperative arrhythmias. In this review article, the author highlights a basic electrophysiology and molecular pathophysiology of heart rhythm disturbances, and on the background of recent clinical studies he tries to propose a simplified therapeutic algorithm for treatment of these difficult states. Beta-blockers and group III, antiarrhythmics of Vaughan-Williams classification (amidarone) are recommended as the optimal remedies for the treatment of tachyarrhythmias in the perioperative period.

  3. Mineralization process during acellular cementogenesis in rat molars: a histochemical and immunohistochemical study using fresh-frozen sections.

    PubMed

    Yamamoto, Tsuneyuki; Domon, Takanori; Takahashi, Shigeru; Anjuman, Khan Ara Yasmin; Fukushima, Chifumi; Wakita, Minoru

    2007-03-01

    This study was designed to detect tissue non-specific alkaline phosphatase (TNSALP) by Azo-dye staining, calcium by glyoxal bis (2-hydroxyanil) (GBHA) staining, bone sialoprotein (BSP) and osteopontin (OPN) by immunoperoxidase staining in developing rat molars, and also to discuss the mineralization process during acellular cementogenesis. To restrain a reduction in histochemical and immunohistochemical reactions, fresh-frozen undemineralized sections were prepared. Where the epithelial sheath was intact, TNSALP reaction was observed in the dental follicle, but not in the epithelial sheath. With the onset of dentin mineralization, the BSP- and OPN-immunoreactive, initial cementum layer appeared. At this point, cementoblasts had shown intense TNSALP reaction and GBHA reactive particles (=calcium-GBHA complex) appeared on the root surface. With further development, the reaction of TNSALP and GBHA became weak on the root surface. Previous studies have shown that the initial cementum is fibril-poor and that matrix vesicles and calciferous spherules appear on the root surface only during the initial cementogenesis. The findings mentioned above suggest that: during the initial cementogenesis, cementoblasts release matrix vesicles which result in calciferous spherules, corresponding to the GBHA reactive particles. The calciferous spherules trigger the mineralization of the initial cementum. After principal fiber attachment, mineralization advances along collagen fibrils without matrix vesicles. PMID:17043865

  4. Expression of blood group antigens in urinary tract tumours: prospective fluorescence study using cryostat sections of fresh frozen tissues.

    PubMed Central

    Thorpe, S J; Abel, P; Henderson, D; Jones, N; Feizi, T

    1986-01-01

    Cryostat sections of fresh frozen tissues were used in a prospective study of blood group H and A antigen fluorescence in 73 transitional cell carcinomas of the bladder. The aim was to evaluate antigen expression without subjecting the tumour tissues to organic solvents that extract blood group active glycolipids. Deletion of the genetically predicted antigen was twice as common in tumours of pT1 or greater stage than those of pTa stage and also twice as common in poorly differentiated than in moderately well differentiated tumours. The considerable heterogeneity and overlap, however, in patterns of reactivity in tumours of various histopathological stages and grades and the effect of secretor status on antigenicity meant that there was no obvious antigenic feature that correlated precisely with invasive stage or differentiation grade. It remains to be determined whether the antigen positive and antigen negative tumours represent different disease entities with differing clinical courses. Our results indicate, however, that studies of the blood group antigens in urinary tract tumours are more likely to be of value in research into biochemical disorders in the neoplastic process than in routine clinical assessment as a guide to treatment. Images Fig 1 Fig 2 Fig 3 PMID:3540013

  5. 21 CFR 160.110 - Frozen eggs.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... Frozen eggs. (a) Frozen eggs, frozen whole eggs, frozen mixed eggs is the food prepared by freezing... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Frozen eggs. 160.110 Section 160.110 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR...

  6. [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

  7. 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

  8. Tissue requirements in lung cancer diagnosis for tumor heterogeneity, mutational analysis and targeted therapies: initial experience with intra-operative Frozen Section Evaluation (FROSE) in bronchoscopic biopsies

    PubMed Central

    Iding, Jeffrey S.

    2016-01-01

    Background Recent advances in lung cancer treatment have changed the requirement for the amount and quality of biopsy specimens needed to characterize the tumor and select the best treatment. One adjunct to guide the bronchoscopist on the quality and quantity of specimens during bronchoscopic biopsies for the diagnosis of lung cancer is rapid on-site evaluation (ROSE) of cytological specimens. This technique has been shown to add to the diagnostic yield of bronchoscopy when obtaining adequate specimens for molecular profiling in lung cancer. ROSE is not available at all medical centers. We describe our initial experience using intra-procedural Frozen Section Evaluation (FROSE) of bronchoscopic biopsy specimens as an alternative to ROSE. Methods A retrospective analysis of all interventional pulmonology cases using FROSE between February and July 2015 was performed. Results analyzed to evaluate the success in obtaining adequate specimens for molecular profiling. Results A total of 88 interventional pulmonology cases employing a frozen section in at least one site were identified. In 94.3% of cases, a definitive diagnosis of benign or malignant was made. The concordance of frozen section diagnoses of benign or malignant was 100% with final diagnoses. Thirteen of the eighty-eight cases were ultimately sent for molecular analysis. Of these, twelve of thirteen (92.3%) cases were adequate to perform all ordered molecular testing. In all cases there was sufficient tissue to perform EGFR and ALK testing. Conclusions In medical centers where ROSE may not be available, the use of FROSE by the local pathologist can be an effective technique to obtain adequate tissue and cytological samples for the diagnosis and molecular profiling of lung cancers. Further prospective study in bronchoscopic tissue sampling techniques to obtain the optimum quantity and quality of samples for molecular profiling of lung cancers for targeted treatments is needed. PMID:27606077

  9. Cryo-electron tomography of plunge-frozen whole bacteria and vitreous sections to analyze the recently described bacterial cytoplasmic structure, the Stack.

    PubMed

    Delgado, Lidia; Martínez, Gema; López-Iglesias, Carmen; Mercadé, Elena

    2015-03-01

    Cryo-electron tomography (CET) of plunge-frozen whole bacteria and vitreous sections (CETOVIS) were used to revise and expand the structural knowledge of the "Stack", a recently described cytoplasmic structure in the Antarctic bacterium Pseudomonas deceptionensis M1(T). The advantages of both techniques can be complementarily combined to obtain more reliable insights into cells and their components with three-dimensional imaging at different resolutions. Cryo-electron microscopy (Cryo-EM) and CET of frozen-hydrated P. deceptionensis M1(T) cells confirmed that Stacks are found at different locations within the cell cytoplasm, in variable number, separately or grouped together, very close to the plasma membrane (PM) and oriented at different angles (from 35° to 90°) to the PM, thus establishing that they were not artifacts of the previous sample preparation methods. CET of plunge-frozen whole bacteria and vitreous sections verified that each Stack consisted of a pile of oval disc-like subunits, each disc being surrounded by a lipid bilayer membrane and separated from each other by a constant distance with a mean value of 5.2±1.3nm. FM4-64 staining and confocal microscopy corroborated the lipid nature of the membrane of the Stacked discs. Stacks did not appear to be invaginations of the PM because no continuity between both membranes was visible when whole bacteria were analyzed. We are still far from deciphering the function of these new structures, but a first experimental attempt links the Stacks with a given phase of the cell replication process.

  10. Rapid bright-field detection of oligonucleotide primed in situ (PRINS)-labeled DNA in chromosome preparations and frozen tissue sections.

    PubMed

    Speel, E J; Lawson, D; Ramaekers, F C; Gosden, J R; Hopman, A H

    1996-02-01

    We describe a new application of a bright-field microscopic procedure for rapid enzyme cytochemical detection of repeated DNA sequences in metaphase preparations and frozen tissue sections. Various chromosome-specific oligonucleotide primers were used in up to three sequential primed in situ (PRINS) labeling reactions together with Taq DNA polymerase and biotin, digoxigenin and/or fluorescein isothiocyanate (FITC)-modified nucleotides. DNA target sequences were localized simultaneously by the precipitates of the horseradish peroxidase-diaminobenzidine (PO-DAB, brown color), alkaline phosphatase-Fast Red (APase-Fast Red, red color) and horseradish peroxidase-teramethylbenzidine (PO-TMB, green color) reaction in hematoxylin counterstained metaphases and interphase nuclei using a standard bright-field microscope. In addition, a protocol is reported for the application of PRINS to frozen tissue sections from normal colon and bladder epithelium. Methanol/acetic acid fixation in combination with a pepsin digestion before performing the PRINS reaction proved to be critical steps in the total procedure that permits access of the PRINS reactants, while preserving the morphology of the nuclei in the tissue. Quantification of PRINS signals showed the majority of epithelial cells with the expected two chromosome copies. The described procedures can be considered valuable tools for application in molecular cytogenetics, cell biology and pathology. PMID:8825152

  11. Diagnosis of Ovarian Carcinoma Histotype Based on Limited Sampling: A Prospective Study Comparing Cytology, Frozen Section, and Core Biopsies to Full Pathologic Examination.

    PubMed

    Hoang, Lien N; Zachara, Susanna; Soma, Anita; Köbel, Martin; Lee, Cheng-Han; McAlpine, Jessica N; Huntsman, David; Thomson, Thomas; van Niekerk, Dirk; Singh, Naveena; Gilks, C Blake

    2015-11-01

    Growing insights into the biological features and molecular underpinnings of ovarian cancer has prompted a shift toward histotype-specific treatments and clinical trials. As a result, the preoperative diagnosis of ovarian carcinomas based on small tissue sampling is rapidly gaining importance. The data on the accuracy of ovarian carcinoma histotype-specific diagnosis based on small tissue samples, however, remains very limited in the literature. Herein, we describe a prospective series of 30 ovarian tumors diagnosed using cytology, frozen section, core needle biopsy, and immunohistochemistry (p53, p16, WT1, HNF-1β, ARID1A, TFF3, vimentin, and PR). The accuracy of histotype diagnosis using each of these modalities was 52%, 81%, 85%, and 84% respectively, using the final pathology report as the reference standard. The accuracy of histotype diagnosis using the Calculator for Ovarian Subtype Prediction (COSP), which evaluates immunohistochemical stains independent of histopathologic features, was 85%. Diagnostic accuracy varied across histotype and was lowest for endometrioid carcinoma across all diagnostic modalities (54%). High-grade serous carcinomas were the most overdiagnosed on core needle biopsy (accounting for 45% of misdiagnoses) and clear cell carcinomas the most overdiagnosed on frozen section (accounting for 36% of misdiagnoses). On core needle biopsy, 2/30 (7%) cases had a higher grade lesion missed due to sampling limitations. In this study, we identify several challenges in the diagnosis of ovarian tumors based on limited tissue sampling. Recognition of these scenarios can help improve diagnostic accuracy as we move forward with histotype-specific therapeutic strategies.

  12. Analysis of differential shrinkage in frozen brain sections and its implications for the use of guard zones in stereology.

    PubMed

    Carlo, C N; Stevens, C F

    2011-10-01

    Increasing numbers of neuroanatomists are using stereological methods, and unbiased stereological estimation rules recommend the use of guard zones with the optical disector method to count objects of interest within a volume. Although these methods are statistically unbiased, we believe there is a need to explore sources of systematic bias (e.g., effects of tissue processing and sectioning) that may be affecting estimates of object number. Toward this end, we evaluated neuron distribution through, and tissue shrinkage in, non-embedded tissue cut on a freezing microtome. Our data show that in the x- and y-planes there are minimal changes in tissue area during tissue processing, sectioning, and staining. In the z-axis (perpendicular to the cutting surface), however, sections shrink to ∼25% of the cut thickness. This z-axis shrinkage was quite variable between sections (coefficient of variation about 10%) but stable within the same section (coefficient of variation about 3%). Lastly, individual particle densities are non-uniform through the thickness of the section when the densities should have been uniform. We advise experimenters to use a new protocol, a modified optical disector, for estimation when objects to be counted are marked such that the x-, y-, and z-coordinates are recorded through the full thickness of a section and guard zones are applied post data collection based on the characteristics of the object distribution along the z-axis. It is likely that individual experiments with different embedding materials and histological processing steps could require guard zones of varying sizes, or none at all, depending on object distribution in the z-axis. PMID:21491430

  13. 7 CFR 58.327 - Frozen cream.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 3 2011-01-01 2011-01-01 false Frozen cream. 58.327 Section 58.327 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Standards... Material § 58.327 Frozen cream. To produce frozen cream eligible for official certification, the quality...

  14. 7 CFR 58.327 - Frozen cream.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 3 2012-01-01 2012-01-01 false Frozen cream. 58.327 Section 58.327 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Standards... Material § 58.327 Frozen cream. To produce frozen cream eligible for official certification, the quality...

  15. 7 CFR 58.327 - Frozen cream.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 3 2013-01-01 2013-01-01 false Frozen cream. 58.327 Section 58.327 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Standards... Material § 58.327 Frozen cream. To produce frozen cream eligible for official certification, the quality...

  16. 7 CFR 58.327 - Frozen cream.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 3 2014-01-01 2014-01-01 false Frozen cream. 58.327 Section 58.327 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Standards... Material § 58.327 Frozen cream. To produce frozen cream eligible for official certification, the quality...

  17. 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.

  18. Intraoperative frozen section analysis of margins in breast conserving surgery significantly decreases reoperative rates: one-year experience at an ambulatory surgical center.

    PubMed

    Jorns, Julie M; Visscher, Daniel; Sabel, Michael; Breslin, Tara; Healy, Patrick; Daignaut, Stephanie; Myers, Jeffrey L; Wu, Angela J

    2012-11-01

    Intraoperative frozen section (FS) margin evaluation is not common practice for patients undergoing breast conservation therapy (BCT), but offers a significant reduction in reoperation. In this study, a technique to allow for more effective freezing of breast tissue was developed to perform FS evaluation of lumpectomy margins (FSM) for all patients undergoing BCT at an ambulatory surgery center. FS evaluation of sentinel lymph node biopsy specimens was performed concurrently. One hundred eighty-one study and 188 control patients, with and without FS evaluation, were compared. Reexcision was reduced 34% (from 48.9% to 14.9%) and reoperation was reduced 36% (from 55.3% to 19.3%) with FS evaluation. Most of the decrease in reoperative rate was because of a decrease in the need for margin reexcision. The number of patients requiring 1, 2, or 3 operations to complete therapy was 84, 92, and 12, respectively, in the control group, and 146, 33, and 2, respectively, in the study group. Lobular subtype, multifocal disease, and larger tumor size (≥2 cm) were significantly associated with failure of FSM to prevent reoperation, but reoperation rates were still significantly decreased in this subgroup of patients (from 75.5% to 43.8%) with FSM. This study highlights an innovative yet simple and adaptable FS approach that resulted in a nearly 3-fold reduction in reoperation for patients undergoing BCT.

  19. 21 CFR 160.190 - Frozen egg yolks.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

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

  20. 21 CFR 160.190 - 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...

  1. 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...

  2. 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...

  3. 21 CFR 160.150 - Frozen egg whites.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... § 160.150 Frozen egg whites. (a) Frozen egg whites, frozen egg albumen is the food prepared by freezing... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Frozen egg whites. 160.150 Section 160.150 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD...

  4. 21 CFR 160.190 - Frozen egg yolks.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... Frozen egg yolks. (a) Frozen egg yolks, frozen yolks is the food prepared by freezing egg yolks that... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Frozen egg yolks. 160.190 Section 160.190 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR...

  5. 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.

  6. Discordance of Intraoperative Frozen Section Analysis with Definitive Histology of Sentinel Lymph Nodes in Breast Cancer Surgery: Complementary Axillary Lymph Node Dissection is Irrelevant for Subsequent Systemic Therapy

    PubMed Central

    Geertsema, D.; Gobardhan, P. D.; Madsen, E. V. E.; Albregts, M.; van Gorp, J.; de Hooge, P.

    2010-01-01

    Background In breast cancer surgery, intraoperative frozen section (FS) analysis of sentinel lymph nodes (SLNs) enables axillary lymph node dissection (ALND) during the same operative procedure. In case of discordance between a “negative” FS analysis and definitive histology, an ALND as a second operation is advocated since additional lymph node metastases may be present. The clinical implications of the subsequent ALND in these patients were evaluated. Materials and Methods Between November 2000 and May 2008, 879 consecutive breast cancer patients underwent surgery including sentinel lymph node biopsy (SLNB) with intraoperative FS analysis of 2 central cuts from axillary SLNs. Following fixation and serial sectioning, SLNs were further examined postoperatively with hematoxylin and eosin (H&E) and immunohistochemical techniques. For patients with a discordant FS examination, the effect of the pathology findings of the subsequent ALND specimen on subsequent nonsurgical therapy were evaluated. Results FS analysis detected axillary metastases in the SLN(s) in 200 patients (23%), while the definitive pathology examination detected metastases in SLNs in another 151 patients (17%). A complementary ALND was performed in 108 of the 151 patients with discordant FS. Additional tumor positive axillary lymph nodes were found in 17 patients (16%), leading to “upstaging” in 7 (6%). Subsequent nonsurgical treatment was adjusted in 4 patients (4%): all 4 had more extensive locoregional radiotherapy; no patient received additional hormonal and/or chemotherapy. Conclusion Discordance between intraoperative FS analysis and definitive histology of SLNs is common. In this selection of patients, a substantial proportion had additional lymph node metastases, but postsurgical treatment was rarely adjusted based on the findings of the complementary ALND. PMID:20422461

  7. Intraoperative frozen section evaluation of ureteral and urethral margins: studies of 203 consecutive radical cystoprostatectomy for men with bladder urothelial carcinoma

    PubMed Central

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

    2014-01-01

    Intraoperative frozen section (FS) evaluation of ureteral and urethral margins is frequently requested during radical cystoprostatectomy in patients with bladder urothelial carcinoma. However, it is still controversial whether intraoperative FSs of ureteral and urethral margins are necessary in all patients with cystoprostatectomy or a risk-based assessment with limited to the high risk patients is the best approach. A total of 203 radical cystoprostatectomy specimens with FS evaluation on margin status from men treated for bladder urothelial carcinoma from 2003 to 2010 in our institution were reviewed. Clinicopathologic features studied include: patients’ age, pathologic tumor stage, presence of carcinoma in- situ (CIS), and intraoperative FS diagnosis. All 203 patients had intraoperative FS evaluation of ureter, and of these, 37 patients had additional urethra FS evaluation. Of the 203 ureteral FS cases, 17 (8.4%) had positive margin for CIS (16 cases) or CIS with invasive urothelial carcinoma (1 case). All 17 patients with positive ureteral margin on FS had concomitant CIS in the bladder (15.5%; 17 of 110 patients). In contrast, none of the patients without concomitant CIS (n=93) had positive ureteral margins on FS. Among 37 patients who also had FS evaluation on urethral resection margin, 3 patients (8.1%) had positive margins for CIS and all three of them had concomitant CIS in the bladder. Positive ureteral/urethral margin was not associated with patients’ age or tumor stage, but was significantly associated with the presence of CIS in the bladder (p<0.001). Our study demonstrates that presence of concomitant CIS in bladder cancer was often associated with positive ureteral or urethral margin for CIS or invasive carcinoma; therefore, intraoperative FS evaluation may be indicated to these patients with concomitant bladder CIS. In contrast, in patients with no associated concomitant CIS in the bladder, FS of ureteral/urethral margins may not be necessary

  8. Perioperative Organ Injury

    PubMed Central

    Bartels, Karsten; Karhausen, Jörn; Clambey, Eric T.; Grenz, Almut; Eltzschig, Holger K.

    2014-01-01

    In spite of the fact that a surgical procedure may have been performed for the appropriate indication and in a technically perfect manner, patients are threatened by perioperative organ injury. For example, stroke, myocardial infarction, acute respiratory distress syndrome, acute kidney injury, or acute gut injury are among the most common causes for morbidity and mortality in surgical patients. In the present review, we discuss the pathogenesis of perioperative organ injury, and provide select examples for novel treatment concepts that have emerged over the past decade. Indeed, we believe that research to provide mechanistic insight into acute organ injury and to identify novel therapeutic approaches for the prevention or treatment of perioperative organ injury represents the most important opportunity to improve outcomes of anesthesia and surgery. PMID:24126264

  9. 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...

  10. 21 CFR 146.137 - Frozen orange juice.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

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

  11. 21 CFR 146.137 - Frozen orange juice.

    Code of Federal Regulations, 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...

  12. 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...

  13. 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...

  14. Perioperative approach to children.

    PubMed

    Zuckerberg, A L

    1994-02-01

    There has been a tremendous amount of progress in the perioperative approach to the child since Levy wrote "Psychic trauma of operations in children and a note on combat neurosis" nearly 50 years ago. Recognition of prolonged behavioral derangements following the anesthetic-surgical-hospital experience and the prominent role that the parent and physician play in modifying these have dramatically changed the contemporary pediatric perioperative care. Of paramount importance is the psychological preparation of family and child. With increasing outpatient or same-day admission surgery and free-standing surgical centers, preoperative preparation will, of necessity, increasingly become the responsibility of the pediatrician.

  15. Perioperative nutritional support.

    PubMed

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

    2014-01-01

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

  16. Perioperative supply chain management.

    PubMed

    Feistritzer, N R; Keck, B R

    2000-09-01

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

  17. 7 CFR 58.349 - Frozen cream.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 3 2012-01-01 2012-01-01 false Frozen cream. 58.349 Section 58.349 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Standards... Products Bearing Usda Official Identification § 58.349 Frozen cream. The flavor shall be sweet,...

  18. 7 CFR 58.349 - Frozen cream.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 3 2011-01-01 2011-01-01 false Frozen cream. 58.349 Section 58.349 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Standards... Products Bearing Usda Official Identification § 58.349 Frozen cream. The flavor shall be sweet,...

  19. 7 CFR 58.349 - Frozen cream.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 3 2014-01-01 2014-01-01 false Frozen cream. 58.349 Section 58.349 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Standards... Products Bearing Usda Official Identification § 58.349 Frozen cream. The flavor shall be sweet,...

  20. 21 CFR 158.170 - Frozen peas.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Frozen peas. 158.170 Section 158.170 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN.... (a) Identity—(1) Product definition. Frozen peas is the food in “package” form as that term...

  1. [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.

  2. 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.

  3. 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...

  4. 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...

  5. 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...

  6. 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...

  7. 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... 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...

  8. 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...

  9. 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...

  10. 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...

  11. 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...

  12. 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...

  13. 7 CFR 58.650 - Requirements for frozen custard.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 3 2012-01-01 2012-01-01 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...

  14. 7 CFR 58.650 - Requirements for frozen custard.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 3 2014-01-01 2014-01-01 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...

  15. 7 CFR 58.650 - Requirements for frozen custard.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 3 2013-01-01 2013-01-01 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...

  16. Perioperative acute kidney injury.

    PubMed

    Goren, O; Matot, I

    2015-12-01

    Perioperative acute kidney injury (AKI) is not uncommon and is associated with considerable morbidity and mortality. Recently, several definition systems for AKI were proposed, incorporating both small changes of serum creatinine and urinary output reduction as diagnostic criteria. Novel biomarkers are under investigation as fast and accurate predictors of AKI. Several special considerations regarding the risk of AKI are of note in the surgical patient. Co-morbidities are important risk factors for AKI. The surgery in itself, especially emergency and major surgery in the critically ill, is associated with a high incidence of AKI. Certain types of surgeries, such as cardiac and transplantation surgeries, require special attention because they carry higher risk of AKI. Nephrotoxic drugs, contrast dye, and diuretics are commonly used in the perioperative period and are responsible for a significant amount of in-hospital AKI. Before surgery, the anaesthetist is required to identify patients at risk of AKI, optimize anaemia, and treat hypovolaemia. During surgery, normovolaemia is of utmost importance. Additionally, the surgical and anaesthesia team is advised to use measures to reduce blood loss and avoid unnecessary blood transfusion. Hypotension should be avoided because even short periods of mean arterial pressure <55-60 mm Hg carry a risk of postoperative AKI. Higher blood pressures are probably required for hypertensive patients. Urine output can be reduced significantly during surgery and is unrelated to perioperative renal function. Thus, fluids should not be given in excess for the sole purpose of avoiding or treating oliguria. Use of hydroxyethyl starch needs to be reconsidered. Recent evidence indicates a beneficial effect of administering low-chloride solutions. PMID:26658199

  17. 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

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

    NASA Astrophysics Data System (ADS)

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

    2013-02-01

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

  19. Perioperative pharmacology: blood coagulation modifiers.

    PubMed

    Hicks, Rodney W; Wanzer, Linda J; Goeckner, Bradlee

    2011-06-01

    Blood coagulation is the process that results in the formation of a blood clot to stop bleeding from a damaged blood vessel. Various pharmacologic agents can affect the coagulation process. The American College of Chest Physicians' evidence-based practice guidelines for perioperative management of antithrombotic therapy provide guidance for anticoagulant or antiplatelet therapy and bridge therapy. Perioperative nurses must understand the pharmacologic principles of the most common blood coagulation modifiers related to perioperative use. The perioperative nurse's responsibilities regarding administration of blood coagulation modifiers include reviewing the patient's pertinent laboratory results (eg, prothrombin time, partial thromboplastin time, international normalized ratio), recognizing the underlying conditions that require blood coagulation therapy, and documenting all pertinent information. Perioperative nurses also should participate in development of detailed storage and retrieval policies related to heparin.

  20. 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. PMID:26849984

  1. Mohs micrographic surgery for dermatofibrosarcoma protuberans (DFSP): a single-centre series of 76 patients treated by frozen-section Mohs micrographic surgery with a review of the literature.

    PubMed

    Loghdey, Mohamed Saleem; Varma, Sandeep; Rajpara, Sanjay M; Al-Rawi, Haytham; Perks, Graeme; Perkins, William

    2014-10-01

    Dermatofibrosarcoma protuberans (DFSP) is a rare low-grade sarcoma that typically presents with local invasion but rarely metastasises. Surgical excision remains the first-line treatment for DFSP. There are no randomised controlled or prospective studies comparing wide local excision (WLE) with Mohs micrographic surgery (MMS), but available evidence from the retrospective studies and case series available has consistently shown higher recurrence rates for standard surgery and WLE than for MMS. Combined recurrence rates of data within the last 20 years for WLE have been reported at 7.3% compared with 1.1% for MMS. Our aim was to review the clinical details and recurrence rates of DFSP cases treated with frozen-section MMS in our centre between 1996 and February 2013. The relevant data were collected from the case notes. It involved 76 patients with nine of these patients lost to follow-up. In the remaining 67 (67/76) cases, the recurrence rate was 1.5% during the mean follow-up period of 50 months (2-132). This is comparable to recurrence rates for the MMS in the literature [20,21]. Our series is the largest series for frozen-section MMS reported to date. Based on these findings and the current literature evidence, we advocate MMS as the treatment of choice for DFSP in all locations.

  2. 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.

  3. 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 Central

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

    2016-01-01

    Introduction 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. Patients and Methods 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. Results 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

  4. 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...

  5. 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...

  6. 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...

  7. 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. PMID:26068896

  8. Perioperative management of cardiac disease.

    PubMed

    Aresti, N A; Malik, A A; Ihsan, K M; Aftab, S M E; Khan, W S

    2014-01-01

    Pre-existing cardiac disease contributes significantly to morbidity and mortality amongst patients undergoing non cardiac surgery. Patients with pre-existing cardiac disease or with risk factors for it, have as much as a 3.9% risk of suffering a major perioperative cardiac event (Lee et al 1999, Devereaux 2005). Furthermore, the incidence of perioperative myocardial infarction (MI) is increased 10 to 50 fold in patients with previous coronary events (Jassal 2008).

  9. 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.

  10. Frozen shoulder - aftercare

    MedlinePlus

    ... syndrome - aftercare; Pericapsulitis - aftercare; Stiff shoulder - aftercare; Shoulder pain - frozen shoulder ... Call your doctor if: The pain in your shoulder is getting worse You re-injure your arm or shoulder Your frozen shoulder is making you feel sad or depressed

  11. 21 CFR 101.95 - “Fresh,” “freshly frozen,” “fresh frozen,” “frozen fresh.”

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... freezing will not preclude use of the term “fresh frozen” to describe the food. “Quickly frozen” means... 21 Food and Drugs 2 2010-04-01 2010-04-01 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...

  12. Perioperative thermal insulation.

    PubMed

    Sessler, D I; McGuire, J; Sessler, A M

    1991-05-01

    To determine the efficacy of passive insulators advocated for prevention of cutaneous heat loss, we determined heat loss in unanesthetized volunteers covered by one of the following: a cloth "split sheet" surgical drape; a Convertors disposable-paper split sheet; a Thermadrape disposable laparotomy sheet; an unheated Bair Hugger patient-warming blanket; 1.5-mil-thick plastic hamper bags; and a prewarmed, cotton hospital blanket. Cutaneous heat loss was measured using 10 area-weighted thermal flux transducers while volunteers were exposed to a 20.6 degrees C environment for 1 h. Heat loss decreased significantly from 100 +/- 3 W during the control periods to 69 +/- 6 W (average of all covers) after 1 h of treatment. Heat losses from volunteers insulated by the Thermadrape (61 +/- 6 W) and Bair Hugger covers (64 +/- 5 W) were significantly less than losses from those insulated by plastic bags (77 +/- 11 W). The paper drape (67 +/- 7 W) provided slightly, but not significantly, better insulation than the cloth drape (70 +/- 4 W). Coverage by prewarmed cotton blankets initially resulted in the least heat loss (58 +/- 8 W), but after 40 min, resulted in heat loss significantly greater than that for the Thermadrape (71 +/- 7 W). Regional heat loss was roughly proportional to surface area, and the distribution of regional heat loss remained similar with all covers. These data suggest that cost and convenience should be major factors when choosing among passive perioperative insulating covers. It is likely that the amount of skin surface covered is more important than the choice of skin region covered or the choice of insulating material. PMID:2021204

  13. Perioperative functional residual capacity.

    PubMed

    Wahba, R W

    1991-04-01

    The literature dealing with the magnitude, mechanism and effects of reduced FRC in the perioperative period is reviewed. During general anaesthesia FRC is reduced by approximately 20%. The reduction is greater in the obese and in patients with COPD. The most likely mechanism is the loss of inspiratory muscle tone of the muscles acting on the rib cage. Gas trapping is an additional mechanism. Lung compliance decreases and airways resistance increases, in large part, due to decreased FRC. The larynx is displaced anteriorly and elongated, making laryngoscopy and intubation more difficult. The change in FRC creates or increases intrapulmonary shunt and areas of low ventilation to perfusion. This is due to the occurrence of compression atelectasis, and to regional changes in mechanics and airway closure which tend to reduce ventilation to dependent lung zones which are still well perfused. Abdominal and thoracic operations tend to increase shunting further. Large tidal volume but not PEEP will improve oxygenation, although both increase FRC. Both FRC and vital capacity are reduced following abdominal and thoracic surgery in a predictable pattern. The mechanism is the combined effect of incisional pain and reflex dysfunction of the diaphragm. Additional effects of thoracic surgery include pleural effusion, cooling of the phrenic nerve and mediastinal widening. Postoperative hypoxaemia is a function of reduced FRC and airway closure. There is no real difference among the various methods of active lung expansion in terms of the speed of restoration of lung function, or in preventing postoperative atelectasis/pneumonia. Epidural analgesia does not influence the rate of recovery of lung function, nor does it prevent atelectasis/pneumonia. PMID:2036700

  14. [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.

  15. 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. PMID:27472973

  16. Perioperative acupuncture modulation: more than anaesthesia.

    PubMed

    Lu, Z; Dong, H; Wang, Q; Xiong, L

    2015-08-01

    Accumulated evidences from clinical trials and updated reviews suggest that the role of acupuncture in perioperative medicine extends beyond the classical scope of anaesthesia and has been underestimated. Perioperative acupuncture reduces not only the consumption of anaesthetics and analgesics, but also anaesthesia-related complications, and protects organs in the perioperative period. These beneficial effects make acupuncture a promising approach in perioperative management, especially with respect to enhanced surgery recovery and specific surgical populations, such as elderly patients and 'triple-low' patients. Furthermore, efforts have been made to optimize the clinical application of perioperative acupuncture. PMID:26170347

  17. 21 CFR 146.120 - Frozen concentrate for lemonade.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

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

  18. 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...

  19. 21 CFR 146.120 - Frozen concentrate for lemonade.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

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

  20. 21 CFR 146.120 - Frozen concentrate for lemonade.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

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

  1. 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... system for frozen blood is a device used to glycerolize red blood cells prior to freezing to...

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

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ....110 Ice cream and frozen custard. (a) Description. (1) Ice cream is a food produced by freezing, while... 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...

  3. Frozen-intensity test research of frozen coal with steel

    NASA Astrophysics Data System (ADS)

    Zhang, Xiaopeng; Huang, Cheng; Liu, Weibo

    2002-05-01

    As a sort of multiple component, and dispersed state granule aggregation, frozen coal behaves similar to frozen soil. On the basis of its unique ice-cementation effect and not-frozen water along with dynamical balance state between the frameworks of mineral granule, the mechanical behavior of frozen coal is more complex than usual in compact medium, restrictedly with force amount, process time period and temperature. In all factors which impact on frozen intensity of frozen coal frozen with steel plate, water content is relatively easy to control. From results of this test research, values of frozen intensity is changeable under different water content. Up to the critical water content, the value of frozen intensity increase rapidly till a certain steady value. Under a certain temperature and water content condition, the granule component of frozen coal has somewhat effect on the frozen intensity. Usually, the frozen intensity of large granule coal is greater than the small granule's However, the distributing of coal granule size present a steady probability rule. So the effect from granule size is tiny.

  4. Strategies for Successful Perioperative Orientation.

    PubMed

    Mollohan, Joseph K; Morales, Maria

    2016-08-01

    The successful orientation of new employees facilitates their transition to the complex and demanding world of perioperative nursing. Whether a nurse is a recent graduate or an experienced nurse who has recently joined the facility or department, a new nurse benefits from a transition period during which new skills, processes, and concepts can be learned. Training should offer new employees the opportunity to develop competency, experience, collegial relationships, clinical judgment, and, overall, specialized knowledge for application in the clinical setting. Concerns surrounding orientation and training include the initial costs for training and the possibility of new employees leaving after the completion of training. The associated costs can be staggering, but adopting perioperative nurse residency programs may be a way to provide quality, high-level training and improve retention rates while minimizing long-term costs. PMID:27472970

  5. 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.…

  6. Patients requiring perioperative nutritional support.

    PubMed

    Enomoto, T Miko; Larson, Dawn; Martindale, Robert G

    2013-11-01

    One of the most important factors affecting outcome and recovery from surgical trauma is preoperative nutritional status. Research in perioperative nutritional support has suffered from a lack of consensus as to the definition of malnutrition, no recognition of which nutrients are important to surgical healing, and a paucity of well-designed studies. In the past decade, there has been some activity to address this situation, recognizing the importance of nutrition as a therapy before surgery, after surgery, and possibly even during surgery.

  7. Prevention of inadvertent perioperative hypothermia.

    PubMed

    Burger, Leona; Fitzpatrick, Jane

    All patients undergoing surgery are at risk of developing hypothermia; up to 70% develop hypothermia perioperatively. Inadvertent hypothermia is associated with complications such as impaired wound healing, increased blood loss, cardiac arrest and increased risk of wound infection. Anaesthesia increases the risk as the normal protective shivering reflex is absent. Ambient temperature also has a major effect on the patient's body temperature. Prevention of hypothermia not only reduces the incidence of complications, but patients also experience a greater level of comfort, and avoid postoperative shivering and the unpleasant sensation of feeling cold. Nurses should be aware of the risks of hypothermia so that preventative interventions can be employed to minimize the risk of hypothermia. Preoperative assessment is essential to enable identification of at-risk patients. Simple precautionary measures initiated by nurses can considerably reduce the amount of heat lost, minimize the risk of associated complications and ultimately improve patients' short- and long-term recovery. Minimizing skin exposure, providing adequate bed linen for the transfer to theatre and educating patients about the importance of keeping warm perioperatively are all extremely important. It is also worth considering using forced-air warmers preoperatively as research suggests that initiating active warming preoperatively may be successful in preventing hypothermia during the perioperative period. PMID:19966730

  8. Perioperative cognitive trajectory in adults.

    PubMed

    Nadelson, M R; Sanders, R D; Avidan, M S

    2014-03-01

    Approximately a quarter of a billion people undergo surgery every year hoping that the operation will alleviate symptoms, cure diseases, and improve quality-of-life. A concern has arisen that, despite the benefits of surgery, elderly patients might suffer neurological injury from surgery and general anaesthesia leading to persistent cognitive decline. However, many studies of postoperative cognition have had methodological weaknesses, including lack of suitable control groups, dissociation of cognitive outcomes from surgical outcomes, sub-optimal statistical techniques, and absence of longitudinal preoperative cognitive assessments. Emerging evidence suggests that after early cognitive decline, most patients return to their preoperative cognitive trajectories within 3 months of surgery; some even experience subsequent cognitive improvement. In this review, we summarize the scientific literature on perioperative cognition. We propose that the most important determinants of the postoperative cognitive trajectory are the preoperative cognitive trajectory, the success of the surgery, and events in the perioperative period. Postoperative complications, ongoing inflammation, and chronic pain are probably modifiable risk factors for persistent postoperative cognitive decline. When surgery is successful with minimal perioperative physiological perturbations, elderly patients can expect cognition to follow its preoperative course. Furthermore, when surgery alleviates symptoms and enhances quality-of-life, postoperative cognitive improvement is a possible and desirable outcome.

  9. 21 CFR 160.110 - Frozen eggs.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... Frozen eggs. (a) Frozen eggs, frozen whole eggs, frozen mixed eggs is the food prepared by freezing liquid eggs that conform to § 160.115, with such precautions that the finished food is free of...

  10. 21 CFR 160.110 - Frozen eggs.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... Frozen eggs. (a) Frozen eggs, frozen whole eggs, frozen mixed eggs is the food prepared by freezing liquid eggs that conform to § 160.115, with such precautions that the finished food is free of...

  11. 21 CFR 160.110 - Frozen eggs.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... Frozen eggs. (a) Frozen eggs, frozen whole eggs, frozen mixed eggs is the food prepared by freezing liquid eggs that conform to § 160.115, with such precautions that the finished food is free of...

  12. 21 CFR 160.110 - Frozen eggs.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... Frozen eggs. (a) Frozen eggs, frozen whole eggs, frozen mixed eggs is the food prepared by freezing liquid eggs that conform to § 160.115, with such precautions that the finished food is free of...

  13. 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 ...

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

    Code of Federal Regulations, 2013 CFR

    2013-07-01

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

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

    Code of Federal Regulations, 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...

  16. 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...

  17. 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...

  18. 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...

  19. 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.

  20. 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.

  1. FROZEN HYDROCARBONS IN COMETS

    SciTech Connect

    Simonia, Irakli

    2011-02-15

    Recent investigations of the luminescence of frozen hydrocarbon particles of icy cometary halos have been carried out. The process of luminescence of organic icy particles in a short-wavelength solar radiation field is considered. A comparative analysis of observed and laboratory data leads to 72 luminescent emission lines in the spectrum of the comet 153P/Ikeya-Zhang. The concept of cometary relict matter is presented, and the creation of a database of unidentified cometary emission lines is proposed.

  2. Frozen cultural plasticity.

    PubMed

    Houdek, Petr; Novakova, Julie

    2016-01-01

    We discuss cultural group selection under the view of the frozen plasticity theory and the different explanatory power and predictions of this framework. We present evidence that cultural adaptations and their influence on the degree of cooperation may be more complex than presented by Richerson et al., and conclude with the gene-environment-culture relationship and its impacts on cultural group selection. PMID:27561647

  3. 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

  4. 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

  5. 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

  6. 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

  7. Perioperative medicine. Are the anesthesiologists ready?

    PubMed

    Carli, F

    2001-04-01

    Perioperative medicine starts with preoperative assessment and preparation of patients undergoing various procedures. It includes intraoperative care and continues postproceudral management, from recovery room to intensive care and step-down facilities. Acute pain management must be optimized in order to enhance rehabilitation and restoration of functions. Perioperative medicine also includes management of acute and chronic pain. Potential areas of anesthesia involvement, still unclear, include preoperative and postoperative ward management and complete preparation such as cardiology or pulmonary testing. Further steps to take in the direction of perioperative medicine are the development of a different model of resident training, and the improvement of information technology and medical record.

  8. Perioperative anaphylaxis: diagnosis, evaluation, and management.

    PubMed

    Kannan, Jennifer A; Bernstein, Jonathan A

    2015-05-01

    Perioperative anaphylaxis can occur during or after surgery and can have life-threatening consequences. As anesthesia protocols become more complex and incorporate multiple agents to regulate physiologic processes intraoperatively, perioperative anaphylaxis is becoming increasingly recognized. The allergist should obtain detailed records from the anesthesiologist in order to perform appropriate testing to identify the likely causative agents. Testing should ideally be performed 4 to 6 weeks after the reaction to account for a refractory period after mast cell activation. This article includes 2 cases of perioperative anaphylaxis and reviews the historical elements that must be considered after a reaction has occurred. PMID:25841554

  9. Optimal glucose management in the perioperative period.

    PubMed

    Evans, Charity H; Lee, Jane; Ruhlman, Melissa K

    2015-04-01

    Hyperglycemia is a common finding in surgical patients during the perioperative period. Factors contributing to poor glycemic control include counterregulatory hormones, hepatic insulin resistance, decreased insulin-stimulated glucose uptake, use of dextrose-containing intravenous fluids, and enteral and parenteral nutrition. Hyperglycemia in the perioperative period is associated with increased morbidity, decreased survival, and increased resource utilization. Optimal glucose management in the perioperative period contributes to reduced morbidity and mortality. To readily identify hyperglycemia, blood glucose monitoring should be instituted for all hospitalized patients. PMID:25814110

  10. [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. PMID:27004381

  11. Perioperative anaphylaxis: diagnosis, evaluation, and management.

    PubMed

    Kannan, Jennifer A; Bernstein, Jonathan A

    2015-05-01

    Perioperative anaphylaxis can occur during or after surgery and can have life-threatening consequences. As anesthesia protocols become more complex and incorporate multiple agents to regulate physiologic processes intraoperatively, perioperative anaphylaxis is becoming increasingly recognized. The allergist should obtain detailed records from the anesthesiologist in order to perform appropriate testing to identify the likely causative agents. Testing should ideally be performed 4 to 6 weeks after the reaction to account for a refractory period after mast cell activation. This article includes 2 cases of perioperative anaphylaxis and reviews the historical elements that must be considered after a reaction has occurred.

  12. Perioperative medicine. Are the anesthesiologists ready?

    PubMed

    Carli, F

    2001-04-01

    Perioperative medicine starts with preoperative assessment and preparation of patients undergoing various procedures. It includes intraoperative care and continues postproceudral management, from recovery room to intensive care and step-down facilities. Acute pain management must be optimized in order to enhance rehabilitation and restoration of functions. Perioperative medicine also includes management of acute and chronic pain. Potential areas of anesthesia involvement, still unclear, include preoperative and postoperative ward management and complete preparation such as cardiology or pulmonary testing. Further steps to take in the direction of perioperative medicine are the development of a different model of resident training, and the improvement of information technology and medical record. PMID:11376518

  13. [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.

  14. 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.

  15. [Perioperative management of diabetic patient].

    PubMed

    Carles, Michel; Raucoules-Aimé, Marc

    2011-06-01

    The prevalence of diabetes is rising and diabetics may soon represent more than 5% of the world population. The type 2 diabetes is a major independent risk factor for coronary artery disease. The screening for silent myocardial ischemia (IMS) must be systematic. The autonomic dysfunction and the cardiac microcirculatory disorders are at risk of hypotension and hypothermia during anesthesia. After 10 years of diabetes duration the incidence of perioperative complications and of difficult intubation are increased. The neurological deficits related to anesthesia are associated with general anesthesia in 85% of cases. Particular care will be provided during the surgical procedure to avoid skin, muscular and neurologic cuts. In most cases, the regional anesthesia will be preferred to general anesthesia. To avoid hypoglycemia, blood glucose concentration less than 11 mmol.L(-1)(2g.L(-1)) seems a reasonable target during and after surgery.

  16. [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. PMID:27004383

  17. 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. PMID:26775126

  18. [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. PMID:27276074

  19. Controversies in Pediatric Perioperative Airways

    PubMed Central

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

    2015-01-01

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

  20. Perioperative management of obese patients.

    PubMed

    Pelosi, Paolo; Gregoretti, Cesare

    2010-06-01

    Obesity is a metabolic disease that is on the increase all over the world. Up to 35% of the population in North America and 15-20% in Europe can be considered obese. Since these patients are characterised by several systemic physiopathological alterations, the perioperative management may present some problems, mainly related to their respiratory system. Body mass is an important determinant of respiratory function before and during anaesthesia not only in morbidly but also in moderately obese patients. These can manifest as (a) reduced lung volume with increased atelectasis; (b)derangements in respiratory system, lung and chest wall compliance and increased resistance; and (c) moderate to severe hypoxaemia. These physiological alterations are more marked in obese patients with hypercapnic syndrome or obstructive sleep apnoea syndrome. The suggested perioperative ventilation management includes (a) awake and/or facilitated endotracheal intubation by using a video-laryngoscope; (b) tidal volume of 6-10 ml kg(-1) ideal body weight, increasing respiratory rate to maintain physiological PaCO2, while avoiding intrinsic positive end-expiratory pressure (PEEPi); and (c) a recruitment manoeuvre (35-55 cmH2O for 6 s) followed by the application of an end-expiratory pressure (PEEP) of 10 cmH2O. The recruitment manoeuvre should always be performed only when a volemic and haemodynamic stabilisation is reached after induction of anaesthesia. In the postoperative period, beach chair position, aggressive physiotherapy, noninvasive respiratory support and short-term recovery in intermediate critical care units with care of fluid management and pain may be useful to reduce pulmonary complications.

  1. [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.

  2. Stress Dose Steroids: Myths and Perioperative Medicine.

    PubMed

    MacKenzie, C Ronald; Goodman, Susan M

    2016-07-01

    Perioperative medication management for patients with systemic autoimmune inflammatory diseases has focused on strategies to improve outcomes and mitigate risks. The emphasis has been to minimize the risk of infection associated with most antirheumatic medications, while attempting to avoid flares of disease precipitated by medication withdrawal. Management of glucocorticoids in the perioperative period has been based on an assumption that supraphysiologic increases in dose were always necessary to avoid hypotension and shock in glucocorticoid treated patients, and alternative strategies were rarely considered despite the known infectious, metabolic, and wound healing risks associated with glucocorticoid administration. This paper will review current recommendations for perioperative glucocorticoid administration for glucocorticoid treated patients with systemic inflammatory autoimmune diseases and discuss glucocorticoid physiology to analyze the basis for these recommendations and consider alternative perioperative management strategies. PMID:27351679

  3. [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.

  4. The musculoskeletal effects of perioperative smoking.

    PubMed

    Argintar, Evan; Triantafillou, Kostas; Delahay, John; Wiesel, Brent

    2012-06-01

    Although the carcinogenic consequences of smoking are well known, further research is needed on the effects of smoking on musculoskeletal health and surgical outcomes. Orthopaedic perioperative complications of smoking include impaired healing, increased infection, delayed and/or impaired fracture union and arthrodesis, and inferior arthroplasty outcomes. The incorporation of smoking cessation protocols such as transdermal patches, chewing gum, lozenges, inhalers, sprays, bupropion, and varenicline in the perioperative period may result in substantial benefits for patients' musculoskeletal and general health.

  5. Perioperative preparation of the adolescent surgical patient.

    PubMed

    Busen, N H

    2001-02-01

    The perioperative preparation of adolescents for surgery provides a challenge to nurses and other health care providers because of the wide diversity in adolescents' age, physical maturation, and cognitive and psychosocial development. Perioperative issues, informed consent, and assent differ considerably depending on the age and developmental level of each adolescent. This article provides information about adolescent growth and development and approaches to managing adolescent surgical patients.

  6. [Clinical characteristics of perioperative pulmonary thromboembolism: analysis of 18 patients in Kitasato University Hospital].

    PubMed

    Kuroiwa, Masayuki; Arai, Masayasu; Kinoshita, Shin; Takenaka, Tomoaki; Okamoto, Hirotsugu; Hoka, Sumio

    2002-09-01

    Clinical characteristics of perioperative pulmonary thromboembolism (PTE) at Kitasato University Hospital in Japan were analyzed. Eighteen patients were documented as apparent diagnosis of PTE which developed perioperatively in the period of 1991-1999. The incidence of PTE was 18 out of approximately 50,000 surgical cases. Mean age of patients was 48 years (range, 21 to 79 years). There were 4 men and 14 women. Perioperative risk factors included obesity with body mass index over 26.4 (6/18), and prolonged bed rest after surgery more than 4 days (6/18). Perioperative PTE tended to occur in patients with laparoscopic cholecystectomy (3/18) and cesarean section (3/18). Seven out of 18 PTE patients died. It should be noted that perioperative PTE is prevalent in patients with risk factors of obesity and prolonged bed rest after surgery, and that laparoscopic cholecystectomy and cesarean section may become additional risk factors in patients who are otherwise healthy young adults.

  7. 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...

  8. 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...

  9. 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...

  10. 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...

  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...

  12. 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

  13. Assessment and Reporting of Perioperative Cardiac Risk by Canadian General Internists

    PubMed Central

    Taher, Taha; Khan, Nadia A; Devereaux, P J; Fisher, Bruce W; Ghali, William A; McAlister, Finlay A

    2002-01-01

    OBJECTIVE Physicians may use several validated risk indices to estimate perioperative cardiac risk, but there is little evidence for interventions to reduce this risk. We were interested in evaluating how general internists assess, define, communicate, and attempt to modify perioperative cardiac risk. DESIGN Cross-sectional survey of all 312 general internists in the Canadian Society of Internal Medicine with Canadian mailing addresses; 117 (38%) responded. RESULTS Respondents' mean age was 46 years, 79% were male, and on average they did 17 preoperative consults per month. Of the 104 respondents who routinely performed preoperative assessments, 96% (100/104) informed patients of their perioperative cardiac risk, but 77% did so only subjectively (i.e., stating risk as low, moderate, or high). Respondents provided 8, 27, and 12 different definitions for low, moderate, and high risk, respectively, with marked variability in the range of definitions they provided: from <1% to < 20% for “low risk,” from 1% to 2% to 20% to 50% for “moderate risk,” and from >2% to >50% for “high risk.” The 67% of respondents who reported using a perioperative cardiac risk index used a variety of indices and exhibited just as much variability in their risk estimates and definitions as those who didn't use risk indices. While virtually all advised perioperative β blockade in patients with known coronary artery disease, they varied substantially in the recommended agent or dose; further, these internists were evenly split on whether antiplatelet agents should be held or continued perioperatively. CONCLUSIONS These physicians differed widely in their assessment of perioperative cardiac risk and their definitions of low, moderate, or high risk. This raises concerns about whether patients (and surgeons) are provided with adequate information to make fully informed decisions about the potential risks of elective surgical operations. PMID:12472929

  14. 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

  15. 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.

  16. Frozen beverage machine

    SciTech Connect

    Williams, J.D.

    1988-04-12

    A frozen beverage machine is described, comprising: a. a frame having an exterior, an interior, a front and a back; b. a cylinder, having an interior and an exterior as well as first and second ends and further having an opening in each of the ends, the cylinder being horizontally and fixedly positioned within the interior of the frame with the second end facing the front of the frame; c. a means, sealingly attached to the opening in the second end of the cylinder, for emptying the cylinder; d. a means, positioned within the frame and communicating with the exterior of the cylinder, for removing heat from the cylinder; e. at least one support bracket; f. a shaft, rotatably attached within the opening in the support bracket and rotatably and sealingly attached within the opening in the first end of the cylinder and extending to the interior of the cylinder; g. a motor assembly, operatively connected to a portion of the shaft exterior to the cylinder and suspended from the shaft such that the weight of the motor assembly is supported only by the shaft; h. a contact switch; and i. a resilient means, connected to the frame and the motor assembly, for maintaining the position of the motor assembly relative to the shaft until a desired threshold resistance to rotation of the shaft within the cylinder occur, and then allowing the motor assembly to rotate to a desired position relative to the shaft.

  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. 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.

  19. 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. PMID:18494388

  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. 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.

  2. Perioperative Management in Sickle Cell Disease.

    PubMed

    Paschal, Rita D

    2016-09-01

    Many patients with sickle cell disease (SCD) will require surgical intervention during the course of their lifetime. Common surgeries include orthopedic and abdominal procedures. Perioperative complications occur commonly and can be related to the surgical procedure or the underlying hemoglobinopathy. The complication rate may be reduced by preoperative optimization of disease and careful attention to the patient in the postoperative period. This review examines the perioperative management of patients with SCD. For patients undergoing both elective and emergent surgery, attempts should be made to coordinate care with an SCD specialist. PMID:27598361

  3. [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.

  4. 76 FR 16384 - Certain Frozen Warmwater Shrimp From the Socialist Republic of Vietnam: Initiation of Antidumping...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-23

    ... the Socialist Republic of Vietnam, 70 FR 5152 (February 1, 2005) (``Order''). Pursuant to section 751... International Trade Administration Certain Frozen Warmwater Shrimp From the Socialist Republic of Vietnam... antidumping duty order on certain frozen warmwater shrimp (``shrimp'') from the Socialist Republic of...

  5. 75 FR 76754 - Non-Frozen Apple Juice Concentrate From China

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-09

    ... COMMISSION Non-Frozen Apple Juice Concentrate From China AGENCY: United States International Trade Commission... 2010 to determine whether revocation of the antidumping duty order on non- frozen apple juice... review * * *'' (75 FR 69628). Accordingly, pursuant to section 751(c) of the Tariff Act of 1930 (19...

  6. 77 FR 20008 - Certain Frozen Fish Fillets From the Socialist Republic of Vietnam: Initiation of Antidumping...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-03

    ... Fillets From the Socialist Republic of Vietnam, 68 FR 47909 (August 12, 2003). Pursuant to section 751(a... International Trade Administration Certain Frozen Fish Fillets From the Socialist Republic of Vietnam... antidumping duty order on certain frozen fish fillets (``fish'') from the Socialist Republic of...

  7. 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...

  8. 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...

  9. 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...

  10. 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...

  11. 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...

  12. 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...

  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. 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... MEAT AND POULTRY PRODUCTS INSPECTION AND VOLUNTARY INSPECTION AND CERTIFICATION IMPORTED PRODUCTS § 327.21 Inspection procedures for chilled fresh and frozen boneless manufacturing meat. (a)...

  15. 9 CFR 327.21 - Inspection procedures for chilled fresh and frozen boneless manufacturing meat.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... fresh and frozen boneless manufacturing meat. 327.21 Section 327.21 Animals and Animal Products FOOD... MEAT AND POULTRY PRODUCTS INSPECTION AND VOLUNTARY INSPECTION AND CERTIFICATION IMPORTED PRODUCTS § 327.21 Inspection procedures for chilled fresh and frozen boneless manufacturing meat. (a)...

  16. 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

  17. Rotigotine transdermal system for perioperative administration.

    PubMed

    Korczyn, A D; Reichmann, H; Boroojerdi, B; Häck, H-J

    2007-02-01

    We present a series of patients participating in clinical trials with the rotigotine transdermal system. All patients were scheduled for surgery with general anaesthesia unrelated to the trial procedure or to rotigotine. Perioperative administration of rotigotine appeared to be feasible and efficacious. No safety issues emerged from these observations.

  18. Perioperative management of the diabetic patient.

    PubMed

    Bergman, Stewart A

    2007-06-01

    Diabetes mellitus is a significant global public health problem and is a major source of morbidity and mortality in the world today. Type 2 diabetes mellitus is the predominant form of diabetes worldwide and represents approximately 90% of all cases. There is an epidemic of type 2 diabetes mellitus in the world today in both developed and developing countries. Globally, it is expected that the number of people with diabetes will increase from the current 150 million to 220 million by the year 2010 and to 300 million by the year 2025. In addition, there has been an alarming increase in the incidence of type 2 diabetes in children and adolescents. It is therefore increasingly likely that diabetic patients will appear for dental and oral maxillofacial surgical treatment in both the office and ambulatory surgery clinic setting. Surgical stress often produces hyperglycemia in the perioperative period. Hyperglycemia has been shown to cause a significant increase in perioperative morbidity and mortality. It is the general consensus that strict glycemic control is beneficial and should be achieved for diabetic patients in the perioperative period. Preoperative, intraoperative, and postoperative management protocols for improved perioperative glycemic control of both type 1 and type 2 diabetics are presented.

  19. [Perioperative acute kidney injury and failure].

    PubMed

    Chhor, Vibol; Journois, Didier

    2014-04-01

    Perioperative period is very likely to lead to acute renal failure because of anesthesia (general or perimedullary) and/or surgery which can cause acute kidney injury. Characterization of acute renal failure is based on serum creatinine level which is imprecise during and following surgery. Studies are based on various definitions of acute renal failure with different thresholds which skewed their comparisons. The RIFLE classification (risk, injury, failure, loss, end stage kidney disease) allows clinicians to distinguish in a similar manner between different stages of acute kidney injury rather than using a unique definition of acute renal failure. Acute renal failure during the perioperative period can mainly be explained by iatrogenic, hemodynamic or surgical causes and can result in an increased morbi-mortality. Prevention of this complication requires hemodynamic optimization (venous return, cardiac output, vascular resistance), discontinuation of nephrotoxic drugs but also knowledge of the different steps of the surgery to avoid further degradation of renal perfusion. Diuretics do not prevent acute renal failure and may even push it forward especially during the perioperative period when venous retourn is already reduced. Edema or weight gain following surgery are not correlated with the vascular compartment volume, much less with renal perfusion. Treatment of perioperative acute renal failure is similar to other acute renal failure. Renal replacement therapy must be mastered to prevent any additional risk of hemodynamic instability or hydro-electrolytic imbalance.

  20. 21 CFR 146.126 - Frozen concentrate for colored lemonade.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 2 2014-04-01 2014-04-01 false Frozen concentrate for colored lemonade. 146.126 Section 146.126 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION CANNED FRUIT JUICES Requirements for Specific Standardized...

  1. 21 CFR 146.126 - Frozen concentrate for colored lemonade.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 2 2013-04-01 2013-04-01 false Frozen concentrate for colored lemonade. 146.126 Section 146.126 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION CANNED FRUIT JUICES Requirements for Specific Standardized...

  2. 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...

  3. Frozen shoulder: a sympathetic dystrophy?

    PubMed

    Müller, L P; Müller, L A; Happ, J; Kerschbaumer, F

    2000-01-01

    Diagnostic and clinical features of the frozen shoulder syndrome and the Sudeck syndrome are similar in many aspects. Radioisotope bone scan shows an increased uptake in affected areas in both diseases, while native radiographs show a progressive demineralisation. Measurement of bone mineral density (BMD) by quantitative digital radiography objectified these local decalcification processes in an early stage of the frozen shoulder syndrome; 10 of 12 patients with primary frozen shoulder had BMD decreases greater 21% in the humeral head of the affected shoulder compared to the non-affected side. In the immobilised control group with degenerative changes of the rotator cuff, calcifying tendinitis and shoulder instability (n = 12) and in the group of healthy probands (n = 20), the difference between the affected and non-affected side (left and right humerus of the healthy probands) was only more than 21% in one case each. There are several references in the literature that assume frozen shoulder to be an algoneurodystrophic process; our observations support this hypothesis, possibly leading to earlier diagnoses and extended therapeutic management. PMID:10653111

  4. 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…

  5. 7 CFR 58.327 - Frozen cream.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 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...

  6. 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

  7. 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.

  8. [The perioperative myocardial infarction - an interdisciplinary task].

    PubMed

    Karatolios, Konstantinos; Rolfes, Caroline; Wulf, Hinnerk; Schieffer, Bernhard

    2016-09-01

    Cardiovascular complications, particularly perioperative myocardial infarction (PMI), are major contributors to mortaliyt after noncardiac surgery. PMI often occurs unnoticed without symptoms or ECG changes. Despite ist silent presentation, PMI is associated with increased mortality. The combination of high associated mortality and diagnostic challenges mandates increased awareness of PMI. Perioperative myocardial infarction may result from plaque rupture (PMI type I) or be caused by a myocardial supply-demand imbalance of oxygen without plaque rupture (PMI type II). Most PMIs occur within the first 3 days after surgery, highlighting the need for clinical monitoring in order to allow fast diagnosis and initiation of appropriate therapy. Measurement of cardiac troponin and 12-lead ECG are the diagnostic cornerstone. Therapy of PMI represents a challenge for physicians and requires a collaboration of surgeons, anesthesiologists and cardiologists. PMID:27631445

  9. 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.

  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 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.

  12. Perioperative management of diabetes insipidus in children.

    PubMed

    Wise-Faberowski, Lisa; Soriano, Sulpicio G; Ferrari, Lynne; McManus, Michael L; Wolfsdorf, Joseph I; Majzoub, Joseph; Scott, R Michael; Truog, Robert; Rockoff, Mark A

    2004-07-01

    Managing children with diabetes insipidus (DI) in the perioperative period is complicated and frequently associated with electrolyte imbalance compounded by over- or underhydration. In this study the authors developed and prospectively evaluated a multidisciplinary approach to the perioperative management of DI with a comparison to 19 historical control children. Eighteen children either with preoperative DI or undergoing neurosurgical operations associated with a high risk for developing postoperative DI were identified and managed using a standardized protocol. In all patients in whom DI occurred during or after surgery, a continuous intravenous infusion of aqueous vasopressin was initiated and titrated until antidiuresis was established. Intravenous fluids were given as normal saline and restricted to two thirds of the estimated maintenance rate plus amounts necessary to replace blood losses and maintain hemodynamic stability. In all children managed in this fashion, perioperative serum sodium concentrations were generally maintained between 130 and 150 mEq/L, and no adverse consequences of this therapy developed. In the 24-hour period evaluated, the mean change in serum sodium concentrations between the historical controls was 17.6 +/- 9.2 mEq/L versus 8.36 +/- 6.43 mEq/L in those children managed by the protocol. Hyponatremia occurred less frequently in the children managed with this protocol compared with historical controls.

  13. 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.

  14. Heat Diffusion with Frozen Boundary

    NASA Astrophysics Data System (ADS)

    Florescu, Laura; Ganguly, Shirshendu; Peres, Yuval; Spencer, Joel

    2015-11-01

    Consider "frozen random walk" on Z: n particles start at the origin. At any discrete time, the leftmost and rightmost lfloor {n/4}rfloor particles are "frozen" and do not move. The rest of the particles in the "bulk" independently jump to the left and right uniformly. The goal of this note is to understand the limit of this process under scaling of mass and time. To this end we study the following deterministic mass splitting process: start with mass 1 at the origin. At each step the extreme quarter mass on each side is "frozen". The remaining "free" mass in the center evolves according to the discrete heat equation. We establish diffusive behavior of this mass evolution and identify the scaling limit under the assumption of its existence. It is natural to expect the limit to be a truncated Gaussian. A naive guess for the truncation point might be the 1 / 4 quantile points on either side of the origin. We show that this is not the case and it is in fact determined by the evolution of the second moment of the mass distribution.

  15. The bariatric patient: an overview of perioperative care.

    PubMed

    Fencl, Jennifer L; Walsh, Angela; Vocke, Dawn

    2015-08-01

    Obesity (ie, a body mass index of ≥30 kg/m(2)) is increasing in the United States. As a result, more overweight individuals are being surgically treated for weight loss, thus making it imperative for perioperative RNs to understand obesity's effects on patients' health, its contribution to significant comorbidities (eg, diabetes, cardiovascular disease, hypertension, sleep apnea, musculoskeletal issues, stroke), the perioperative care requirements (eg, specialized instruments and equipment, positioning and lifting aids), and unique needs of these patients (eg, diet, counseling). It is vital that the perioperative nurse accurately assesses the patient undergoing bariatric surgery to provide safe and appropriate nursing interventions during the perioperative continuum of care. PMID:26227516

  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 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

  18. Perioperative lung protective ventilation in obese patients.

    PubMed

    Fernandez-Bustamante, Ana; Hashimoto, Soshi; Serpa Neto, Ary; Moine, Pierre; Vidal Melo, Marcos F; Repine, John E

    2015-01-01

    The perioperative use and relevance of protective ventilation in surgical patients is being increasingly recognized. Obesity poses particular challenges to adequate mechanical ventilation in addition to surgical constraints, primarily by restricted lung mechanics due to excessive adiposity, frequent respiratory comorbidities (i.e. sleep apnea, asthma), and concerns of postoperative respiratory depression and other pulmonary complications. The number of surgical patients with obesity is increasing, and facing these challenges is common in the operating rooms and critical care units worldwide. In this review we summarize the existing literature which supports the following recommendations for the perioperative ventilation in obese patients: (1) the use of protective ventilation with low tidal volumes (approximately 8 mL/kg, calculated based on predicted -not actual- body weight) to avoid volutrauma; (2) a focus on lung recruitment by utilizing PEEP (8-15 cmH2O) in addition to recruitment maneuvers during the intraoperative period, as well as incentivized deep breathing and noninvasive ventilation early in the postoperative period, to avoid atelectasis, hypoxemia and atelectrauma; and (3) a judicious oxygen use (ideally less than 0.8) to avoid hypoxemia but also possible reabsorption atelectasis. Obesity poses an additional challenge for achieving adequate protective ventilation during one-lung ventilation, but different lung isolation techniques have been adequately performed in obese patients by experienced providers. Postoperative efforts should be directed to avoid hypoventilation, atelectasis and hypoxemia. Further studies are needed to better define optimum protective ventilation strategies and analyze their impact on the perioperative outcomes of surgical patients with obesity. PMID:25907273

  19. Perioperative thrombotic complications in liver transplantation

    PubMed Central

    Feltracco, Paolo; Barbieri, Stefania; Cillo, Umberto; Zanus, Giacomo; Senzolo, Marco; Ori, Carlo

    2015-01-01

    Although the perioperative bleeding complications and the major side effects of blood transfusion have always been the primary concern in liver transplantation (OLT), the possible cohesion of an underestimated intrinsic hypercoagulative state during and after the transplant procedure may pose a major threat to both patient and graft survival. Thromboembolism during OLT is characterized not only by a complex aetiology, but also by unpredictable onset and evolution of the disease. The initiation of a procoagulant process may be triggered by various factors, such as inflammation, venous stasis, ischemia-reperfusion injury, vascular clamping, anatomical and technical abnormalities, genetic factors, deficiency of profibrinolytic activity, and platelet activation. The involvement of the arterial system, intracardiac thrombosis, pulmonary emboli, portal vein thrombosis, and deep vein thrombosis, are among the most serious thrombotic events in the perioperative period. The rapid detection of occlusive vascular events is of paramount importance as it heavily influences the prognosis, particularly when these events occur intraoperatively or early after OLT. Regardless of the lack of studies and guidelines on anticoagulant prophylaxis in this setting, many institutions recommend such an approach especially in the subset of patients at high risk. However, the decision of when, how and in what doses to use the various chemical anticoagulants is still a difficult task, since there is no common consensus, even for high-risk cases. The risk of postoperative thromboembolism causing severe hemodynamic events, or even loss of graft function, must be weighed and compared with the risk of an important bleeding. In this article we briefly review the risk factors and the possible predictors of major thrombotic complications occurring in the perioperative period, as well as their incidence and clinical features. Moreover, the indications to pharmacological prophylaxis and the current

  20. 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.

  1. [Use of clonidine for perioperative therapy].

    PubMed

    Fidziańska-Długosz, E

    1998-01-01

    Clonidine is a selective alpha 2 adrenergic receptors agonist with a wide spectrum of activity. Except well known hypotensive effect, clonidine stabilizes circulatory system and has sedative, anxiolytic, analgesic, diuretic etc. activities. Clonidine has some appliance during perioperative period. When used in premedication it has a lot of advantages: causes sedation, has anxiolytic properties, reduces secretion of saliva, stabilizes circulatory system, diminishes stress reaction, augments action of anaesthetic and analgesic drugs. When used during the operation, regulates circulatory system, prolongs and amplifies central and peripheral blocks. Clonidine diminishes patients requirement for opioids and local anaesthetics during postoperative and long-term pain therapy.

  2. Perioperative issues and sleep-disordered breathing.

    PubMed

    Wood, Karen L; Besecker, Beth Y

    2015-07-01

    Sleep-disordered breathing in the perioperative setting poses an increase in both perceived and demonstrated challenges for health care providers. Some of these challenges relate to identifying patients at high risk for obstructive sleep apnea prior to surgery. Other management challenges include identifying the proper monitoring techniques, using the correct mix of pharmacologic and nonpharmacologic strategies to manage these patients, and identifying the proper and safe disposition strategy after surgery. Additional populations, such as pediatrics and the morbidly obese, are also highlighted, which may help address questions in populations that are frequently managed in the critical care setting postoperatively.

  3. Performance improvement in the perioperative system.

    PubMed

    Brooks, Kathleen V; Krupka, Dan C

    2012-12-01

    Hospital finance leaders should work with their organizations' perioperative leaders to implement a three-step process for identifying projects with the greatest potential for improving quality while reducing costs and increasing revenue. In essence, this process involves mapping the strategy, developing a list of potential projects, and culling projects that cannot reasonably be accomplished with available resources. The extent to which staff resources are available for such projects can best be measured using a simple spreadsheet designed for tracking special assignments of each staff member.

  4. 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. PMID:21884843

  5. Forensic perioperative nursing. Advocates for justice.

    PubMed

    Carrigan, M; Collington, P; Tyndall, J

    2000-12-01

    Facts and evidence have been negated or lost by the inexperience of health care professionals who are not cognizant of the legal requirements concerning potential criminal cases. In the perioperative setting, policy and procedure should provide guidelines for potential criminal cases based on the key concepts and principles of forensic science. Potential forensic cases and traumatic injuries are not limited to major health care centres. All hospitals should have policies and procedures which outline: traumatic injuries/death, staff responsibilities, details of collecting evidence, documentation, chain of custody. The procedure should also include care of victims, suspected perpetrators as well as family/persons accompanying patient.

  6. 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.

  7. Perioperative Vision Loss in Spine Surgery and Other Orthopaedic Procedures.

    PubMed

    Su, Alvin W; Lin, Shuai-Chun; Larson, A Noelle

    2016-10-01

    Perioperative vision loss is a rare complication of orthopaedic surgery and has been documented after spine, knee, hip, and shoulder procedures. It is associated with several ophthalmologic diagnoses, most commonly ischemic optic neuropathy. Although the pathophysiology remains unclear, current evidence suggests that systemic hemodynamic compromise and altered balance of intraocular perfusion contribute to the development of ischemic optic neuropathy. Although vision recovery has been reported, the prognosis of perioperative vision loss is poor, and no proven effective treatment is available. Perioperative vision loss is unpredictable and can occur in healthy patients. Associated risk factors include pediatric or elderly age, male sex, obesity, anemia, hypotension or hypertension, perioperative blood loss, prolonged surgical time, and prone positioning. Preventive strategies include avoiding direct pressure to the eye, elevating the head, optimizing perioperative hemodynamic status, and minimizing surgical time with staged surgical procedures as appropriate. PMID:27564793

  8. Perioperative Vision Loss in Spine Surgery and Other Orthopaedic Procedures.

    PubMed

    Su, Alvin W; Lin, Shuai-Chun; Larson, A Noelle

    2016-10-01

    Perioperative vision loss is a rare complication of orthopaedic surgery and has been documented after spine, knee, hip, and shoulder procedures. It is associated with several ophthalmologic diagnoses, most commonly ischemic optic neuropathy. Although the pathophysiology remains unclear, current evidence suggests that systemic hemodynamic compromise and altered balance of intraocular perfusion contribute to the development of ischemic optic neuropathy. Although vision recovery has been reported, the prognosis of perioperative vision loss is poor, and no proven effective treatment is available. Perioperative vision loss is unpredictable and can occur in healthy patients. Associated risk factors include pediatric or elderly age, male sex, obesity, anemia, hypotension or hypertension, perioperative blood loss, prolonged surgical time, and prone positioning. Preventive strategies include avoiding direct pressure to the eye, elevating the head, optimizing perioperative hemodynamic status, and minimizing surgical time with staged surgical procedures as appropriate.

  9. 40 CFR 405.80 - Applicability; description of the ice cream, frozen desserts, novelties and other dairy desserts...

    Code of Federal Regulations, 2013 CFR

    2013-07-01

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

  10. 40 CFR 405.80 - Applicability; description of the ice cream, frozen desserts, novelties and other dairy desserts...

    Code of Federal Regulations, 2011 CFR

    2011-07-01

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

  11. 40 CFR 405.80 - Applicability; description of the ice cream, frozen desserts, novelties and other dairy desserts...

    Code of Federal Regulations, 2012 CFR

    2012-07-01

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

  12. 40 CFR 405.80 - Applicability; description of the ice cream, frozen desserts, novelties and other dairy desserts...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

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

  13. 40 CFR 405.80 - Applicability; description of the ice cream, frozen desserts, novelties and other dairy desserts...

    Code of Federal Regulations, 2014 CFR

    2014-07-01

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

  14. Perioperative management for patients with hereditary angioedema

    PubMed Central

    Williams, Anesu H.

    2015-01-01

    Hereditary angioedema (HAE) is a rare autosomal dominant disease that results from mutations in the C1-esterase inhibitor (C1-INH) gene. HAE is characterized by recurrent episodes of angioedema of the skin (face, extremities, genitalia, trunk), the gastrointestinal tract, and respiratory tract. Symptoms experienced can be debilitating, may impact quality of life, and can be life threatening. Preventing attacks particularly for patients undergoing procedures is critical. Patients with HAE may now treat acute attacks or prevent attacks with medications that have recently become available in the United States; however, these same medications can be used for perioperative management for patients undergoing medical, surgical, and dental procedures. Periprocedural planning is important for patients to reduce the incidence of acute attacks. Education is critical and increasing awareness of short-term prophylaxis options will allow providers to develop an appropriate action plan for their patients. The goal of this review is to increase awareness for HAE treating physicians, surgeons, anesthesia, and emergency room physicians by examining the available treatment options, researching the literature, and summarizing available data for periprocedural management. The availability of treatment options has increased over the past few years, expanding options for physicians and patients living with HAE and improve safety during the perioperative period and at the time of other procedures. PMID:25860171

  15. 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).

  16. How do perioperative nurses cope with stress?

    PubMed

    Gillespie, Brigid M; Kermode, Steven

    In recent years there has been broad discussion on the nature of stressors experienced by members of "high risk" occupations and professions, for instance nursing and emergency workers, whose role is to support others through traumatic scenarios (Lam et al, 1999:23). Perioperative nursing is a major specialization in nursing practice in which there is an increased risk of exposure to traumatic events (Schwann, 1998:645). Moreover, the cumulative nature of critical events, if left undealt with that will potentiate attrition among nurses in the perioperative environment (Michael and Jenkins, 2001:39). This triangulated study using self-administered questionaires focused on how theatre nurses coped with contextual stressors in the work milieu. A purposive sample of 46 registered and enrolled nurses who worked at a major Brisbane hospital were asked to describe a recent stressful workplace event, and rate it using Horowitz's (1993) Impact of Event Scale (IES). Results indicated that nurses with the least general theatre experience, demonstrated the highest negative impacts. 25% of females demonstrated avoidance tendencies when stressed, while 83% of males used problem-solving strategies. Reactions following trauma among the nurses were predominantly negative, and included feelings of frustration and self-doubt. These findings support the eminent need for hospital organizations to take a more person-centered approach when dealing with workplace stress. PMID:14994893

  17. 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. PMID:22464619

  18. [Progress in perioperative neuromonitoring: preface and comments].

    PubMed

    Fukuda, Satoru

    2006-03-01

    The aims of the neuromonitoring during perioperative period are 1) to detect the brain, spinal cord and peripheral nerve ischemia immediately and hence prevention from neuronal injury, 2) to measure the depth of anesthesia, especially sedative effect of anesthetics and 3) to evaluate brain death. For the detection of brain and spinal cord ischemia during operation, we have to bear in mind 1) whether we truly monitor the possible ischemic risk sites in the brain and spinal cord; 2) whether we know the false-negative and false-positive ratio of the neuromonitoring with account being taken of the effect of anesthetics, the patient's own pathologies, the body temperature etc. If we detect the abnormal change through neuromonitoring, we should immediately warn the surgeon to improve his subsequent procedures and confirm his decision to prevent neuronal damage. To understand these reviews, we have to know the fundamental basic knowledge such as International 10-20 System on EEG monitoring, the expression of negative wave and positive wave in evoked potential, the meaning of near-field potential and far-field potential, temporal dispersion and so on. In this issue, the recent progress in neuromonitoring is described by the specialists in each fields. I hope the anesthesiologists understand the significance of neuromonitoring and apply these techniques for the patient undergoing the neurological operation during perioperative periods. PMID:16541775

  19. Shoulder pain in primary care: frozen shoulder.

    PubMed

    Cadogan, Angela; Mohammed, Khalid D

    2016-03-01

    BACKGROUND AND CONTEXT Frozen shoulder is a painful condition that follows a protracted clinical course. We aim to review the management of patients with a diagnosis of frozen shoulder who are referred for specialist orthopaedic evaluation against existing guidelines in primary care. ASSESSMENT OF PROBLEM Referrals and clinical records were reviewed for all patients referred for orthopaedic specialist assessment who received a specialist diagnosis of frozen shoulder. Diagnostic, investigation and management practices from a regional primary health care setting in New Zealand were compared with guideline-recommended management. RESULTS Eighty patients with frozen shoulder were referred for orthopaedic evaluation in the 13 month study period, mostly from general practice. Fifteen patients (19%) were identified as having a frozen shoulder in their medical referral. Most (99%) had received previous imaging. Seven patients (12%) had received guideline recommended treatment. STRATEGIES FOR IMPROVEMENT Education of all clinicians involved in patient management is important to ensure an understanding of the long natural history of frozen shoulder and provide reassurance that outcomes are generally excellent. HealthPathways now include more information regarding diagnosis, imaging and evidence-based management for frozen shoulder. LESSONS Frozen shoulder may be under-diagnosed among patients referred for orthopaedic review. Ultrasound imaging is commonly used and may identify occult and unrelated pathology in this age-group. When managed according to clinical guidelines, patients report significant clinical and functional improvement with most reporting 80% function compared with normal after 1 year. KEYWORDS Adhesive capsulitis; bursitis; injections; practice guideline; primary health care; ultrasound.

  20. 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

  1. 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

  2. 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.

  3. KNOWLEDGE AND SKILLS ENHANCEMENT THROUGH PERIOPERATIVE NURSING SIMULATION LAB TRAINING.

    PubMed

    Whelan, Trish; Shi, Xinzhe; Yorke, Sue; Andony, Keith; Andony, Keith; McKenzie, Mary Lou

    2016-06-01

    In Edmonton Zone, the attrition rate among new perioperative nursing staff is an issue of concern and many ORs are facing noticeable staffing challenges. In the Edmonton area there are approximately 79 surgical suites. A series of simulation labs were established in 2015 to provide perioperative nurses in order to increase their comfort on the job and to help build confidence levels. The expectations for this simulation are an overall improvement in perioperative nurses' competency, a reduction in OR orientation and training time, and a decrease in the attrition rates among OR nurses. PMID:27509765

  4. Optimal perioperative medical management of the vascular surgery patient.

    PubMed

    Singh, Saket; Maldonado, Yasdet; Taylor, Mark A

    2014-09-01

    Perioperative medical management of patients undergoing vascular surgery can be challenging because they represent the surgical population at highest risk. β-Blockers should be continued perioperatively in patients already taking them preoperatively. Statins may be used in the perioperative period in patients who are not on statin therapy preoperatively. Institutional guidelines should be used to guide insulin replacement. Recent research suggests that measurement of troponins may provide some risk stratification in clinically stable patients following vascular surgery. Multimodal pain therapy including nonopioid strategies is necessary to improve the efficacy of pain relief and decrease the risk of side effects and complications. PMID:25113724

  5. Creating a patient-safe environment in a perioperative setting.

    PubMed

    Karanfil, Lynne; Bahner, Jan; Most, Rosalie

    2005-01-01

    As a result of new regulatory requirements and consumer demands for optimal health care, a focus on patient safety is even more important. In 2001, a corporate patient safety project was initiated by managers at one facility's six hospital-based perioperative suites. Although each suite had its own policies and procedures, no formal assessment of compliance with policies existed. A perioperative safety assessment was designed by resource management department consultants. The assessment included a tool, a questionnaire, and an assessment process. After being tested at one facility, perioperative safety assessments were performed in the organization's six ORs and two ambulatory surgery centers. Best practices then were shared across the system.

  6. Setting a research agenda for perioperative systems design.

    PubMed

    Sandberg, Warren S; Ganous, Timothy J; Steiner, Charles

    2003-06-01

    Perioperative care may be considered as a system amenable to industrial design approaches. The current care model is disjointed, prone to breakdown by failure of one component, and hostile to personnel. Moving a patient as a person and data set through the flow of perioperative care is not only possible, but it is essential for efficiency and safety. Perioperative systems design integrates the research agenda in technology, safety, informatics, and even telemedicine by putting all the pieces that constitute patient care into a cogent, flexible, and well-managed model.

  7. Oesophageal perforation following perioperative transoesophageal echocardiography.

    PubMed

    Massey, S R; Pitsis, A; Mehta, D; Callaway, M

    2000-05-01

    Transoesophageal echocardiography (TOE) is being used more often by cardiothoracic anaesthetists for the perioperative management of cardiac problems. Reports of iatrogenic oesophageal perforation by instrumentation of the oesophagus are increasing. Although TOE is considered safe, it may be more risky during surgery, because the probe is passed and manipulated in an anaesthetized patient. It may be in place for several hours so the risk of mucosal pressure and thermal damage is increased. Patients on cardiopulmonary bypass are also fully anticoagulated. We describe a case of oesophageal perforation following insertion of the TOE probe in a patient with gross cardiomegaly. Oesophageal distortion by cardiac enlargement may increase the risk of oesophageal perforation. Difficulty in passage of the TOE probe should be regarded with suspicion and withdrawal should be contemplated because the symptoms of oesophageal perforation are often delayed and non-specific. Delay in investigation, diagnosis and treatment will increase morbidity and mortality.

  8. [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. PMID:23437637

  9. Perioperative neonatal and paediatric blood transfusion

    PubMed Central

    Bharadwaj, Avnish; Khandelwal, Mamta; Bhargava, Suresh Kumar

    2014-01-01

    Paediatric patients undergoing surgical procedures commonly require some volume of blood or blood component replacement in the perioperative period. Paediatric patients undergoing major surgery associated with substantial blood loss should be evaluated pre-operatively. Pre-operative correction of anaemia may be done considering the age, plasma volume status, clinical status and comorbidities. Maximum allowable blood loss (MABL) for surgery must be calculated, and appropriate quantity of blood and blood components should be arranged. Intraoperative monitoring of blood loss should be done, and volume of transfusion should be calculated in a protocol based manner considering the volemia and the trigger threshold for transfusion for the patient and the MABL. Early haemostasis should be achieved by judicious administration of red blood cells, blood components and pharmacological agents. PMID:25535431

  10. Oesophageal perforation following perioperative transoesophageal echocardiography.

    PubMed

    Massey, S R; Pitsis, A; Mehta, D; Callaway, M

    2000-05-01

    Transoesophageal echocardiography (TOE) is being used more often by cardiothoracic anaesthetists for the perioperative management of cardiac problems. Reports of iatrogenic oesophageal perforation by instrumentation of the oesophagus are increasing. Although TOE is considered safe, it may be more risky during surgery, because the probe is passed and manipulated in an anaesthetized patient. It may be in place for several hours so the risk of mucosal pressure and thermal damage is increased. Patients on cardiopulmonary bypass are also fully anticoagulated. We describe a case of oesophageal perforation following insertion of the TOE probe in a patient with gross cardiomegaly. Oesophageal distortion by cardiac enlargement may increase the risk of oesophageal perforation. Difficulty in passage of the TOE probe should be regarded with suspicion and withdrawal should be contemplated because the symptoms of oesophageal perforation are often delayed and non-specific. Delay in investigation, diagnosis and treatment will increase morbidity and mortality. PMID:10844846

  11. Pierre Robin Sequence: a perioperative review.

    PubMed

    Cladis, Franklyn; Kumar, Anand; Grunwaldt, Lorelei; Otteson, Todd; Ford, Matthew; Losee, Joseph E

    2014-08-01

    The clinical triad of micrognathia (small mandible), glossoptosis (backward, downward displacement of the tongue), and airway obstruction defines the Pierre Robin sequence (PRS). Airway obstruction and respiratory distress are clinical hallmarks. Patients may present with stridor, retractions, and cyanosis. Severe obstruction results in feeding difficulty, reflux, and failure to thrive. Treatment options depend on the severity of airway obstruction and include prone positioning, nasopharyngeal airways, tongue lip adhesion, mandibular distraction osteogenesis, and tracheostomy. The neonate and infant with PRS require care from multiple specialists including anesthesiology, plastic surgery, otolaryngology, speech pathology, gastroenterology, radiology, and neonatology. The anesthesiologist involved in the care of patients with PRS will interface with a multidisciplinary team in a variety of clinical settings. This perioperative review is a collaborative effort from multiple specialties including anesthesiology, plastic surgery, otolaryngology, and speech pathology. We will discuss the background and clinical presentation of patients with PRS, as well as some of the controversies regarding their care.

  12. [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.

  13. Perioperative Care of Prisoners: Providing Safe Care.

    PubMed

    Smith, Francis Duval

    2016-03-01

    Correctional nurses are trained to care for prisoners in a controlled security environment; however, when a convict is transferred to a noncorrectional health care facility, the nurses there are often unfamiliar with custody requirements or how to safely care for these patients. The care of prisoners outside of prison has not been adequately investigated, and a gap exists between research and nursing education and practice. Nurses rarely have to consider how providing care for a prisoner in custody affects their practice, the potential dissonance between routine nursing care and the requirements to maintain security, or that care of prisoners in unsecured clinical areas places the nurse and other personnel at risk for physical assault or prisoner escape. Educating perioperative nurses in the care of prisoners in a public hospital environment is important for the provision of safe care and prevention of physical and emotional repercussions to personnel.

  14. Perioperative management of the hemodialysis patient.

    PubMed

    Trainor, Dominic; Borthwick, Emma; Ferguson, Andrew

    2011-01-01

    Dialysis-dependent chronic kidney disease (CKD) is an expanding problem for healthcare systems worldwide. The prevalence of end-stage renal disease (ESRD) has increased by 20% since 2000 and stands at 1699 per million people in the USA. ESRD is associated with an increased risk of cardiovascular comorbidity, increased severity of cardiovascular disease, and an adjusted all-cause mortality rate that is 6.4-7.8-fold higher than the general population. These patients may present electively or emergently for surgery related to, or remote from, the CKD. In any perioperative setting, the patient with hemodialysis-dependent CKD represents a significant clinical challenge, and successful management of these patients requires effective cooperation and communication between nephrology, anesthesia, and surgical staff. The ESRD patient's nephrologist will have the best knowledge of their medical history, comorbidities, and future management goals and may have been the clinician who instigated the referral for the surgery, e.g., for parathyroidectomy, vascular access surgery, nephrectomy or renal transplantation. As such, they are in an ideal position to contribute to, or coordinate, early preoperative medical optimization of the patient and also to provide advice during postoperative recovery and rehabilitation. In this article, we provide an overview of some of the key aspects of managing these patients successfully during the perioperative period. We propose the integration of cardiopulmonary exercise testing and cardiovascular optimization into the care of these high-risk patients and provide an overview of the importance of maintaining microvascular perfusion and the role of viscosity in preserving the capillary perfusion network. PMID:21435000

  15. 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.

  16. Guidelines for Perioperative Management of the Diabetic Patient

    PubMed Central

    Surani, Salim R.

    2015-01-01

    Management of glycemic levels in the perioperative setting is critical, especially in diabetic patients. The effects of surgical stress and anesthesia have unique effects on blood glucose levels, which should be taken into consideration to maintain optimum glycemic control. Each stage of surgery presents unique challenges in keeping glucose levels within target range. Additionally, there are special operative conditions that require distinctive glucose management protocols. Interestingly, the literature still does not report a consensus perioperative glucose management strategy for diabetic patients. We hope to outline the most important factors required in formulating a perioperative diabetic regimen, while still allowing for specific adjustments using prudent clinical judgment. Overall, through careful glycemic management in perioperative patients, we may reduce morbidity and mortality and improve surgical outcomes. PMID:26078998

  17. Chasing myocardial outcomes: perioperative myocardial infarction and cardiac troponin.

    PubMed

    Royo, Marc B; Fleisher, Lee A

    2016-02-01

    Perioperative myocardial infarction represents the most common cardiovascular complication following non-cardiac surgery, but frequently presents without the usual clinical signs and symptoms consistent with acute coronary syndrome. Given the silent nature of this event, a clinician's reliance on risk stratification tools and cardiac specific biomarkers to assist in the identification of at-risk individuals is heightened in the perioperative setting. Although cardiac troponin elevations following non-cardiac surgery have been consistently linked to increased mortality, uncertainty remains over how to clinically intervene to prevent harm. This decision is further complicated by the increasing sensitivity of the newest generation of cardiac biomarker immunoassays. In this narrative review, the growing body of evidence surrounding cardiac troponin elevations in the perioperative setting, how the evidence has been integrated into recent clinical practice guidelines, and its implications for the detection of perioperative myocardial infarction are discussed. PMID:26634279

  18. Job analysis. National Certification Board: Perioperative Nursing, Inc, document.

    PubMed

    Fox, V; Blue, M R

    1988-05-01

    The document is the critical element in developing an exam that reflects current perioperative nursing practice. The test specifications ensure that each phase of perioperative nursing practice is adequately measured at a proficient level of care. In addition to developing test specifications, the NCB:PNI has recommended that A Job Analysis could be used in the following situations. 1. Nurse managers could use the document in refining job descriptions, evaluating employee performance, creating clinical ladder criteria, and establishing standards of patient care. 2. Perioperative nurse educators could use it in developing self-directed learning contracts, designing curriculum for students or staff development. 3. Researchers could use the document in justifying the existence of registered nurses in the OR. 4. Perioperative nurses could use it for peer review and self-evaluation.

  19. An Agenda for Improving Perioperative Code Status Discussion.

    PubMed

    Hickey, Thomas R; Cooper, Zara; Urman, Richard D; Hepner, David L; Bader, Angela M

    2016-06-15

    Code status discussions (CSDs) clarify patient preferences for cardiopulmonary resuscitation in the event of cardiac or respiratory arrest. CSDs are a key component of perioperative care, particularly at the end of life, and must be both patient-centered and shared. Physicians at all levels of training are insufficiently trained in and inappropriately perform CSD; this may be particularly true of perioperative physicians. In this article, we describe the difficulty of achieving a patient-centered, shared perioperative CSD in the case of a medical professional with a do-not-resuscitate order. We provide a brief background in cardiopulmonary resuscitation, do-not-resuscitate, and CSD before proposing an agenda for improving perioperative CSD. PMID:27301059

  20. Pseudothrombocytopenia in perioperative patient: A significant laboratory artifact

    PubMed Central

    Senthilkumaran, Subramanian; Menezes, Ritesh G; Jena, Narendra Nath; Thirumalaikolundusubramanian, Ponniah

    2013-01-01

    Pseudothrombocytopenia secondary to ethylenediaminetetra-acetic acid induced platelet aggregation observed in a healthy perioperative male patient is reported in order to create awareness among anesthesiologist and laboratory personnel. The mechanisms for such changes have been highlighted. PMID:24249998

  1. Transdermal rotigotine for the perioperative management of Parkinson's disease.

    PubMed

    Wüllner, Ullrich; Kassubek, Jan; Odin, Per; Schwarz, Michael; Naumann, Markus; Häck, Hermann-Josef; Boroojerdi, Babak; Reichmann, Heinz

    2010-07-01

    Continuous delivery of antiparkinsonian medication during a perioperative period is desirable to avoid 'off'-symptom complications in surgical patients with concomitant Parkinson's disease (PD). Fourteen PD patients undergoing surgery under general anesthesia were switched from oral dopaminergic medication to transdermally delivered 24-h rotigotine (median dose 12 mg/24 h) for the perioperative period. Rotigotine treatment was considered feasible by patients, their anesthesiologists and neurologists with good control of PD symptoms and easy switching and re-switching of PD medication.

  2. Ethics in perioperative practice--principles and applications.

    PubMed

    Schroeter, Kathryn

    2002-04-01

    Though often difficult, ethical decision making is necessary when caring for surgical patients. Perioperative nurses have to recognize ethical dilemmas and be prepared to take action based on the ethical code outlined in the American Nurses Association's (ANA's) Code of Ethics for Nurses with Interpretive Statements. In this first of a nine-part series that will help perioperative nurses relate the ANA code to their own area of practice, the author looks at the first statement, which emphasizes respect for people.

  3. [Perioperative management of intracranial tumours: the neurosurgeon's role].

    PubMed

    Polo-Torres, C; Moscote-Salazar, L R; Alvis-Miranda, H R; Villa-Delgado, R

    2013-01-01

    The perioperative management of patients with brain tumours is a challenge for the neurosurgeon and the entire surgical team. The treating physician should consider factors such as the type of tumour, extent of disease, treatment received, the presence of comorbidities and prognosis of the disease itself. The successful execution of all aspects involved in perioperative management in patients with brain tumours will help prolong the life and improve the quality of life of patients. PMID:24008533

  4. Perioperative cardiovascular care for patients undergoing noncardiac surgical intervention.

    PubMed

    Eagle, Kim A; Vaishnava, Prashant; Froehlich, James B

    2015-05-01

    The field of perioperative medicine has garnered legitimacy during the past 3 decades. Adverse cardiovascular events in the perioperative period account for significant morbidity and mortality. Although testing patients preoperatively to detect ischemia and identify those who may benefit from modifications in care is a tempting strategy, risk assessment should account for posterior probability. Validated risk stratification tools, such as the Revised Cardiac Risk Index or the National Surgical Quality Improvement Program risk calculator, can assist in the identification of patients for whom preoperative noninvasive testing is justified and may change the plan of care. Furthermore, current guidelines emphasize that prophylactic coronary revascularization should not be performed exclusively for the purposes of reducing the risk of perioperative events. There has been enthusiasm for medical therapies that may reduce the risk of adverse cardiovascular events in the perioperative period. Current guidelines encourage the perioperative use of β-blockade in patients already receiving such therapy and caution against initiating such therapy on the day of the surgical procedure. Reduction of morbidity and mortality in the perioperative period relies on an understanding of the myriad physiological perturbations in this period and thoughtful selection of patients for further testing and treatment.

  5. Perioperative corticosteroid management for patients with inflammatory bowel disease.

    PubMed

    Hicks, Caitlin W; Wick, Elizabeth C; Salvatori, Roberto; Ha, Christina Y

    2015-01-01

    Guidelines on the appropriate use of perioperative steroids in patients with inflammatory bowel disease (IBD) are lacking. As a result, corticosteroid supplementation during and after colorectal surgery procedures has been shown to be highly variable. A clearer understanding of the indications for perioperative corticosteroid administration relative to preoperative corticosteroid dosing and duration of therapy is essential. In this review, we outline the basic tenets of the hypothalamic-pituitary-adrenal (HPA) axis and its normal response to stress, describe how corticosteroid use is thought to affect this system, and provide an overview of the currently available data on perioperative corticosteroid supplementation including the limited evidence pertaining to patients with inflammatory bowel disease. Based on currently existing data, we define "adrenal suppression," and propose a patient-based approach to perioperative corticosteroid management in the inflammatory bowel disease population based on an individual's historical use of corticosteroids, the type of surgery they are undergoing, and HPA axis testing when applicable. Patients without adrenal suppression (<5 mg prednisone per day) do not require extra corticosteroid supplementation in the perioperative period; patients with adrenal suppression (>20 mg prednisone per day) should be treated with additional perioperative corticosteroid coverage above their baseline home regimen; and patients with unclear HPA axis function (>5 and <20 mg prednisone per day) should undergo preoperative HPA axis testing to determine the best management practices. The proposed management algorithm attempts to balance the risks of adrenal insufficiency and immunosuppression.

  6. Promoting Patient Safety With Perioperative Hand-off Communication.

    PubMed

    Robinson, Nancy Leighton

    2016-06-01

    Effective perioperative hand-off communication is essential for patient safety. The purpose of this quality improvement project was to demonstrate how a structured hand-off tool and standardized process could increase effective perioperative communication of essential elements of care and assist in the timely recognition of patients at risk for clinical deterioration in the initial postoperative period. A team-based pilot project used the Iowa Model of Evidence-Based Practice and the principles of Lean Six Sigma to implement Perioperative PEARLS, a perioperative specific hand-off communication tool and a standardized framework for hand-off communication. The implementation of a structured hand-off tool and standardized process supports compliance with regulatory standards of care and eliminates waste from the hand-off process. A review of pre-implementation and post-implementation data revealed evidence of safer patient care. Evidence-based perioperative hand-off communication facilitates expedited patient evaluation, rapid interventions, reduction in adverse events, and a safer perioperative environment.

  7. Perioperative management of the patient with pulmonary hypertension.

    PubMed

    Fox, Daniel L; Stream, Amanda R; Bull, Todd

    2014-12-01

    Patients with pulmonary hypertension are at increased risk for perioperative morbidity and mortality. Elective surgery is generally discouraged in this patient population; however, there are times when surgery is deemed necessary. Currently, there are no guidelines for the preoperative risk assessment or perioperative management of subjects with pulmonary hypertension. The majority of the literature evaluating perioperative risk factors and mortality rates is observational and includes subjects with multiple etiologies of pulmonary hypertension. Subjects with pulmonary arterial hypertension, also referred to as World Health Organization group I pulmonary hypertension, and particularly those receiving pulmonary arterial hypertension-specific therapy may be at increased risk. Perioperative management of these patients requires a solid understanding and careful consideration of the hemodynamic effects of anesthetic agents, positive pressure ventilation and volume shifts associated with surgery in order to prevent acute right ventricular failure. We reviewed the most recent data regarding perioperative morbidity and mortality for subjects with pulmonary hypertension in an effort to better guide preoperative risk assessment and perioperative management by a multidisciplinary team. PMID:24828282

  8. Promoting Patient Safety With Perioperative Hand-off Communication.

    PubMed

    Robinson, Nancy Leighton

    2016-06-01

    Effective perioperative hand-off communication is essential for patient safety. The purpose of this quality improvement project was to demonstrate how a structured hand-off tool and standardized process could increase effective perioperative communication of essential elements of care and assist in the timely recognition of patients at risk for clinical deterioration in the initial postoperative period. A team-based pilot project used the Iowa Model of Evidence-Based Practice and the principles of Lean Six Sigma to implement Perioperative PEARLS, a perioperative specific hand-off communication tool and a standardized framework for hand-off communication. The implementation of a structured hand-off tool and standardized process supports compliance with regulatory standards of care and eliminates waste from the hand-off process. A review of pre-implementation and post-implementation data revealed evidence of safer patient care. Evidence-based perioperative hand-off communication facilitates expedited patient evaluation, rapid interventions, reduction in adverse events, and a safer perioperative environment. PMID:27235961

  9. Frozen shoulder--an algoneurodystrophic process?

    PubMed

    Müller, L P; Rittmeister, M; John, J; Happ, J; Kerschbaumer, F

    1998-12-01

    The frozen shoulder syndrome and the Sudeck syndrome are clinically in many aspects similar. Radioisotope bone scan shows an increased uptake in the affected areas in both diseases, while standard radiographs show a progressive demineralization. With measurement of bone-mineral density by quantitative digital radiography these local decalcification processes were diagnosed in an early stage of the frozen shoulder syndrome: of 12 patients with primary frozen shoulder 10 had a bone-mineral density decrease of more than 21% in the humeral head of the affected shoulder compared to the unaffected side. In the control groups (n = 32) the difference between affected and unaffected side (left and right humerus of the healthy probands) was in only one case each above 21%. There are several indications in the literature assuming the frozen shoulder to be an algoneurodystrophic process. Our observation supports this hypothesis, and may possibly lead to earlier diagnosis and improved therapeutic management. PMID:9922549

  10. Group for frozen soil and rock

    NASA Astrophysics Data System (ADS)

    The American Society for Testing and Materials wants participants for D18.19, its new subcommittee on frozen soil and rock. The group will write standards for engineering practices in northern Canada, Alaska, and other areas where soil and rock are commonly in the frozen or recently thawed state. Three standards are currently under development: axial compressive load tests o n piles in frozen soils, laboratory rate of frost-heave tests, and laboratory creep testing of frozen soil.The next D18.19 meeting is June 26 in St. Louis, Mo. Scientists who want to work on the subcommittee should contact Bill Lovell, School of Civil Engineering, Purdue University, West Lafayette, IN 47904, tel. 317-494- 5034; or Wendy Dyer, ASTM, 1916 Race Street, Philadelphia, PA 19103, tel. 215-299-5526.

  11. 7 CFR 58.349 - Frozen cream.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... Specifications for Dairy Plants Approved for USDA Inspection and Grading Service 1 Requirements for Finished Products Bearing Usda Official Identification § 58.349 Frozen cream. The flavor shall be sweet,...

  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. Frozen singularities in M and F theory

    NASA Astrophysics Data System (ADS)

    Tachikawa, Yuji

    2016-06-01

    We revisit the duality between ALE singularities in M-theory and 7-branes on a circle in F-theory. We see that a frozen M-theory singularity maps to a circle compactification involving a rotation of the plane transverse to the 7-brane, showing an interesting correspondence between commuting triples in simply-laced groups and Kodaira's classification of singular elliptic fibrations. Our analysis strongly suggests that the O7+ plane is the only completely frozen F-theory singularity.

  15. 21 CFR 160.150 - Frozen egg whites.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... § 160.150 Frozen egg whites. (a) Frozen egg whites, frozen egg albumen is the food prepared by freezing liquid egg whites that conform to § 160.140, with such precautions that the finished food is free of viable Salmonella microorganisms. (b) When frozen egg whites are prepared from liquid egg...

  16. 21 CFR 160.150 - Frozen egg whites.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... § 160.150 Frozen egg whites. (a) Frozen egg whites, frozen egg albumen is the food prepared by freezing liquid egg whites that conform to § 160.140, with such precautions that the finished food is free of viable Salmonella microorganisms. (b) When frozen egg whites are prepared from liquid egg...

  17. 21 CFR 160.150 - Frozen egg whites.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... § 160.150 Frozen egg whites. (a) Frozen egg whites, frozen egg albumen is the food prepared by freezing liquid egg whites that conform to § 160.140, with such precautions that the finished food is free of viable Salmonella microorganisms. (b) When frozen egg whites are prepared from liquid egg...

  18. 21 CFR 160.150 - Frozen egg whites.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... § 160.150 Frozen egg whites. (a) Frozen egg whites, frozen egg albumen is the food prepared by freezing liquid egg whites that conform to § 160.140, with such precautions that the finished food is free of viable Salmonella microorganisms. (b) When frozen egg whites are prepared from liquid egg...

  19. 21 CFR 146.126 - Frozen concentrate for colored 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 colored lemonade. 146.126... Fruit Juices and Beverages § 146.126 Frozen concentrate for colored lemonade. (a) Frozen concentrate for colored lemonade conforms to the definition and standard of identity prescribed for frozen concentrate...

  20. Perioperative implications and management of dextrocardia.

    PubMed

    Rapoport, Yury; Fox, Charles J; Khade, Parth; Fox, Mary E; Urman, Richard D; Kaye, Alan David

    2015-10-01

    Dextrocardia, a term used to describe all varieties of developmental malformations resulting in the positioning of the heart in the right hemithorax, is linked to a number of highly significant cardiac disorders. Current estimates vary tremendously in the literature. Only about 10 % of patients with diagnosed dextroversion show no substantial cardiac pathology; however, the incidence of congenital heart defects associated with dextrocardia is close to 100 %. The majority of studies previously reported include dextrocardia associated with situs inversus and cases of Kartagener syndrome. There is complex embryology and pathogenesis that results in dextrocardia. Physical examinations of the heart, such as percussion and palpation during routine exams, are vitally important initial diagnostic instruments. X-ray, CT scan, echocardiography (ECHO), and MRI are all invaluable imaging modalities to confirm and classify the diagnosis of dextrocardia. In summary, heart malposition is a group of complex pathologic associations within the human body, rather than just a single congenital defect. Clinicians such as anesthesiologists have unique challenges managing patients with dextrocardia. An appreciation of associated pathogenesis, appropriate diagnosis, and management is paramount in ensuring the best outcome for these patients perioperatively.

  1. LOEYS-DIETZ SYNDROME: PERIOPERATIVE ANESTHESIA CONSIDERATIONS.

    PubMed

    Johnson, Judy G; Bray, Jacob P; Risher, William H; Kaye, Alan David

    2016-06-01

    Loeys-Dietz syndrome (LDS) is a rare autosomal dominant disease related to genetic mutations in receptors for the cytokine transforming growth factor-receptor type 1 (TGFB-R1) or 2 gene (TGFB-R2) on the cell surface. LDS results in abnormal protein synthesis and dysfunctional connective tissue, which can result in unique cardiovascular anesthesia challenges related to perioperative management. Patients with LDS may manifest hypertelorism, bifid uvula or cleft palate, and arterial tortuosity. Virtually all LDS patients show some type of abnormal skin findings and bleeding tendency. These patients may show a rapid progression of aortic dilation, regurgitation, and a propensity towards rupture and/or dissection at a much earlier age and smaller aneurysm size. LDS patients who require surgical intervention require meticulous vigilance from the anesthesiologist. We describe a 26 year old patient with documented LDS type 1 who presented for repair of an ascending/root aneurysm in this case report. Recognition of LDS and intra-operative management of the cardiovascular manifestations of this disease is paramount in ensuring successful surgical outcome and to limit morbidity and mortality. PMID:27487644

  2. Algorithmic Summaries of Perioperative Blood Pressure Fluctuations.

    PubMed

    Toddenroth, Dennis; Ganslandt, Thomas; Drescher, Caroline; Weith, Thomas; Prokosch, Hans-Ulrich; Schuettler, Juergen; Muenster, Tino

    2016-01-01

    Automated perioperative measurements such as cardiovascular monitoring data are commonly compared to established upper and lower thresholds, but could also allow for more complex interpretations. Analyzing such time series in extensive electronic medical records for research purposes may itself require customized automation, so we developed a set of algorithms for quantifying different aspects of temporal fluctuations. We implemented conventional measures of dispersion, summaries of absolute gradients between successive values, and Poincaré plots. We aggregated the severity and duration of hypotensive episodes by calculating the average area under different mean arterial pressure (MAP) thresholds. We applied these methods to 30,452 de-identified MAP series, and analyzed the similarity between alternative indices via hierarchical clustering. To explore the potential utility of these propositional metrics, we computed their statistical association with presumed complications due to cardiovascular instability. We observed that hierarchical clustering reliably segregated features that had been designed to quantify dissimilar aspects. Summaries of temporary hypotension turned out to be significantly increased among patient subgroups with subsequent signs of a complicated recovery. These associations were even stronger for measures that were specifically geared to capturing short-term MAP variability. These observations suggest the potential capability of our proposed algorithms for quantifying heterogeneous aspects of short-term MAP fluctuations. Future research might also target a wider selection of outcomes and other attributes that may be subject to intraoperative variability. PMID:27577440

  3. Oxygraphy: an unexplored perioperative monitoring modality.

    PubMed

    Gadhinglajkar, Shrinivas Vitthal; Sreedhar, Rupa; Unnikrishnan, K P

    2009-06-01

    Capnography waveforms and capnometry are useful perioperative monitoring tools. The paramagnetic oxygen analyzers incorporated in many clinical monitoring systems estimate oxygen concentration in the breathing circuit during various phases of ventilation. The oxygen concentration is plotted as a real-time waveform and displayed as an oxygraph. However, the clinical utility of oxygraphy is under evaluated. We are reporting four different clinical scenarios in neurosurgical patients, wherein the information yielded by oxygraphy were either not available on the capnograph or were revealed in a more promising way on the oxygraph than on the capnograph. A real-time oxygraphy waveform has four phases similar to a capnograph, although displayed in a reverse manner. Oxygraphy was useful in our patient to determine the adequacy of preoxygenation. Airway complications and unwanted neuromuscular recovery can be detected earlier by oxygraphy compared to capnography. The oxygraphy peak-to-baseline scale difference can be compressed to as low as to 6% of oxygen concentration. When the peak-to-baseline scale difference is 6 mmHg, the oxygraph becomes sensitive to even minute changes in respiratory flow characteristics. Oxygraphy may have a potential role in clinical monitoring. PMID:19353279

  4. Perioperative morbidity of radical cystectomy: A review

    PubMed Central

    Kulkarni, Jagdeesh N.

    2011-01-01

    A systematic review of the literature on perioperative morbidity (POM) was done using Medline software with a combination of keywords like mortality, morbidity, and complications. In addition, we review the analysis of our hospital data of 261 Radical cystectomies (RCs) performed in an 11-year period and our latest clinical pathway for RC. Age range in our series was 50 to 81 years with 240 males and 21 females. RCs were performed by intraperitoneal method in 172 patients and by our extraperitoneal (EP) method in 89 patients. Urinary diversion was ileal conduit in 159 patients and neobladder in 102 patients. Blood loss ranged between 500 and 1500 ccs. Postoperative mortality occurred in eight patients (3%). Among the other early post-op complications, major urinary leak was seen in nine and minor in 11, requiring PCN in five patients and reoperation in four patients. Bowel leak or obstruction was seen in six and four patients, respectively, requiring reoperation in six patients. EP RC in our series showed some benefit in reduction of POM. The mortality of RC has declined but the POM still ranges from 11 to 68%, as reported in 23 series (1999-2008) comprising of 14 076 patients. Various risk factors leading to POM and some corrective measures are discussed in detail. However, most of these series are retrospective and lack standard complication reporting, which limits the comparison of outcomes. Various modifications in open surgical technique and laparoscopic and Robotic approaches are aimed at reduction in mortality and POM of RC. PMID:21814314

  5. 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

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

    PubMed

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

    2008-08-01

    Most anesthesiologists will experience the perioperative death of a patient or a major perioperative catastrophe in the course of their careers. Anesthesia training, however, does not prepare individuals to handle the aftermath of such a stressful event. Multiple surveys have shown that the death of a patient has a major emotional impact on up to 75% of health care providers involved, regardless of whether the death was expected or whether the patient was well known to the practitioner. Psychological recovery often takes weeks or months and is hampered by lack of emotional and professional support. Data indicate that the majority of anesthesiologists would prefer a more formal support structure, including the option to take time off from clinical work. Although a formal assessment of professional functioning after a perioperative catastrophe has not been done, the Association of Anaesthetists of Great Britain and Ireland instituted guidelines recommending support at multiple levels, and the "Adverse Event Protocol" available on the Anesthesia Patient Safety Foundation website provides a suggested series of steps to minimize patient injury and identify the cause of an adverse anesthesia event after it occurs. The negative consequences of failure to cope well after these events are significant to individuals and health care systems alike. Further study into the short-term and long-term impact of perioperative catastrophes on providers and health systems is needed. Additionally, education on how to handle the aftermath of perioperative catastrophes and formal support structures should be provided to practitioners at all levels of training. PMID:18633037

  7. [Pathophysiology and management of perioperative hypothermia].

    PubMed

    Witkowski, Wojciech; Maj, Jakub

    2006-06-01

    The paper is a review of pathophysiology and management of perioperative hypothermia. The advanced methods of rewarming, such as passive and active: external and core used in clinic allow for efficient management ant prophylactics of hypothermia. Thermotherapy with use of infrared ceiling heaters CTS and mobile MTC as well as Infutherm system applying by authors are desirable and even indispensable in contemporary equipment of surgery clinics, cardiovascular surgery clinics and burn centers. The ideal rewarming method should be safe and enable fast, reliable and predictable warming or rewarming. The clinical parameter to determine the efficacy of rewarming is the change of core temperature. There is no doubt that active warming with forced-air warmers (Warm Touch 5700 and Bair Hugger 500) or radiative heaters (IR-A:Hydrosun 500, IR-C radiation: CTC X, MTC) is more effective than use of standard, passive insulation hospital blankets or convectional heaters. Actually the forced-air warmers are counted to be more useful in cardiovascular surgery hypothermia management, because of fast rate core temperature rise and faster rise in mean skin temperature compared to the control group. CTC X and MTC Aragona radiative heaters are useful in burn management being the most effective when the distance of heater from the patient body is less than 80 cm. The observation of 60 consecutive extensive burns leads to conclusion that long-lasting dressings in burn patients when the whole body is not covered and protected, can be performed safely only in conditions excluding heat losses and core temperature drop. While the cold intravenous fluids may significantly contribute to the temperature drop depending on the volume infused, the use of fluids warming systems as well as external heat application is absolutely indicated to improve the heat balance of the patient body. PMID:17007255

  8. Tranexamic Acid: From Trauma to Routine Perioperative Use

    PubMed Central

    Simmons, Jeff; Sikorski, Robert A.; Pittet, Jean-Francois

    2015-01-01

    Purpose Of Review Optimizing hemostasis with antifibrinolytics is becoming a common surgical practice. Large clinical studies have demonstrated efficacy and safety of tranexamic acid (TXA) in the trauma population to reduce blood loss and transfusions. Its use in patients without preexisting coagulopathies is debated, as thromboembolic events are a concern. In this review, perioperative administration of TXA is examined in non-trauma surgical populations. Additionally, risk of thromboembolism, dosing regimens, and timing of dosing are assessed. Recent Findings Perioperative use of tranexamic acid is associated with reduced blood loss and transfusions. Thromboembolic effects do not appear to be increased. However, optimal dosing and timing of TXA administration is still under investigation for non-trauma surgical populations. Summary As part of a perioperative blood management program, tranexamic acid can be used to help reduce blood loss and mitigate exposure to blood transfusion. PMID:25635366

  9. SWITCH for safety: Perioperative hand-off tools.

    PubMed

    Johnson, Fay; Logsdon, Patty; Fournier, Kim; Fisher, Sandra

    2013-11-01

    Communication breakdown is the leading cause of reported sentinel events in the perioperative setting. Barriers to optimal communication include noise, stress, multitasking, and rapid turnover between procedures. AORN has identified communication during personnel changes (ie, hand offs) as a point of vulnerability for the surgical patient. A standardized hand-off method provides an opportunity for personnel to ask and answer questions and should be available in the perioperative setting. At one facility, the standardization of hand-off reporting resulted in the development of new hand-off tools specific to the perioperative environment. A standardized reporting method enabled health care providers to address communication barriers and to maintain their focus on the patient during critical moments (eg, shift changes), thereby improving patient safety.

  10. Optimizing perioperative decision making: improved information for clinical workflow planning.

    PubMed

    Doebbeling, Bradley N; Burton, Matthew M; Wiebke, Eric A; Miller, Spencer; Baxter, Laurence; Miller, Donald; Alvarez, Jorge; Pekny, Joseph

    2012-01-01

    Perioperative care is complex and involves multiple interconnected subsystems. Delayed starts, prolonged cases and overtime are common. Surgical procedures account for 40-70% of hospital revenues and 30-40% of total costs. Most planning and scheduling in healthcare is done without modern planning tools, which have potential for improving access by assisting in operations planning support. We identified key planning scenarios of interest to perioperative leaders, in order to examine the feasibility of applying combinatorial optimization software solving some of those planning issues in the operative setting. Perioperative leaders desire a broad range of tools for planning and assessing alternate solutions. Our modeled solutions generated feasible solutions that varied as expected, based on resource and policy assumptions and found better utilization of scarce resources. Combinatorial optimization modeling can effectively evaluate alternatives to support key decisions for planning clinical workflow and improving care efficiency and satisfaction.

  11. Frozen red cells in Rhesus immunization.

    PubMed

    Cook, I A; Robb, A L; Mitchell, R; McLaren, E A; Urbaniak, S; Robertson, A E

    1980-04-01

    The use of frozen washed cells in varying doses in primary Rh immunization is compared to two groups of men with the use of fresh washed cells in a third group. In the first two groups, using frozen cells, doses ranging from 0.5 to 20 ml of whole blood (Group I) are compared with a 200.0 ml dose of red cell concentrate (Group II), while Group III served as a control using a 20 ml dose of fresh washed red cell suspension (9.0 ml concentrated red cell equivalent). The response rate was 93% in Group II compared with only 43% in Group I, suggesting the desirability of using relatively large doses of Rh-positive red cells for primary Rh immunization. The use of frozen washed cells from a special panel for 'booster' injections is also recommended.

  12. 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

  13. 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.

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

    PubMed Central

    2012-01-01

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

  15. Integrating Simulations Into Perioperative Education for Undergraduate Nursing Students.

    PubMed

    Bashaw, Marie

    2016-02-01

    Incorporating high-fidelity simulations into an undergraduate nursing program's perioperative elective course capitalizes on students' active learning. Simulations allow students the opportunity to assess and participate in clinical scenarios, apply standards, and demonstrate correct nursing actions without compromising patient safety. Incorporating a high-risk, low-volume malignant hyperthermia simulation experience into the undergraduate nursing curriculum emphasizes active learning and provides an opportunity for students to experience an uncommon emergency perioperative event. A high-fidelity malignant hyperthermia simulation links a scenario with course content, incorporates didactic information from previous courses, and emphasizes the importance of debriefing. PMID:26849993

  16. 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...

  17. 9 CFR 381.148 - Processing and handling requirements for frozen poultry products.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

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

  18. 9 CFR 381.148 - Processing and handling requirements for frozen poultry products.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

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

  19. 9 CFR 381.148 - Processing and handling requirements for frozen poultry products.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

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

  20. 76 FR 17837 - Certain Frozen Fish Fillets From the Socialist Republic of Vietnam: Initiation of Antidumping...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-31

    ... Republic of Vietnam, 68 FR 47909 (August 12, 2003). On February 28, 2011, pursuant to section 751(a)(2)(B... International Trade Administration Certain Frozen Fish Fillets From the Socialist Republic of Vietnam... Vietnam (``Vietnam''), received on February 28, 2011, meets the statutory and regulatory requirements...

  1. 78 FR 6297 - Certain Frozen Fish Fillets From the Socialist Republic of Vietnam: Preliminary Results of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-30

    ... been calculated in accordance with section 772 of the Act. Because Vietnam is a nonmarket economy... Vietnam: Final Results of the Antidumping Duty Administrative Review and New Shipper Reviews, 75 FR 12726... International Trade Administration Certain Frozen Fish Fillets From the Socialist Republic of...

  2. 75 FR 12188 - Certain Frozen Warmwater Shrimp from Thailand: Preliminary Results of Antidumping Duty...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-15

    ..., 74 FR 5638, 5639 (January 30, 2009) (Section 129 Determination); Certain Frozen Warmwater Shrimp from..., 74 FR 52452 (October 13, 2009). We preliminarily determine that sales were made by MRG, Pakfood and... Warmwater Shrimp from Thailand, 70 FR 5145 (February 1, 2005). On February 4, 2009, the Department...

  3. 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... products by prompt and efficient freezing. Adequate freezing facilities shall be provided within the... moved from the official establishment prior to freezing: Provided, That the official establishment...

  4. 75 FR 54847 - Certain Frozen Warmwater Shrimp from Thailand: Final Results and Partial Rescission of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-09

    ..., 74 FR 5638, 5639 (January 30, 2009) (Section 129 Determination); Certain Frozen Warmwater Shrimp from..., 74 FR 52452 (October 13, 2009). Based on our analysis of the comments received, we have made certain... Duty Administrative Review, 75 FR 12188 (March 15, 2010) (Preliminary Results). We invited parties...

  5. 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)

  6. 21 CFR 158.170 - Frozen peas.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... thermostatically controlled at 100±2 °C. (v) Procedure—Transfer frozen contents of package to plastic bag; tie bag securely and immerse in water bath with continuous flow at room temperature. Avoid agitation of bag during thawing by using clamps or weights. When sample completely thaws, remove bag, blot off adhering water,...

  7. 21 CFR 158.170 - Frozen peas.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... thermostatically controlled at 100±2 °C. (v) Procedure—Transfer frozen contents of package to plastic bag; tie bag securely and immerse in water bath with continuous flow at room temperature. Avoid agitation of bag during thawing by using clamps or weights. When sample completely thaws, remove bag, blot off adhering water,...

  8. 21 CFR 158.170 - Frozen peas.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... thermostatically controlled at 100±2 °C. (v) Procedure—Transfer frozen contents of package to plastic bag; tie bag securely and immerse in water bath with continuous flow at room temperature. Avoid agitation of bag during thawing by using clamps or weights. When sample completely thaws, remove bag, blot off adhering water,...

  9. 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.

  10. 7 CFR 58.349 - Frozen cream.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ..., GENERAL SPECIFICATIONS FOR APPROVED PLANTS AND STANDARDS FOR GRADES OF DAIRY PRODUCTS 1 General Specifications for Dairy Plants Approved for USDA Inspection and Grading Service 1 Requirements for Finished Products Bearing Usda Official Identification § 58.349 Frozen cream. The flavor shall be sweet,...

  11. On a Frozen Fellow and Melding Media.

    ERIC Educational Resources Information Center

    Wheeler, David

    1996-01-01

    Describes an art project that constructed a realistic model of a frozen prehistoric cadaver including its clothing and tool kit. Originally conceived as a way to introduce students to art materials, ancient history, and different cultures, the project grew to include a traveling exhibit and instructional puppet shows. (MJP)

  12. Fresh frozen plasma: past, present and future.

    PubMed

    McCarthy, L J

    1989-12-01

    Fresh frozen plasma has been transfused for decades. However, the dramatic increase in its use has caused concern that much of it is transfused without the proper indications. Because of this, the National Institutes of Health held a Consensus Conference to clarify its genuine indications and contraindications.

  13. 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.

  14. 7 CFR 58.650 - Requirements for frozen custard.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 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...

  15. Freezing rate and frozen storage effects on the ultrastructure of samples of pork.

    PubMed

    Ngapo, T M; Babare, I H; Reynolds, J; Mawson, R F

    1999-11-01

    Cryo-scanning electron microscopy was used to study the ultrastructure of small samples (approximately 6 g) of pork. Combinations of six freezing rates, two storage times and three thawing rates were used. Cavities created after sublimation of the ice crystals were quantitatively analysed using an image analysis software package. The cross-sectional areas of cavities of meat samples in the frozen state were approximately ten times the areas of the cavities of the fresh and thawed samples. The large cavities in the frozen state grossly distorted the muscle cell structures. Upon thawing, the meat structure had almost completely recovered. No significant freezing rate effects were observed, however, trends were evident. Significant storage time effects were observed. In the frozen state, at the 90th percentile level, the hole area fraction was greater in stored samples for intermediate cavity areas. In thawed samples, hole area fractions of stored samples were greater than in samples without storage.

  16. The long-term fate of fresh and frozen orthotopic bone allografts in genetically defined rats.

    PubMed

    Bos, G D; Goldberg, V M; Gordon, N H; Dollinger, B M; Zika, J M; Powell, A E; Heiple, K G

    1985-01-01

    Fresh and frozen orthotopic iliac crest bone grafts in rats were studied histologically for determination of the long-term effects of histocompatibility matching and the freezing process on orthotopic bone graft incorporation. Grafts exchanged between groups of inbred rats, syngeneic or differing with respect to major or minor histocompatibility loci, were studied histologically at 20, 30, 40, 50, and 150 days after bone transplantation. A numerical histologic scoring system was developed and used by three observers for evaluation of coded hematoxylin and eosin sections. All frozen graft groups had the same fate regardless of histocompatibility relations between donors and recipients, and all grafts were inferior to fresh syngeneic grafts. Both fresh allograft groups received similar scores and initially at 20 and 30 days had scores similar to those of the fresh syngeneic groups. In the later intervals, however, the fresh allografts were inferior to the fresh syngeneic grafts and similar to the frozen groups. This is consistent with an older model describing two distinct phases of osteogenesis. In the long term, frozen syngeneic and fresh and frozen allografts across major and minor histocompatibility barriers were comparable, but all were significantly inferior to fresh syngeneic bone grafts.

  17. 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. PMID:16404062

  18. Perioperative cultures and the role of antibiotics during stone surgery.

    PubMed

    Motamedinia, Piruz; Korets, Ruslan; Badalato, Gina; Gupta, Mantu

    2014-09-01

    Urinary tract infection and urosepsis are the most common complications associated with the procedures urologists employ to manage stone disease. Recommendations regarding antibiotic prophylaxis and utilization of perioperative urine and stone culture prior to shockwave lithotripsy (SWL) or endoscopic intervention have evolved overtime. We sought to provide readers with a comprehensive consensus regarding these most recent recommendations.

  19. Perioperative Diabetic Consultation: A Plea for Improved Training

    ERIC Educational Resources Information Center

    Rudd, Peter; And Others

    1978-01-01

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

  20. Perioperative risk and management in patients with pulmonary hypertension.

    PubMed

    Minai, Omar A; Yared, Jean-Pierre; Kaw, Roop; Subramaniam, Kathirvel; Hill, Nicholas S

    2013-07-01

    Pulmonary hypertension (PH) is a known risk factor for perioperative complications. Unlike in the case of cardiac surgery, PH is currently not listed as an independent risk factor for postoperative complications in guidelines for the management of noncardiac surgery. Despite the paucity of data, though, patients with PH are often counseled against having elective procedures because early and sudden postoperative deaths have been reported. Patients with PH are unable to accommodate alterations in right ventricular (RV) preload or afterload induced by fluid shifts, medications, or changes in the autonomic nervous system precipitated by hypoxia or hypercapnia. These factors become magnified in situations of added stress such as surgical intervention. Systemic hypotension and arrhythmias may precipitate RV ischemia, further worsening RV function. Patient and surgical characteristics and choice of anesthetic technique are crucial factors in perioperative management. The two main principles of perioperative management are the prevention of systemic hypotension (risk of RV ischemia) and the prevention of acute elevations in pulmonary arterial pressure (risk of RV failure). Close monitoring, optimization of systemic BP, pain control, oxygenation and ventilation, avoidance of exacerbating factors, and use of vasopressors and pulmonary vasodilators as necessary are essential elements of management. Understanding the pathophysiology, cause, and severity of PH in the individual perioperative patient allows accurate risk assessment, optimization of PH and RV function prior to surgery, and appropriate intraoperative and postoperative management.

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

    PubMed

    Williams, Marilyn

    2009-03-01

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

  2. Topiramate as concomitant antiepileptic treatment; an isolated perioperative hypofibrinogenaemia.

    PubMed

    Iglesias Morales, C; Duca Rezzulini, F; Latre Saso, C; Gonzalez Paniagua, C; Iturri Clavero, F; Martinez Ruiz, A

    2016-04-01

    A description of a case is presented of an isolated hypofibrinogenaemia acquired in relation to taking topiramate used as concomitant treatment of a drug resistant epilepsy. The hypofibrinogenaemia developed in the course of a month after the introduction of the drug, and was diagnosed in the perioperative period. PMID:26386515

  3. Nursing reflections from journaling during a perioperative internship.

    PubMed

    Kuiper, Ruth Ann

    2004-01-01

    AN IMPORTANT CONCERN in nursing practice and education is the difficulties nurses experience as they transition into a new clinical area. THIS STUDY compared the reflective journals of 26 experienced and inexperienced nurses participating in a nine-week perioperative internship. THE STUDY examined self-regulated learning strategies used to enhance metacognitive critical thinking abilities.

  4. Preoperative myocardial ischaemia: its relation to perioperative infarction.

    PubMed Central

    Yousif, H; Davies, G; Westaby, S; Prendiville, O F; Sapsford, R N; Oakley, C M

    1987-01-01

    One hundred consecutive patients undergoing coronary artery bypass surgery were randomly allocated to a preoperative (24 h) intravenous infusion of isosorbide dinitrate (1.5-15 mg/hr) (50 patients) or to placebo (50 patients). The characteristics of the two groups were similar. Evidence of acute myocardial ischaemia was sought by continuous electrocardiographic Holter recordings and acute myocardial infarction by the appearance of new Q waves and increased activity of the creatine kinase MB isoenzyme. Episodes of acute myocardial ischaemia were found in 18% of patients in the control group and in none of those who received isosorbide dinitrate. None the less, the frequency of perioperative myocardial infarction was similar (22% and 18% respectively) in the two groups. Perioperative infarction was significantly more common in women, in patients with unstable angina or poor left ventricular function, in those who had coronary endarterectomy, and in those in whom the aortic clamping time was greater than 50 minutes. These factors may have obscured any effect that prevention of preoperative ischaemia had on perioperative infarction. Preoperative infusion of isosorbide dinitrate eliminated preoperative ischaemia but did not influence the occurrence of perioperative infarction. The probable benefits of prevention of preoperative ischaemia on postoperative left ventricular function, which is a determinant of long term survival, remain to be established. PMID:3304371

  5. Coordinating perioperative care for the 'high risk' general surgical patient using risk prediction scoring.

    PubMed

    Hafiz, Shaziz; Lees, Nicholas Peter

    2016-01-01

    Identifying 'high risk' (> 5% mortality score) emergency general surgical patients early, allows appropriate perioperative care to be allocated by securing critical care beds and ensuring the presence of senior surgeons and senior anesthetists intraoperatively. Scoring systems can be used to predict perioperative risk and coordinate resources perioperatively. Currently it is unclear which estimate of risk correlates with current resource deployment. A retrospective study was undertaken assessing the relationship between deployment of perioperative resources: senior surgeon, senior anesthetist and critical care bed. The study concluded that almost all high risk patients with high POSSUM mortality and morbidity scores had a consultant senior surgeon present intraoperatively. Critically unwell patients with higher operative severity and perioperative morbidity scores received higher care (HDU/ICU) beds postoperatively, ensuring that they received appropriate care if their condition deteriorated. Therefore POSSUM scoring should be used perioperatively in emergency cases to coordinate appropriate perioperative care for high risk general surgical patients. PMID:26901929

  6. 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...

  7. 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...

  8. 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...

  9. 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...

  10. 48 CFR 870.111-5 - Frozen processed food products.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 48 Federal Acquisition Regulations System 5 2014-10-01 2014-10-01 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...

  11. 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...

  12. 21 CFR 864.9145 - Processing system for frozen blood.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

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

  13. 21 CFR 864.9145 - Processing system for frozen blood.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

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

  14. 21 CFR 864.9145 - Processing system for frozen blood.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

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

  15. 21 CFR 864.9145 - Processing system for frozen blood.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

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

  16. 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...

  17. 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...

  18. 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...

  19. 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...

  20. An audit of fresh frozen plasma usage in a tertiary referral centre in a developing country.

    PubMed

    Prathiba, R; Jayaranee, S; Ramesh, J C; Lopez, C G; Vasanthi, N

    2001-06-01

    This paper evaluates the practice of fresh frozen plasma (FFP) transfusion at the University Hospital, Kuala Lumpur, and analyses its usage by the various clinical departments. The aim of this study is to identify where it is inappropriately used and the clinical indications in which such misuse is common. A retrospective analysis of the blood bank request forms and work sheets during a 6-month period between January 1998 and June 1998 formed the basis of this study. Overall, 40% of 2665 units transfused were considered appropriate. However, out of the 931 episodes of FFP transfusions only 31% were for appropriate indications. The average FFP requirement when used for appropriate indication was about 4 units per episode, whereas for inappropriate indication it was 2.5 units per episode. Inappropriate use in terms of the number of units was highest by the surgical services (68%) and Orthopaedics (64%), while the Department of Paediatrics had the lowest incidence of inappropriate use (40%). When Paediatrics was used as the benchmark, the incidence of inappropriate use by other departments was significantly higher (p < 0.01). As for FFP usage in common clinical indications, there was a high incidence of inappropriate use in burns (82%), perioperative period (73%), cardiac surgery (68%), massive bleeding (62%) and trauma (60%). The findings in this study, specifically the use of FFP for volume support in trauma, massive bleeding and burns, routine requests without identified indication in cardiac bypass surgery, and prophylactic use in the perioperative period can be the basis for recommendations to minimize the inappropriate use of FFP in the future.

  1. Batch testing for noroviruses in frozen raspberries.

    PubMed

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

    2015-01-01

    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

  2. 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.

  3. Electron microscopy of frozen hydrated eukaryotic flagella.

    PubMed

    Murray, J M

    1986-01-01

    Resting and active sea urchin sperm flagella have been examined by low-dose electron microscopy of frozen hydrated specimens. The flagella are unfixed, unstained, completely intact, and able to swim vigorously after going through the entire preparative procedure. The most prominent features of the image arise from the edges of the axonemal doublets and central-pair microtubules seen in projection. By comparison with these longitudinal markings, transverse features are less easy to discern, being camouflaged by superposition. However, Fourier transforms of digitized micrographs reveal a remarkable degree of crystalline order in quiescent flagella. Filtered images derived from these Fourier transforms show clearly features arising from the central-pair complex and radial spokes that were obscured in the original data. Potentially complicating effects of specimen thickness are shown to be quantitatively insignificant in the formation of images of unstained frozen hydrated flagella. Determination of native flagellar structure by 3-D reconstruction from multiple-tilted views appears to be feasible.

  4. 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

  5. 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.

  6. Phase separation in frozen erythrocyte membrane preparations.

    PubMed

    Finean, J B; Hutchinson, A; Mills, D

    1985-10-01

    The reversible formation of a lipid-like phase in frozen preparations of erythrocyte membranes has been studied by X-ray diffraction and by electron microscopy of freeze-fracture replicas. The observations provide strong evidence for lateral migration or displacement at specific temperatures of intra-membrane particles. This creates large areas of particle-free membranes which fracture preferentially so as to dominate the freeze-fracture image.

  7. A peri-operative statin update for non-cardiac surgery. Part II: Statin therapy for vascular surgery and peri-operative statin trial design.

    PubMed

    Biccard, B M

    2008-02-01

    This is the second of two review articles evaluating peri-operative statin therapy. In surgical patients, the utility of peri-operative statin therapy is strongly suggested by retrospective studies, although it is probably overestimated, as important confounding factors have not been controlled for and hence the literature is considered to be currently inconclusive. This review examines the potential mechanisms and indications for peri-operative statin protection, the efficacy of acute peri-operative beta-blockade in addition to statin therapy, the effect of peri-operative statin therapy withdrawal and the implications of comorbidities associated with peri-operative cardiovascular risk on statin therapy. Recommendations concerning appropriate dosing, duration, therapeutic targets and necessary investigations when prescribing peri-operative statins are made. Peri-operative study design recommendations are suggested, so that future meta-analyses may be more informative. Recommendations are made regarding retrospective reporting of statin studies to minimise the bias inherent in a number of the current retrospective studies on this subject. PMID:18211448

  8. Viscous Energy Dissipation in Frozen Cryogens

    NASA Astrophysics Data System (ADS)

    Meitner, S. J.; Pfotenhauer, J. M.; Andraschko, M. R.

    2008-03-01

    ITER is an international research and development project with the goal of demonstrating the feasibility of fusion power. The fuel for the ITER plasma is injected in the form of frozen deuterium pellets; the current injector design includes a batch extruder, cooled by liquid helium. A more advanced fuel system will produce deuterium pellets continuously using a twin-screw extruder, cooled by a cryocooler. One of the critical design parameters for the advanced system is the friction associated with the shearing planes of the frozen deuterium in the extruder; the friction determines the required screw torque as well as the cryocooler heat load. An experiment has been designed to measure the energy dissipation associated with shearing frozen deuterium. Deuterium gas is cooled to its freezing point in the gap between a stationary outer canister and a rotating inner cylinder. The dissipation is measured mechanically and through calorimetric means. The experiment has also been used to measure dissipation in other cryogens, such as neon, as a function of rotational velocity and temperature. This paper describes the design and construction of the experiment and presents measurements over a range of cryogens and test conditions.

  9. 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.

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

    NASA Astrophysics Data System (ADS)

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

    2012-02-01

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

  11. Ethical perception and resulting action in perioperative nurses.

    PubMed

    Schroeter, K

    1999-05-01

    This study examined whether perioperative nurses (n = 40) were able to perceive and identify selected ethical issues occurring within their practice setting. The nurses described ethical conflicts and identified factors influential to their ethical decision making. The issues reported were organized into five categories: consent/advocacy, impaired provider/potential for unsafe practice, misrepresentation by care provider, disrespect for patient, and provider judgment/competency. The results of this study support that perioperative nurses both perceive and identify specific ethical issues in the surgical environment. Analysis of their reported actions revealed that the most common methods used for ethical conflict resolution were reporting to the immediate supervisor or personally confronting those directly involved. PMID:10332553

  12. Perioperative Management of Multiple Noncardiac Implantable Electronic Devices.

    PubMed

    Ramos, Juan A; Brull, Sorin J

    2015-12-01

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

  13. Recurrent perioperative anaphylaxis in a 54-year-old man.

    PubMed

    Franxman, Timothy J; Greenhawt, Matthew J; Baldwin, James L

    2013-01-01

    Reports suggest that perioperative anaphylaxis in patients undergoing general anesthesia range from 1 in 5000 to 1 in 20,000 with mortality rates as high as 9%. Because of the variety of medications that are used for general anesthesia and the rapid succession in which they are administered, it is often difficult to determine the etiology of a severe allergic episode in this setting. Antibiotics and anesthetics are notorious for precipitating allergic reactions and are often implicated. Other perioperative exposures and patient risk factors must also be considered. In this article, we describe the case of a patient who exhibited recurrent anaphylaxis episodes while trying to undergo a vital cardiac surgery. PMID:23883604

  14. Intravenous sub-anesthetic ketamine for perioperative analgesia

    PubMed Central

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

    2016-01-01

    Ketamine, an N-methyl-d-aspartate antagonist, blunts central pain sensitization at sub-anesthetic doses (0.3 mg/kg or less) and has been studied extensively as an adjunct for perioperative analgesia. At sub-anesthetic doses, ketamine has a minimal physiologic impact though it is associated with a low incidence of mild psychomimetic symptoms as well as nystagmus and double vision. Contraindications to its use do exist and due to ketamine's metabolism, caution should be exercised in patients with renal or hepatic dysfunction. Sub-anesthetic ketamine improves pain scores and reduces perioperative opioid consumption in a broad range of surgical procedures. In addition, there is evidence that ketamine may be useful in patients with opioid tolerance and for preventing chronic postsurgical pain. PMID:27275042

  15. Perioperative Management of Multiple Noncardiac Implantable Electronic Devices.

    PubMed

    Ramos, Juan A; Brull, Sorin J

    2015-12-01

    The number of patients with noncardiac implantable electronic devices is increasing, and the absence of perioperative management standards, guidelines, practice parameters, or expert consensus statements presents clinical challenges. A 69-year-old woman presented for latissimus dorsi breast reconstruction. The patient had previously undergone implantation of a spinal cord stimulator, a gastric pacemaker, a sacral nerve stimulator, and an intrathecal morphine pump. After consultation with device manufacturers, the devices with patient programmability were switched off. Bipolar cautery was used intraoperatively. Postoperatively, all devices were interrogated to ensure appropriate functioning before home discharge. Perioperative goals include complete preoperative radiologic documentation of device component location, minimizing electromagnetic interference, and avoiding mechanical damage to implanted device components. PMID:26588030

  16. Evaluating Enhancements to a Perioperative Nurse Liaison Program.

    PubMed

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

    2016-04-01

    The impetus for the perioperative nurse liaison (PNL) program at our cancer center was to reduce anxiety for family members of patients undergoing surgery by improving communication between the family and the perioperative team. The purpose of our quality improvement project was to increase contact with family members during the patient's surgery and to support families and surgeons during the postoperative family consult when findings were unexpected. After implementing process changes, the PNLs evaluated the program using a short survey given to families after the postoperative consult. Families reported a reduction in stress and anxiety when intraoperative updates were received either in person or by telephone. In addition, when the PNL accompanied family members to the postoperative consult, the family felt supported when receiving unexpected findings. Further, family contact with the PNL increased from 77% to 98%, and the number of consults with surgeons that included the PNL rose from an average of 254 to 500 per year. PMID:27004504

  17. Technological advances in perioperative monitoring: Current concepts and clinical perspectives.

    PubMed

    Chilkoti, Geetanjali; Wadhwa, Rachna; Saxena, Ashok Kumar

    2015-01-01

    Minimal mandatory monitoring in the perioperative period recommended by Association of Anesthetists of Great Britain and Ireland and American Society of Anesthesiologists are universally acknowledged and has become an integral part of the anesthesia practice. The technologies in perioperative monitoring have advanced, and the availability and clinical applications have multiplied exponentially. Newer monitoring techniques include depth of anesthesia monitoring, goal-directed fluid therapy, transesophageal echocardiography, advanced neurological monitoring, improved alarm system and technological advancement in objective pain assessment. Various factors that need to be considered with the use of improved monitoring techniques are their validation data, patient outcome, safety profile, cost-effectiveness, awareness of the possible adverse events, knowledge of technical principle and ability of the convenient routine handling. In this review, we will discuss the new monitoring techniques in anesthesia, their advantages, deficiencies, limitations, their comparison to the conventional methods and their effect on patient outcome, if any.

  18. Using YouTube in perioperative nursing education.

    PubMed

    Logan, Rebecca

    2012-04-01

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

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

    PubMed Central

    Shamoun, Fadi; Obeid, Hiba; Ramakrishna, Harish

    2015-01-01

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

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

    PubMed

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

    2015-01-01

    Adhesive capsulitis of the shoulder (frozen shoulder) is a common disease characterised by spontaneous onset of pain and restriction of movement, followed by 'thawing', with complete or near-complete resolution. Adhesive capsulitis of the hip has been reported in around a dozen patients. This report describes an otherwise-healthy middle-aged woman with apparent sequential resolving adhesive capsulitis of all four ball-and-socket joints over a 9-year period, initially affecting each hip and then each shoulder sequentially. The likely hip diagnosis became clear only retrospectively with development of the second frozen shoulder, 5 years after the first pain. All joints subsequently resolved within the expected timeframe and the patient remains healthy, other than having mild hypertension. This case illustrates that, when hip precedes shoulder involvement, there is the potential for the frozen hip to receive alternate diagnoses for which invasive open hip surgery could unnecessarily be recommended. PMID:26564111

  1. Negotiation for the perioperative nurse: it's all up to you.

    PubMed

    Barkley, T W

    1996-07-01

    This article explores negotiation and related theories involved in the negotiation process. Philosophical views, stages, and various negotiation styles are discussed. Particularly, principled negotiation is addressed as a useful framework for conflict resolution. In addition, barriers, strategies, and skills inherent to the negotiation process are explored. Finally, a case application is presented to highlight the potential effectiveness of using successful negotiation tactics in the perioperative nursing setting. PMID:8718407

  2. Biliopancreatic Diversion with Duodenal Switch: Surgical Technique and Perioperative Care.

    PubMed

    Biertho, Laurent; Lebel, Stéfane; Marceau, Simon; Hould, Frédéric-Simon; Julien, François; Biron, Simon

    2016-08-01

    The goal of this article is to present an overview of selection criteria, surgical technique, and perioperative outcomes of biliopancreatic diversion with duodenal switch. The standard follow-up requirements, including vitamin supplementation, and long-term risks associated with metabolic surgery are also discussed. Most of the data reported here are based on the authors' experience with 4000 biliopancreatic diversions with duodenal switch performed in their institution since 1990.

  3. Expanding your perioperative practice into the health care industry.

    PubMed

    Shoup, A J; Stein, P S

    2000-03-01

    Perioperative nurses who pursue nontraditional roles with medical products companies must assess their personal and professional skills to determine if they would fill that role satisfactorily. They must consider the risks involved and determine if the job is appealing. Working as a health care industry nurse can positively affect patient outcomes while providing a company with unique skills and insights. This career choice can be very rewarding.

  4. [Perioperative treatment of patients with long QT syndrome].

    PubMed

    Krönauer, T; Friederich, P

    2015-08-01

    Long QT syndrome (LQTS) is caused by a change in cardiac repolarization due to functional ion channel dysfunction which is associated with an elongation of the QT interval (hence the name) in the electrocardiogram and a predisposition to cardiac rhythm disorders (e.g. torsade de pointes, TdP) as well as cardiac events up to sudden cardiac death. There is a congenital (cLQTS) and an acquired (aLQTS) form of the disease. The prevalence of cLQTS is 1 in 2000 but aLQTS is much more common and includes a grey area due to many asymptomatic patients. The LQTS is, therefore, more common than malignant hyperthermia which is much discussed in anesthesiology and has a reported prevalence in the population of 1:3000. Considering the prevalence of both aLQTS as well as cLQTS the importance of the LQTS seems to be underestimated in current perioperative care. Potential perioperative risks of such patients can be significantly reduced by appropriate patient management. This includes adequate preoperative preparation, the correct choice of anesthetic medication as well as adequate perioperative monitoring and preparedness for immediate pharmaceutical and electrical intervention in case of typical cardiac rhythm disturbances, such as TdP arrhythmia. PMID:26260197

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

    PubMed

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

    2016-06-01

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

  6. Hyperglycemia and Acute Kidney Injury During the Perioperative Period.

    PubMed

    Mendez, Carlos E; Der Mesropian, Paul J; Mathew, Roy O; Slawski, Barbara

    2016-01-01

    Hyperglycemia and acute kidney injury (AKI) are frequently observed during the perioperative period. Substantial evidence indicates that hyperglycemia increases the prevalence of AKI as a surgical complication. Patients who develop hyperglycemia and AKI during the perioperative period are at significantly elevated risk for poor outcomes such as major adverse cardiac events and all-cause mortality. Early observational and interventional trials demonstrated that the use of intensive insulin therapy to achieve strict glycemic control resulted in remarkable reductions of AKI in surgical populations. However, more recent interventional trials and meta-analyses have produced contradictory evidence questioning the renal benefits of strict glycemic control. Although the exact mechanisms through which hyperglycemia increases the risk of AKI have not been elucidated, multiple pathophysiologic pathways have been proposed. Hypoglycemia and glycemic variability may also play a significant role in the development of AKI. In this literature review, the complex relationship between hyperglycemia and AKI as well as its impact on clinical outcomes during the perioperative period is explored.

  7. Update on perioperative management of the child with asthma.

    PubMed

    Dones, Francesco; Foresta, Grazia; Russotto, Vincenzo

    2012-04-01

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

  8. Survival in sensitized lung transplant recipients with perioperative desensitization.

    PubMed

    Tinckam, K J; Keshavjee, S; Chaparro, C; Barth, D; Azad, S; Binnie, M; Chow, C W; de Perrot, M; Pierre, A F; Waddell, T K; Yasufuku, K; Cypel, M; Singer, L G

    2015-02-01

    Donor-specific HLA antibodies (DSA) have an adverse effect on short-term and long-term lung transplant outcomes. We implemented a perioperative strategy to treat DSA-positive recipients, leading to equivalent rejection and graft survival outcomes. Pretransplant DSA were identified to HLA-A, B, C, DR and DQ antigens. DSA-positive patients were transplanted if panel reactive antibody (PRA) ≥30% or medically urgent and desensitized with perioperative plasma exchange, intravenous immune globulin, antithymocyte globulin (ATG), and mycophenolic acid (MPA). PRA-positive/DSA-negative recipients received MPA. Unsensitized patients received routine cyclosporine, azathioprine and prednisone without ATG. From 2008-2011, 340 lung-only first transplants were performed: 53 DSA-positive, 93 PRA-positive/DSA-negative and 194 unsensitized. Thirty-day survival was 96 %/99%/96% in the three groups, respectively. One-year graft survival was 89%/88%/86% (p = 0.47). DSA-positive and PRA-positive/DSA-negative patients were less likely to experience any ≥ grade 2 acute rejection (9% and 9% vs. 18% unsensitized p = 0.04). Maximum predicted forced expiratory volume (1 s) (81%/74%/76%, p = NS) and predicted forced vital capacity (81%/77%/78%, respectively, p = NS) were equivalent between groups. With the application of this perioperative treatment protocol, lung transplantation can be safely performed in DSA/PRA-positive patients, with similar outcomes to unsensitized recipients. PMID:25612494

  9. Update on perioperative management of the child with asthma.

    PubMed

    Dones, Francesco; Foresta, Grazia; Russotto, Vincenzo

    2012-04-01

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

  10. [Croatian guidelines for perioperative enteral nutrition of surgical patients].

    PubMed

    Zelić, Marko; Bender, Darija Vranesić; Kelecić, Dina Ljubas; Zupan, Zeljko; Cicvarić, Tedi; Maldini, Branka; Durut, Iva; Rahelić, Velimir; Skegro, Mate; Majerović, Mate; Perko, Zdravko; Sustić, Alan; Madzar, Tomislav; Kovacić, Borna; Kekez, Tihomir; Krznarić, Zeljko

    2014-01-01

    Nutritional status of patients significantly affects the outcome of surgical treatment, whether it's about being obese or malnutrition with loss of muscle mass. Inadequate nutritional support in the perioperative period compromises surgical procedures even in patients who are adequately nourished. In this paper, particular attention was paid to malnourished patients, and their incidence in population hospitalized in surgical wards can be high up to 30%. Special emphasis was paid to the appropriateness of preoperative fasting and to the acceptance of new knowledge in this area of treatment. The aim of this working group was to make guidelines for perioperative nutritional support with different modalities of enteral nutrition. The development of these guidelines was attended by representatives of Croatian Medical Association: Croatian Society for Digestive Surgery, Croatian Society for Clinical Nutrition, Croatian Society of Surgery, Croatian Society for Endoscopic Surgery, Croatian Trauma Society and the Croatian Society of Anesthesiology and Intensive Care. The guidelines are designed as a set of questions that arise daily in clinical practice when preparing patients for surgery and after the surgical treatment, which relate to the assessment of nutritional status, perioperative nutritional support, duration of preoperative fasting period and the selection of food intake route. Assessment of nutritional status and the use of different modes of enteral nutrition should enter into standard protocols of diagnosis and treatment in the Croatian hospitals.

  11. [Perioperative management of a patient complicated with Quincke's edema].

    PubMed

    Nakaigawa, Naoko; Kamata, Kotoe; Komatsu, Ryu; Ozaki, Makoto

    2010-04-01

    We experienced perioperative management of a patient with Quincke's edema who underwent clipping of ruptured intracranial aneurysm. At the time of presentation, he complained of lip and tongue swelling. We administered dl-chlorpheniramine malate and tranexamic acid perioperatively to prevent further edema. Intraoperatively, we avoided contact of objects to the face and the oral cavity which might have caused mechanical stimuli, and infused albumin to maintain plasma osmotic pressure. The patient was kept intubated postoperatively because of significant tongue edema at the end of the procedure. On postoperative day 1, we extubated the trachea after prophylactic administration of methylpredonisolone. Significant upper airway edema was denied by flexible laryngoscopy. Pathophysiological cause of Quincke's edema is increased permeability of capillary vessels due to vasoactive substances. Aside from anti-histaminergic agents and steroids, tranexamic acid, which reduces production of kinin, is specifically effective for this condition. Although there is a reported case of Quincke's edema, eventually diagnosed after development of postoperative upper airway obstruction, there have been no reports of planned perioperative management of this condition. We demonstrated that Quincke's edema could be managed without life-threatening airway compromise by employing adequate pharmacologic interventions and sensible determination of the timing of extubation.

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

    PubMed

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

    2016-06-01

    Extraction of data from the electronic medical record is becoming increasingly important for quality improvement initiatives such as the American Society of Anesthesiologists Perioperative Surgical Home. To meet this need, the authors have built a robust and scalable data mart based on their implementation of EPIC containing data from across the perioperative period. The data mart is structured in such a way so as to first simplify the overall EPIC reporting structure into a series of Base Tables and then create several Reporting Schemas each around a specific concept (operating room cases, obstetrics, hospital admission, etc.), which contain all of the data required for reporting on various metrics. This structure allows centralized definitions with simplified reporting by a large number of individuals who access only the Reporting Schemas. In creating the database, the authors were able to significantly reduce the number of required table identifiers from >10 to 3, as well as to correct errors in linkages affecting up to 18.4% of cases. In addition, the data mart greatly simplified the code required to extract data, making the data accessible to individuals who lacked a strong coding background. Overall, this infrastructure represents a scalable way to successfully report on perioperative EPIC data while standardizing the definitions and improving access for end users. PMID:27195633

  13. Perioperative management of diabetes insipidus in children [corrected].

    PubMed

    Wise-Faberowski, Lisa; Soriano, Sulpicio G; Ferrari, Lynne; McManus, Michael L; Wolfsdorf, Joseph I; Majzoub, Joseph; Scott, R Michael; Truog, Robert; Rockoff, Mark A

    2004-01-01

    Managing children with diabetes insipidus (DI) in the perioperative period is complicated and frequently associated with electrolyte imbalance compounded by over- or underhydration. In this study the authors developed and prospectively evaluated a multidisciplinary approach to the perioperative management of DI with a comparison to 19 historical control children. Eighteen children either with preoperative DI or undergoing neurosurgical operations associated with a high risk for developing postoperative DI were identified and managed using a standardized protocol. In all patients in whom DI occurred during or after surgery, a continuous intravenous infusion of aqueous vasopressin was initiated and titrated until antidiuresis was established. Intravenous fluids were given as normal saline and restricted to two thirds of the estimated maintenance rate plus amounts necessary to replace blood losses and maintain hemodynamic stability. In all children managed in this fashion, perioperative serum sodium concentrations were generally maintained between 130 and 150 mEq/L, and no adverse consequences of this therapy developed. In the 24-hour period evaluated, the mean change in serum sodium concentrations between the historical controls was 17.6 +/- 9.2 mEq/L versus 8.36 +/- 6.43 mEq/L in those children managed by the protocol. Hyponatremia occurred less frequently in the children managed with this protocol compared with historical controls.

  14. Update on perioperative management of the child with asthma

    PubMed Central

    Dones, Francesco; Foresta, Grazia; Russotto, Vincenzo

    2012-01-01

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

  15. Perioperative Hemostatic Management in Ehlers-Danlos Syndrome: A Report of 2 Cases and Literature Review.

    PubMed

    Lindsay, Holly; Lee-Kim, YoungNa J; Srivaths, Lakshmi V

    2016-03-01

    Ehlers-Danlos syndrome (EDS) is associated with easy bruising and bleeding complications in the majority. Although bleeding complications are frequently observed during surgery in these patients, the perioperative hemostatic prophylaxis of patients with EDS is not standardized. We present 2 cases of effective perioperative hemostatic management of patients with EDS and review the literature to raise awareness of hemostatic issues during surgery and discuss medical options to consider for perioperative hemostatic management based on our clinical experience and literature review.

  16. Contemporary perioperative management of adult familial dysautonomia (Riley-Day syndrome).

    PubMed

    Milne, Andrew; Mon, Wint Yu; Down, James; Obichere, Austin; Ackland, Gareth L

    2015-05-01

    Familial dysautonomia (Riley-Day syndrome) is a rare multisystem disorder associated with an excess risk of perioperative morbidity and mortality. Because life expectancy is limited, few reports consider the perioperative management of familial dysautonomia in adults with advanced disease and end-organ dysfunction. Here, we report on the management of an adult patient with familial dysautonomia, highlighting recent developments in perioperative technology and pharmacology of special relevance to this challenging population.

  17. Perioperative Hemostatic Management in Ehlers-Danlos Syndrome: A Report of 2 Cases and Literature Review.

    PubMed

    Lindsay, Holly; Lee-Kim, YoungNa J; Srivaths, Lakshmi V

    2016-03-01

    Ehlers-Danlos syndrome (EDS) is associated with easy bruising and bleeding complications in the majority. Although bleeding complications are frequently observed during surgery in these patients, the perioperative hemostatic prophylaxis of patients with EDS is not standardized. We present 2 cases of effective perioperative hemostatic management of patients with EDS and review the literature to raise awareness of hemostatic issues during surgery and discuss medical options to consider for perioperative hemostatic management based on our clinical experience and literature review. PMID:26334432

  18. Optimal use of fresh frozen plasma.

    PubMed

    DomBourian, Melkon; Holland, Lorne

    2012-01-01

    Fresh frozen plasma contains a number of therapeutically useful substances, most notably coagulation factors. As with any transfusion, there are risks associated with plasma transfusion. Ironically, the risk of viral transmission (human immunodeficiency virus or hepatitis), although widely publicized, is extremely small. On the other hand, less well-known, noninfectious complications are common. Indeed, these noninfectious complications are the most significant cause of morbidity and mortality following transfusion. Although certain patients undeniably benefit from plasma transfusion, the benefit for many patients is less clear. This review will discuss indications for plasma transfusion, the associated risks, and special considerations for plasma administration.

  19. Post-vaccination frozen shoulder syndrome. Report of 3 cases.

    PubMed

    Degreef, I; Debeer, Ph

    2012-01-01

    The cause of frozen shoulder syndrome is unknown in most cases, although it can be preceded by minor trauma. Here, we report 3 patients with severe frozen shoulder after an intramuscular vaccination in the deltoid muscle. A distention arthrography resulted in good pain relief and improved the mobility. Frozen shoulder syndrome can be a severe manifestation of vaccination-related shoulder dysfunction. Correct intramuscular administration is crucial to prevent post-vaccination frozen shoulder and on the other hand, physicians' awareness is needed to recognize this feature early on.

  20. Survival of salmonella in processed chicken products during frozen storage.

    PubMed

    Dominguez, Silvia A; Schaffner, Donald W

    2009-10-01

    Frozen chicken products have been identified recently as a cause of salmonellosis. At least eight salmonellosis outbreaks from 1998 to 2008 have implicated undercooked frozen chicken nuggets, strips, and entrees as infection vehicles. Thus, the presence of Salmonella in frozen products may pose an infection risk if the product is improperly cooked. The objective of this study was to assess the survivability of Salmonella during frozen storage (-20 degrees ) when inoculated in processed chicken products. Four Salmonella strains originally isolated from poultry were inoculated into frozen chicken nuggets (fully cooked) and frozen chicken strips (containing raw poultry) at initial populations of 10(4) to 10(5) CFU/g. Survival was assessed during storage at -20 degrees for 16 weeks by measuring bacterial growth on minimal, selective, and nonselective agars. Results indicate that cell populations measured in nonselective agars (plate count agar and plate count agar supplemented with tetracycline) and minimal (M9) agar remained relatively constant during the entire -20 degrees storage period studied (16 weeks) for both chicken nuggets and strips. However, cell populations were significantly (P < 0.05) lower when measured in selective agar (XLT4) during the 16 weeks of frozen storage for both chicken nuggets and strips, suggesting that these cells were structurally injured. The data presented in this study indicate that Salmonella can survive frozen storage when inoculated in frozen, processed chicken products and confirm that microbial counts on selective agar are not representative of the total population of samples subject to freezing.

  1. Primary Frozen Shoulder Syndrome: Arthroscopic Capsular Release

    PubMed Central

    Arce, Guillermo

    2015-01-01

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

  2. Frozen Chemistry Effects on Nozzle Performance Simulations

    NASA Technical Reports Server (NTRS)

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

    2009-01-01

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

  3. Modelling infiltration processes in frozen soils

    NASA Astrophysics Data System (ADS)

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

    2014-12-01

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

  4. Frozen spin targets in ribosomal structure research.

    PubMed

    Stuhrmann, H B

    1991-01-01

    Polarized neutron scattering strongly depends on nuclear spin polarisation, particularly on proton spin polarisation. A single proton in a deuterated environment then is as efficient as 10 electrons in X-ray anomalous diffraction. Neutron scattering from the nuclear spin label is controlled by the polarisation of neutron spins and nuclear spins. Pure deuteron spin labels and proton spin labels are created by NMR saturation. We report on results obtained from the large subunit of E. coli ribosomes which have been obtained at the research reactor of GKSS using the polarized target facility developed by CERN. The nuclear spins were oriented with respect to an external field by dynamic nuclear polarisation. Proton spin polarisations of more than 80% were obtained in ribosomes at temperatures below 0.5 K. At T = 130 mK the relaxation time of the polarized target is one month (frozen spin target). Polarized small-angle neutron scattering of the in situ structure of rRNA and the total ribosomal protein (TP) has been determined from the frozen spin targets of the large ribosomal subunit, which has been deuterated in the TP and rRNA respectively. The results agree with those from neutron scattering in H2O/D2O mixtures obtained at room temperature. This is a necessary prerequisite for the planned determination of the in situ structure of individual ribosomal proteins and especially of that of ribosome bound mRNA and tRNAs. PMID:1720669

  5. Searching for Frozen Super Earth via Microlensing

    NASA Astrophysics Data System (ADS)

    Batista, V.; Beaulieu, J. P.; Cassan, A.; Coutures, C.; Donatowicz, J.; Fouqué, P.; Kubas, D.; Marquette, J. B.

    2009-04-01

    Microlensing planet hunt is a unique method to probe efficiently for frozen Super Earth orbiting the most common stars of our galaxy. It is nicely complementing the parameter space probed by very high accuracy radial velocity measurements and future space based detections of low mass transiting planets. In order to maximize the planet catch, the microlensing community is engaged in a total cooperation among the different groups (OGLE, MicroFUN, MOA, PLANET/RoboNET) by making the real time data available, and mutual informing/reporting about modeling efforts. Eight planets have been published so far by combinations of the different groups, 4 Jovian analogues, one Neptune and two Super Earth. Given the microlensing detection efficiency, it suggests that these Neptunes/Super Earths may be quite common. Using networks of dedicated 1-2m class telescopes, the microlensing community has entered a new phase of planet discoveries, and will be able to provide constraints on the abundance of frozen Super-Earths in the near future. Statistics about Mars to Earth mass planets, extending to the habitable zone will be achieved with space based wide field imagers (EUCLID) at the horizon 2017.

  6. Stability of Frozen Orbits Around Europa

    NASA Astrophysics Data System (ADS)

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

    2013-05-01

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

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

    PubMed

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

    2013-06-01

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

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

    PubMed

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

    2013-06-01

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

  9. Assessment of selected perioperative parameters in patients undergoing laparoscopic and abdominal supracervical hysterectomy

    PubMed Central

    Skręt-Magierło, Joanna; Kluz, Tomasz; Barnaś, Edyta; Sobolewski, Marek; Raś, Renata; Skręt, Andrzej

    2015-01-01

    Introduction Subtotal hysterectomy is a method of treatment of patients with mild changes in the uterine body. Laparoscopic methods are increasingly used in surgical gynaecology. One of the limitations of laparoscopy is the proper level of operating surgeon's training, which may be assessed with the use of the learning curve. The aim of the study was to compare data regarding the perioperative period in patients who underwent subtotal hysterectomy with the two methods, and to establish a learning curve for laparoscopic subtotal hysterectomy. Material and methods One hundred and twenty-seven patients qualified for subtotal hysterectomy due to mild disturbances in the uterine body participated in the study. The study was conducted at the Clinical Department of Gynaecology and Obstetrics of Fryderyk Chopin Provincial Specialist Hospital in Rzeszów in 2012-2013. Results The time of laparoscopic subtotal hysterectomy is longer than that of the classical surgical procedure. Uterine myomas are the main indication for subtotal hysterectomy. Laparoscopic operation results in lower blood loss compared to the classical surgical method. The mean age of the patients operated due to mild changes in the uterine body is similar in both groups. Patients who are obese or have undergone Caesarean sections are more frequently qualified for the classical surgery. The study revealed a reduction in time of laparoscopic subtotal hysterectomy by ca. 31 minutes (33%). Conclusions Laparoscopic subtotal hysterectomy is a method chosen by operating surgeons for patients with a lower perioperative risk. The period of the study made it possible to determine a learning curve for laparoscopic subtotal hysterectomy. PMID:26848296

  10. [Cesarean section through history].

    PubMed

    Rabinerson, David; Ashwal, Eran; Gabbay-Benziv, Rinat

    2014-11-01

    According to historic documents, delivery by abdominal and uterine incision was already known to mankind at the beginning of the second millennium BC. This delivery method was eventually referred to as "Cesarean Section" because it was wrongfully attributed to the way by which Julius Caesar was born. The indications for cesarean sections performed in ancient cultures and to the end of the medieval period were mainly kings law, that mandated burial of the fetus separately from his mother, legal rights regarding inheritance of the father or religious motives mandating baptism of the newborn in order to ensure him eternal life in heaven. As from the second half of the 19th century AD, and with improvement in surgical techniques, as well as in the perioperative environment (asepsis, antibiotics, anaesthesia, blood transfusion, etc.), the obstetric outcome of cesarean sections was dramaticay improved, both in terms of maternal, as well as fetal, outcome. Hence, it became very prevalent throughout the world. The emergence of medico-legal medicine and medical ethics issues, have further contributed to the use of cesarean sections as the ultimate solution of every unusual delivery. PMID:25563029

  11. Prothrombin Complex Concentrates for Bleeding in the Perioperative Setting.

    PubMed

    Ghadimi, Kamrouz; Levy, Jerrold H; Welsby, Ian J

    2016-05-01

    Prothrombin complex concentrates (PCCs) contain vitamin K-dependent clotting factors (II, VII, IX, and X) and are marketed as 3 or 4 factor-PCC formulations depending on the concentrations of factor VII. PCCs rapidly restore deficient coagulation factor concentrations to achieve hemostasis, but like with all procoagulants, the effect is balanced against thromboembolic risk. The latter is dependent on both the dose of PCCs and the individual patient prothrombotic predisposition. PCCs are approved by the US Food and Drug Administration for the reversal of vitamin K antagonists in the setting of coagulopathy or bleeding and, therefore, can be administered when urgent surgery is required in patients taking warfarin. However, there is growing experience with the off-label use of PCCs to treat patients with surgical coagulopathic bleeding. Despite their increasing use, there are limited prospective data related to the safety, efficacy, and dosing of PCCs for this indication. PCC administration in the perioperative setting may be tailored to the individual patient based on the laboratory and clinical variables, including point-of-care coagulation testing, to balance hemostatic benefits while minimizing the prothrombotic risk. Importantly, in patients with perioperative bleeding, other considerations should include treating additional sources of coagulopathy such as hypofibrinogenemia, thrombocytopenia, and platelet disorders or surgical sources of bleeding. Thromboembolic risk from excessive PCC dosing may be present well into the postoperative period after hemostasis is achieved owing to the relatively long half-life of prothrombin (factor II, 60-72 hours). The integration of PCCs into comprehensive perioperative coagulation treatment algorithms for refractory bleeding is increasingly reported, but further studies are needed to better evaluate the safe and effective administration of these factor concentrates. PMID:26983050

  12. Perioperative Smartphone Apps and Devices for Patient-Centered Care.

    PubMed

    Simpao, Allan F; Lingappan, Arul M; Ahumada, Luis M; Rehman, Mohamed A; Gálvez, Jorge A

    2015-09-01

    Smartphones have grown in ubiquity and computing power, and they play an ever-increasing role in patient-centered health care. The "medicalized smartphone" not only enables web-based access to patient health resources, but also can run patient-oriented software applications and be connected to health-related peripheral devices. A variety of patient-oriented smartphone apps and devices are available for use to facilitate patient-centered care throughout the continuum of perioperative care. Ongoing advances in smartphone technology and health care apps and devices should expand their utility for enhancing patient-centered care in the future. PMID:26265239

  13. Perioperative Smartphone Apps and Devices for Patient-Centered Care.

    PubMed

    Simpao, Allan F; Lingappan, Arul M; Ahumada, Luis M; Rehman, Mohamed A; Gálvez, Jorge A

    2015-09-01

    Smartphones have grown in ubiquity and computing power, and they play an ever-increasing role in patient-centered health care. The "medicalized smartphone" not only enables web-based access to patient health resources, but also can run patient-oriented software applications and be connected to health-related peripheral devices. A variety of patient-oriented smartphone apps and devices are available for use to facilitate patient-centered care throughout the continuum of perioperative care. Ongoing advances in smartphone technology and health care apps and devices should expand their utility for enhancing patient-centered care in the future.

  14. PERIOPERATIVE CARE OF A CHILD WITH CRISPONI SYNDROME.

    PubMed

    Rafiq, Mahmood; Almasry, Shadi; Abdulrahman, Anas; Al-Sohabani, Mazen; Tobias, Joseph D

    2016-06-01

    Crisponi syndrome is an autosomal recessive disorder characterized by intermittent episodes of muscular contraction of the facial muscles with trismus and excessive salivation simulating a tetanic spasm. These episodes occur in response to tactile stimulation or during crying. Associated physical and constitutional findings include characteristic facial anomalies, camptodactyly, intermittent hyperthermia, and feeding difficulties. We present a 15-month-old girl who required anesthetic care during laparoscopic fundoplication and gastric tube insertion. The perioperative implications of the disorder are reviewed and suggestions for anesthetic management provided. PMID:27487643

  15. Perioperative anaphylactic risk score for risk-oriented premedication.

    PubMed

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

    2013-01-01

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

  16. Educating perioperative managers about materials and financial management.

    PubMed

    Davis, Eric

    2005-04-01

    One of the most resource intensive areas in many hospitals is the OR, which often accounts for more than 50% of a hospital's materials management budget. Surgical services managers often have no formal training in materials and financial management, but they are held accountable for one of the most costly clinical areas in the hospital. A program proposed for Navy perioperative nurse managers is a five-day course that covers the basics of Navy medical materials and financial management as they apply to the OR. Application strategies for the civilian sector also are discussed. PMID:15875959

  17. Advance directives, living wills, and futility in perioperative care.

    PubMed

    Goede, Matthew; Wheeler, Matthew

    2015-04-01

    Patient autonomy is preserved through the use of advance directives. A living will defines treatment by establishing parameters under which patients want to be treated. A durable power of attorney for health care establishes a surrogate for patients if they are unable to make decisions for themselves. In the perioperative setting, advance directives are applied with significant variation between surgeons, likely due to surgeons implying from informed consent discussions that patients want to pursue aggressive treatment. Futility is a rare occurrence in patient care that is difficult to define; however, there are some classic surgical conditions in which futility is part of the decision process.

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

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

    2011-05-01

    The population of children with end-stage heart failure requiring mechanical circulatory support is growing. These children present for diagnostic imaging studies, various interventions and noncardiac surgical procedures that require anesthetic care. This article is a review of the population demographics of children on mechanical cardiac support, the alternative devices available, and the important concepts for safe perioperative management of these patients. The discussion will be limited to devices for short- and long-term cardiac support, excluding extracorporeal membrane oxygenation (ECMO) for respiratory support. PMID:21332879

  20. [PERIOPERATIVE VISUAL LOSS AFTER SPINE SURGERY: A CASE REPORT].

    PubMed

    Talmasse, M; Franssen, C; Martin, D; Georges, A; Brichant, J-f

    2016-04-01

    Perioperative visual loss is a rare but devastating complication that may follow spine surgery in the prone position. So far, the incidence, mechanisms and risk factors have not been clearly established. Most commonly, the visual loss results from an ischemic optic neuropathy. We describe the case of a 68 year-old woman who underwent a lumbar laminectomy in the prone position. Upon recovery from anesthesia, the patient complained of total left blindness. This visual loss was, slowly and only partially, recovered after 72 hours. We discuss the most common causes of postoperative visual loss, the risk factors and preventive strategy. PMID:27295895

  1. 78 FR 55676 - Certain Frozen Fish Fillets From the Socialist Republic of Vietnam: Preliminary Results of the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-11

    ...: Certain Frozen Fish Fillets From the Socialist Republic of Vietnam, 68 FR 47909 (August 12, 2003) (``Order... calculated in accordance with section 772 of the Act. Because Vietnam is a non-market economy (``NME... Socialist Republic of Vietnam: Preliminary Results of Antidumping Duty Administrative Review, 71 FR...

  2. 76 FR 55350 - Certain Frozen Warmwater Shrimp From the Socialist Republic of Vietnam: Extension of Time Limit...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-07

    .... \\1\\ See Notice of Amended Final Determination of Sales at Less Than Fair Value and Antidumping Duty Order: Certain Frozen Warmwater Shrimp from the Socialist Republic of Vietnam, 70 FR 5152 (February 1... Antidumping Duty New Shipper Review, 76 FR 16384 (March 23, 2011). Statutory Time Limits Section...

  3. Frozen soil parameterization in a distributed biosphere hydrological model

    NASA Astrophysics Data System (ADS)

    Wang, L.; Koike, T.; Yang, K.; Jin, R.; Li, H.

    2010-03-01

    In this study, a frozen soil parameterization has been modified and incorporated into a distributed biosphere hydrological model (WEB-DHM). The WEB-DHM with the frozen scheme was then rigorously evaluated in a small cold area, the Binngou watershed, against the in-situ observations from the WATER (Watershed Allied Telemetry Experimental Research). First, by using the original WEB-DHM without the frozen scheme, the land surface parameters and two van Genuchten parameters were optimized using the observed surface radiation fluxes and the soil moistures at upper layers (5, 10 and 20 cm depths) at the DY station in July. Second, by using the WEB-DHM with the frozen scheme, two frozen soil parameters were calibrated using the observed soil temperature at 5 cm depth at the DY station from 21 November 2007 to 20 April 2008; while the other soil hydraulic parameters were optimized by the calibration of the discharges at the basin outlet in July and August that covers the annual largest flood peak in 2008. With these calibrated parameters, the WEB-DHM with the frozen scheme was then used for a yearlong validation from 21 November 2007 to 20 November 2008. Results showed that the WEB-DHM with the frozen scheme has given much better performance than the WEB-DHM without the frozen scheme, in the simulations of soil moisture profile at the cold regions catchment and the discharges at the basin outlet in the yearlong simulation.

  4. 21 CFR 152.126 - Frozen cherry pie.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION FRUIT PIES Requirements for Specific Standardized Fruit Pies § 152.126 Frozen cherry... of quality for frozen cherry pie is as follows: (i) The fruit content of the pie is such that...

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

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    .... Except in the case of frozen custard, ice cream contains less than 1.4 percent egg yolk solids by weight... contain 1.4 percent egg yolk solids by weight of the finished food: Provided, however, That when bulky flavors are added the egg yolk solids content of frozen custard may be reduced in proportion to the...

  6. 21 CFR 135.110 - Ice cream and frozen custard.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    .... Except in the case of frozen custard, ice cream contains less than 1.4 percent egg yolk solids by weight... contain 1.4 percent egg yolk solids by weight of the finished food: Provided, however, That when bulky flavors are added the egg yolk solids content of frozen custard may be reduced in proportion to the...

  7. 21 CFR 135.110 - Ice cream and frozen custard.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    .... Except in the case of frozen custard, ice cream contains less than 1.4 percent egg yolk solids by weight... contain 1.4 percent egg yolk solids by weight of the finished food: Provided, however, That when bulky flavors are added the egg yolk solids content of frozen custard may be reduced in proportion to the...

  8. Aspects of three field approximations: Darwin, frozen, EMPULSE

    SciTech Connect

    Boyd, J.K.; Lee, E.P.; Yu, S.S.

    1985-05-25

    The traditional approach used to study high energy beam propagation relies on the frozen field approximation. A minor modification of the frozen field approximation yields the set of equations applied to the analysis of the hose instability. These models are constrasted with the Darwin field approximation. A statement is made of the Darwin model equations relevant to the analysis of the hose instability.

  9. 21 CFR 146.126 - Frozen concentrate for colored lemonade.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

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

  10. 21 CFR 146.126 - Frozen concentrate for colored lemonade.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

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

  11. Role of Esmolol in Perioperative Analgesia and Anesthesia: A Literature Review.

    PubMed

    Harless, Megan; Depp, Caleb; Collins, Shawn; Hewer, Ian

    2015-06-01

    Use of opioids to provide adequate perioperative analgesia often leads to respiratory depression, nausea, vomiting, urinary retention, pruritus, and opioid-induced hyperalgesia, with the potential to increase length of stay in the hospital. In an effort to reduce perioperative opioid administration yet provide appropriate pain relief, researchers began to study the use of esmolol beyond its well-known cardiovascular effects. Perioperative esmolol has been shown to reduce anesthetic requirements, decrease perioperative opioid use, decrease the incidence of postoperative nausea and vomiting, lead to an earlier discharge, and increase patient satisfaction. This article provides a review of the literature on the use of esmolol as an adjunct for perioperative analgesia and anesthesia. PMID:26137757

  12. Being altered by the unexpected: understanding the perioperative patient's experience: a case study.

    PubMed

    Rudolfsson, Gudrun

    2014-08-01

    The present paper focuses on the process of understanding the patient in the context of perioperative caring and reports a story narrated by a perioperative nurse as well as her emerging understanding of the patient prior to surgery at an operating department. This qualitative case study had a dual purpose; firstly, to describe how the perioperative nurse's understanding of the patient emerged and, secondly, to establish how the researcher interpreted the situation. As a perioperative nurse and researcher, the author is both the narrator and interpreter. To date we have rarely discussed the fact that, in a perioperative context, the patient might feel ashamed of his/her body, even before arriving at the operating department. This new understanding emerged from the hermeneutical dialogue in the present study. PMID:24118543

  13. Integrating Perioperative Content in Nursing Curricula: A Case Study Approach.

    PubMed

    Byrne, Michelle; Root, Susan; Culbertson, Laurie

    2016-06-01

    Perioperative nursing care requires unique specialty knowledge, skills, and abilities. National initiatives in nursing education and health care support integrating perioperative nursing content into curricular offerings in nursing schools and health care institutions. We provide an overview of the initiatives affecting nursing education, followed by a case study example and a guide to assist educators with incorporating perioperative case studies into their education plans. These resources may enhance the integration of perioperative nursing concepts in undergraduate curricula, internships, and continuing education offerings. The purpose of this article is to provide resources for nurse educators to systematically create case studies and to encourage increased exposure to perioperative concepts and competencies in a myriad of educational environments. PMID:27234794

  14. 21 CFR 101.95 - “Fresh,” “freshly frozen,” “fresh frozen,” “frozen fresh.”

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... freezing will not preclude use of the term “fresh frozen” to describe the food. “Quickly frozen” means frozen by a freezing system such as blast-freezing (sub-zero Fahrenheit temperature with fast moving...

  15. 21 CFR 101.95 - “Fresh,” “freshly frozen,” “fresh frozen,” “frozen fresh.”

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... freezing will not preclude use of the term “fresh frozen” to describe the food. “Quickly frozen” means frozen by a freezing system such as blast-freezing (sub-zero Fahrenheit temperature with fast moving...

  16. 21 CFR 101.95 - “Fresh,” “freshly frozen,” “fresh frozen,” “frozen fresh.”

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... freezing will not preclude use of the term “fresh frozen” to describe the food. “Quickly frozen” means frozen by a freezing system such as blast-freezing (sub-zero Fahrenheit temperature with fast moving...

  17. 21 CFR 101.95 - “Fresh,” “freshly frozen,” “fresh frozen,” “frozen fresh.”

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... freezing will not preclude use of the term “fresh frozen” to describe the food. “Quickly frozen” means frozen by a freezing system such as blast-freezing (sub-zero Fahrenheit temperature with fast moving...

  18. Title: Characterizing a Frozen Extrasolar World

    NASA Technical Reports Server (NTRS)

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

    2016-01-01

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

  19. 78 FR 33350 - Certain Frozen Warmwater Shrimp From Thailand: Preliminary Countervailing Duty Determination

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-04

    ... International Trade Administration Certain Frozen Warmwater Shrimp From Thailand: Preliminary Countervailing... countervailable subsidies are being provided to producers and exporters of certain frozen warmwater shrimp (frozen shrimp) from Thailand. The period of investigation is January 1, 2011, through December 31,...

  20. Frozen Ground Controls on Hydrological Processes

    NASA Astrophysics Data System (ADS)

    Hinzman, L. D.; Kane, D. L.; Woo, M. K.

    2015-12-01

    Frozen ground establishes a unique discipline of hydrologic science where the hydrologic regime is intimately coupled with the thermal regime to the extent that one may not be completely understood without correct characterization of the other. In permafrost regions, material properties may change drastically on a scale of centimeters to meters, particularly in the vertical dimension due to distinct changes in soil and thermal characteristics. Properties may vary just as dramatically in the horizontal dimension across the boundary of discontinuous permafrost. Although the spatial extent of permafrost changes on relatively slow time scales in response to disturbance or a changing climate, this too introduces an added level of complexity. Permafrost may nearly eliminate the interactions between near-surface and sub-permafrost aquifers, which in essence defines the hydrologic response of every watershed that is directly influenced by permafrost. Even though the principles governing water movement in permafrost areas are the same as those in more temperate regions, interactions of extremes in climate and the land surface characteristics render permafrost hydrology different from the hydrology of temperate latitudes. Ice-rich permafrost prevents deep percolation of rainfall or snowmelt water, often maintaining a moist to saturated active layer above the permafrost table. Most hydrologic activities are confined above-ground or in the thin active layer, which supplies summer moisture for baseflow and/or plant transpiration. Limited storage capacity of the thawed active layer does not support extended baseflow in a stream, though the proportion of baseflow increases as the percentage of permafrost extent decreases. In areas where permafrost is discontinuous or where it has thawed substantially near the surface, local hydrology may display a markedly different character as there are stronger exchanges between the surface water and the ground water system, or water may drain

  1. The role of prophylactic antibiotics in preventing perioperative infection.

    PubMed

    Setiawan, Budi

    2011-10-01

    With the increasing number of surgery or operation, perioperative infection has become one of problems that have been found more often. Surgical site infection is the most common perioperative infection causing increased hospitalization stay, high cost, morbidity and mortality rate. Infection occurs within 30 days after the operation on surgical site or within one year if implant is in place. Such infection may be prevented through several ways including some aspects of health-care provider, operating-room environment, and adequate preoperative preparation of the patients. Antibiotic prophylaxis is one of important modalities in preventing surgical site infection. Antibiotic prophylaxis administration significantly reduces the incidence of surgical site infection up to four-fold of decrease. Short-term antibiotic is given prior to incision in order to reduce the contamination of bacterial inoculums during surgery. The decision to administer antibiotic prophylaxis should be made by considering their risk and benefits. One of them includes utilization of the NNIS (National Nosocomial Infections Surveillance) score system, which considers three factors, such as wound class, ASA physical status scale, and duration of operation according to the NNIS Survey. The selection on timing and appropriately administered antibiotic prophylaxis is critical to maximize the benefits.

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

    PubMed Central

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

    2010-01-01

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

  3. Perioperative regional anaesthesia and postoperative longer-term outcomes

    PubMed Central

    Jakobsson, Jan; Johnson, Mark Z.

    2016-01-01

    Regional anaesthesia provides effective anaesthesia and analgesia in the perioperative setting. Central neuraxial blocks—that is, spinal and epidural blocks—are well established as an alternative or adjunct to general anaesthesia. Peripheral blocks may be used as part of multimodal anaesthesia/analgesia in perioperative practice, reducing the need for opioid analgesics and enhancing early recovery. Furthermore, regional anaesthesia has increased in popularity and may be done with improved ease and safety with the introduction of ultrasound-guided techniques. The effects of local anaesthetics and regional anaesthesia on long-term outcomes such as morbidity, mortality, the quality of recovery beyond the duration of analgesia, and whether it can expedite the resumption of activities of daily living are less clear. It has also been suggested that regional anaesthesia may impact the risk of metastasis after cancer surgery. This article provides an overview of current evidence around quality of recovery, risk for delirium, long-term effects, and possible impact on cancer disease progression associated with the clinical use of local and regional anaesthetic techniques. In summary, there is still a lack of robust data that regional anaesthesia has a clinical impact beyond its well-acknowledged beneficial effects of reducing pain, reduced opioid consumption, and improved quality of early recovery. Further high-quality prospective studies on long-term outcomes are warranted. PMID:27785357

  4. Clevidipine for Perioperative Blood Pressure Control in Infants and Children

    PubMed Central

    Tobias, Joseph D.; Tulman, David B.; Bergese, Sergio D.

    2013-01-01

    Various pharmacologic agents have been used for perioperative BP control in pediatric patients, including sodium nitroprusside, nitroglycerin, β-adrenergic antagonists, fenoldopam, and calcium channel antagonists. Of the calcium antagonists, the majority of the clinical experience remains with the dihydropyridine nicardipine. Clevidipine is a short-acting, intravenous calcium channel antagonist of the dihydropyridine class. It undergoes rapid metabolism by non-specific blood and tissue esterases with a half-life of less than 1 minute. As a dihydropyridine, its cellular and end-organ effects parallel those of nicardipine. The clevidipine trials in the adult population have demonstrated efficacy in rapidly controlling BP in various clinical scenarios with a favorable adverse effect profile similar to nicardipine. Data from large clinical trials regarding the safety and efficacy of clevidipine in children is lacking. This manuscript aims to review the commonly used pharmacologic agents for perioperative BP control in children, discuss the role of calcium channel antagonists such as nicardipine, and outline the preliminary data regarding clevidipine in the pediatric population. PMID:24275788

  5. Angioedema: Classification, management and emerging therapies for the perioperative physician

    PubMed Central

    Misra, Lopa; Khurmi, Narjeet; Trentman, Terrence L

    2016-01-01

    Angioedema is a rare condition which manifests as sudden localised, non-pitting swelling of certain body parts including skin and mucous membranes. It is vital that anaesthesiologists understand this condition, as it may present suddenly in the perioperative period with airway compromise. To identify literature for this review, the authors searched the PubMed, Medline, Embase, Scopus and Web of Science databases for English language articles covering a 10-year period, 2006 through 2016. Angioedema can be either mast-cell mediated or bradykinin-induced. Older therapies for histaminergic symptoms are well known to anaesthesiologists (e.g., adrenaline, anti-histamines and steroids), whereas older therapies for bradykinin-induced symptoms include plasma and attenuated androgens. New classes of drugs for bradykinin-induced symptoms are now available, including anti-bradykinin, plasma kallikrein inhibitor and C1 esterase inhibitors. These can be used prophylactically or as rescue medications. Anaesthesiologists are in a unique position to coordinate perioperative care for this complex group of patients. PMID:27601734

  6. Angioedema: Classification, management and emerging therapies for the perioperative physician.

    PubMed

    Misra, Lopa; Khurmi, Narjeet; Trentman, Terrence L

    2016-08-01

    Angioedema is a rare condition which manifests as sudden localised, non-pitting swelling of certain body parts including skin and mucous membranes. It is vital that anaesthesiologists understand this condition, as it may present suddenly in the perioperative period with airway compromise. To identify literature for this review, the authors searched the PubMed, Medline, Embase, Scopus and Web of Science databases for English language articles covering a 10-year period, 2006 through 2016. Angioedema can be either mast-cell mediated or bradykinin-induced. Older therapies for histaminergic symptoms are well known to anaesthesiologists (e.g., adrenaline, anti-histamines and steroids), whereas older therapies for bradykinin-induced symptoms include plasma and attenuated androgens. New classes of drugs for bradykinin-induced symptoms are now available, including anti-bradykinin, plasma kallikrein inhibitor and C1 esterase inhibitors. These can be used prophylactically or as rescue medications. Anaesthesiologists are in a unique position to coordinate perioperative care for this complex group of patients. PMID:27601734

  7. The role of prophylactic antibiotics in preventing perioperative infection.

    PubMed

    Setiawan, Budi

    2011-10-01

    With the increasing number of surgery or operation, perioperative infection has become one of problems that have been found more often. Surgical site infection is the most common perioperative infection causing increased hospitalization stay, high cost, morbidity and mortality rate. Infection occurs within 30 days after the operation on surgical site or within one year if implant is in place. Such infection may be prevented through several ways including some aspects of health-care provider, operating-room environment, and adequate preoperative preparation of the patients. Antibiotic prophylaxis is one of important modalities in preventing surgical site infection. Antibiotic prophylaxis administration significantly reduces the incidence of surgical site infection up to four-fold of decrease. Short-term antibiotic is given prior to incision in order to reduce the contamination of bacterial inoculums during surgery. The decision to administer antibiotic prophylaxis should be made by considering their risk and benefits. One of them includes utilization of the NNIS (National Nosocomial Infections Surveillance) score system, which considers three factors, such as wound class, ASA physical status scale, and duration of operation according to the NNIS Survey. The selection on timing and appropriately administered antibiotic prophylaxis is critical to maximize the benefits. PMID:22156360

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

    PubMed

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

    2016-08-01

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

  9. Perioperative management of the pediatric patient with traumatic brain injury.

    PubMed

    Bhalla, Tarun; Dewhirst, Elisabeth; Sawardekar, Amod; Dairo, Olamide; Tobias, Joseph D

    2012-07-01

    TBI and its sequelae remain a major healthcare issue throughout the world. With an improved understanding of the pathophysiology of TBI, refinements of monitoring technology, and ongoing research to determine optimal care, the prognosis of TBI continues to improve. In 2003, the Society of Critical Care Medicine published guidelines for the acute management of severe TBI in infants, children, and adolescents. As pediatric anesthesiologists are frequently involved in the perioperative management of such patients including their stabilization in the emergency department, familiarity with these guidelines is necessary to limit preventable secondary damage related to physiologic disturbances. This manuscript reviews the current evidence-based medicine regarding the care of pediatric patients with TBI as it relates to the perioperative care of such patients. The issues reviewed include those related to initial stabilization, airway management, intra-operative mechanical ventilation, hemodynamic support, administration of blood and blood products, positioning, and choice of anesthetic technique. The literature is reviewed regarding fluid management, glucose control, hyperosmolar therapy, therapeutic hypothermia, and corticosteroids. Whenever possible, management recommendations are provided.

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

    PubMed Central

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

    2016-01-01

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

  11. A 2-year audit of perioperative mortality in Malaysian hospitals.

    PubMed

    Inbasegaran, K; Kandasami, P; Sivalingam, N

    1998-12-01

    An audit of all perioperative deaths within seven days of surgery in 14 major public hospitals is presented. This study is part of a quality assurance programme examining the surgical and anaesthetic practices in these hospitals. During the study period from July 1992 till June 1994, 211,354 surgeries were performed and 715 deaths were reported out of which 699 were available for analysis. The data was obtained by confidential enquiry using predetermined questionnaires filled by participating surgeons and anaesthetists and analysed by a group of peers. The overall crude mortality rate was 0.34% and the majority of the deaths occurred in severely ill patients in whom the clinical management was satisfactory. Polytrauma including head, intra-abdominal and skeletal trauma accounted for 253 of the deaths (36.19%). The other causes were bowel obstruction with sepsis, burns, ischaemic limbs, congenital malformations in neonates and pregnancy-related hemorrhage. 62.52% of the deaths occurred within two days of surgery and 85.87% were related to emergency procedures. The review identified some shortfalls in perioperative care and these were lack of adequate critical care facilities, lack of supervision, unnecessary surgery in the moribund and inadequate preoperative optimisation. The results of the study have been forwarded to all participating hospitals for implementation of remedial measures.

  12. Clinical decision support for perioperative information management systems.

    PubMed

    Wanderer, Jonathan P; Ehrenfeld, Jesse M

    2013-12-01

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

  13. Perioperative management of peritoneal dialysis patients: review of abdominal surgery.

    PubMed

    Kleinpeter, Myra A; Krane, N Kevin

    2006-01-01

    On abdominal computed tomography scan for evaluation of hematuria, the index patient, a 23-year-old male, was found to have multiple renal cysts bilaterally. He had been on peritoneal dialysis for 6 years, complicated by intermittent episodes of exit-site infection and peritonitis. Over time, he developed recurrent urinary tract infection and nephrolithiasis with intermittent hematuria. His maintenance dose of recombinant erythropoietin was discontinued, and he maintained a normal hemoglobin level. Annual surveillance of the bilateral renal cysts with magnetic resonance imaging revealed development of a complex cystic mass that warranted further investigation. Following a urology consultation, laparoscopic nephrectomy was performed without complications and with minimal interruption of PD. Pathology evaluation revealed renal cell carcinoma within the renal parenchyma and multiple cystic structures consistent with acquired cystic kidney disease. No clear recommendations exist in the literature regarding continuation or interruption of PD in the perioperative period for planned nephrectomy, tumor resection, or other uncomplicated abdominal or retroperitoneal procedures. A perioperative management strategy for PD patients requiring abdominal or retroperitoneal surgery is outlined here. If these recommendations are followed, patients may continue PD with minimal interruption, preservation of the peritoneal membrane, and few complications.

  14. Angioedema: Classification, management and emerging therapies for the perioperative physician

    PubMed Central

    Misra, Lopa; Khurmi, Narjeet; Trentman, Terrence L

    2016-01-01

    Angioedema is a rare condition which manifests as sudden localised, non-pitting swelling of certain body parts including skin and mucous membranes. It is vital that anaesthesiologists understand this condition, as it may present suddenly in the perioperative period with airway compromise. To identify literature for this review, the authors searched the PubMed, Medline, Embase, Scopus and Web of Science databases for English language articles covering a 10-year period, 2006 through 2016. Angioedema can be either mast-cell mediated or bradykinin-induced. Older therapies for histaminergic symptoms are well known to anaesthesiologists (e.g., adrenaline, anti-histamines and steroids), whereas older therapies for bradykinin-induced symptoms include plasma and attenuated androgens. New classes of drugs for bradykinin-induced symptoms are now available, including anti-bradykinin, plasma kallikrein inhibitor and C1 esterase inhibitors. These can be used prophylactically or as rescue medications. Anaesthesiologists are in a unique position to coordinate perioperative care for this complex group of patients.

  15. Peri-operative cardiac protection for non-cardiac surgery.

    PubMed

    Wong, S S C; Irwin, M G

    2016-01-01

    Cardiovascular complications are an important cause of morbidity and mortality after non-cardiac surgery. Pre-operative identification of high-risk individuals and appropriate peri-operative management can reduce cardiovascular risk. It is important to continue chronic beta-blocker and statin therapy. Statins are relatively safe and peri-operative initiation may be beneficial in high-risk patients and those scheduled for vascular surgery. The pre-operative introduction of beta-blockers reduces myocardial injury but increases rates of stroke and mortality, possibly due to hypotension. They should only be considered in high-risk patients and the dose should be titrated to heart rate. Alpha-2 agonists may also contribute to hypotension. Aspirin continuation can increase the risk of major bleeding and offset the benefit of reduced myocardial risk. Contrary to the initial ENIGMA study, nitrous oxide does not seem to increase the risk of myocardial injury. Volatile anaesthetic agents and opioids have been shown to be cardioprotective in animal laboratory studies but these effects have, so far, not been conclusively reproduced clinically.

  16. [Perioperative myocardial ischemia in patients with peripheral arterial occlusive diseases].

    PubMed

    Rapp, H J; Buselmeier, P; Gasteiger, P; Hoberg, E; Striebel, J P

    1990-04-01

    Patients with peripheral vascular disease (PVD) often have coronary artery disease (CAD) which means an increased risk during anesthesia. The prevalence of CAD is nearly 50% among such patients. Owing to claudication, diagnostic stress tests can rarely be performed in PVD patients. In order to evaluate the frequency of transient perioperative myocardial ischemia, Holter monitoring was performed in 30 consecutive PVD patients with ASA II-III and AVK scale (Fontaine) II-IV who were undergoing femoropopliteal bypass surgery. Patients who had left bundle branch block and left ventricular hypertrophy or were taking digitalis medication were excluded from Holter monitoring. The ST-segment analysis of the frequency modulated recordings (n = 19) revealed episodes of myocardial ischemia in 26% of the patients. Most (75%) of the episodes occurred preoperatively, and 25%, during or after the anesthesia or during preparation for it. Risk factors for CAD were more often found in patients with ST segment alterations than in patients without ST segment deviations, even though the preoperative antianginal medication administered was comparable in the two subgroups. It is concluded that in a considerable subset of PVD patients silent myocardial ischemia occurs, which can be related to the different perioperative intervals by means of ST segment analyses of Holter recordings. The ST segment may allow a better insight into the cardiac state of PVD patients. Further studies are necessary in larger populations to test our suspicion.

  17. Perioperative effects of high doses of intraoperative thymoglobulin induction in liver transplantation

    PubMed Central

    De Pietri, Lesley; Serra, Valentina; Preziosi, Giuseppe; Rompianesi, Gianluca; Begliomini, Bruno

    2015-01-01

    AIM: To describe our single-centre experience in liver transplantation (LT) with the infusion of high perioperative thymoglobulin doses. The optimal dosage and timing of thymoglobulin® [antithymocyte globulin (ATG)] administration during LT remains controversial. Cytokine release syndrome, haemolytic anaemia, thrombocytopenia, neutropenia, fever and serum sickness are potential adverse effects associated with ATG infusion. METHODS: Between December 2009 and December 2010, 16 adult non-randomized patients (ATG group), receiving a liver graft from a deceased donor, received an intraoperative infusion (4-6 h infusion) of thymoglobulin (3 mg/kg, ATG: Thymoglobuline®). These patients were compared (case control approach) with 16 patients who had a liver transplant without ATG treatment (control group) to evaluate the possible effects of intraoperative ATG infusion. The matching parameters were: Sex, recipient age (± 5 years), LT indication including viral status, MELD score (± 5 points), international normalized ratio and platelet count (as close as possible). The exclusion criteria for both groups included the following: Multi-organ or living donor transplant, immunosuppressive therapy before transplantation, contraindications to the administration of any thymocyte globulin, human immunodeficiency virus seropositivity, thrombocytopenia [platelet < 50000/μL] or leukopenia [white blood cells < 1000/μL]. The perioperative side effects (haemodynamic alterations, core temperature variations, colloids and crystalloids requirements, and surgical time) possibly related to ATG infusion and the thromboelastographic (TEG) evaluation of the ATG effects on coagulation, blood loss and blood product transfusion were analysed during the operation and the first three postoperative days. RESULTS: Intraoperative ATG administration was associated with longer surgical procedures [560 ± 88 min vs 480 ± 83 min (control group), P = 0.013], an intraoperative core temperature more than

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

    NASA Technical Reports Server (NTRS)

    Jang, Jong Hoon

    1990-01-01

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

  19. An improved cryo-FIB method for fabrication of frozen hydrated lamella.

    PubMed

    Zhang, Jianguo; Ji, Gang; Huang, Xiaojun; Xu, Wei; Sun, Fei

    2016-05-01

    Cryo-electron tomography (cryo-ET) provides great insights into the ultrastructure of cells and tissues in their native state and provides a promising way to study the in situ 3D structures of macromolecular complexes. However, this technique has been limited on the very thin specimen, which is not applicable for most cells and tissues. Besides cryo-sectioning approach, cryo focused ion beam (cryo-FIB) appeared recently to achieve 'artifact-free' thin frozen hydrated lamella via fabrication. Considering that the current cryo-FIB methods need modified holders or cartridges, here, with a "D-shaped" molybdenum grid and a specific shutter system, we developed a simple cryo-FIB approach for thin frozen hydrated lamella fabrication, which fits both standard transmission cryo-electron microscopes with side-entry cryo-holders and state-of-the-art ones with AutoGrids. Our approach will expand the usage of cryo-FIB approach in many labs.

  20. [Adaptability of sweet corn ears to a frozen process].

    PubMed

    Ramírez Matheus, Alejandra O; Martínez, Norelkys Maribel; de Bertorelli, Ligia O; De Venanzi, Frank

    2004-12-01

    The effects of frozen condition on the quality of three sweet corn ears (2038, 2010, 2004) and the pattern (Bonanza), were evaluated. Biometrics characteristics like ear size, ear diameter, row and kernel deep were measured as well as chemical and physical measurement in fresh and frozen states. The corn ears were frozen at -95 degrees C by 7 minutes. The yield and stability of the frozen ears were evaluated at 45 and 90 days of frozen storage (-18 degrees C). The average commercial yield as frozen corn ear for all the hybrids was 54.2%. The industry has a similar value range of 48% to 54%. The ear size average was 21.57 cm, row number was 15, ear diameter 45.54 mm and the kernel corn deep was 8.57 mm. All these measurements were found not different from commercial values found for the industry. All corn samples evaluated showed good stability despites the frozen processing and storage. Hybrid 2038 ranked higher in quality. PMID:15969270

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

    NASA Astrophysics Data System (ADS)

    Demand, Dominic; Weiler, Markus

    2016-04-01

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

  2. Generating attenuation-resistant frozen waves in absorbing fluid.

    PubMed

    Dorrah, Ahmed H; Zamboni-Rached, Michel; Mojahedi, Mo

    2016-08-15

    We demonstrate a class of nondiffracting beams, called frozen waves, with a central spot that can be made to maintain a predefined intensity profile while propagating in an absorbing fluid. Frozen waves are composed of Bessel beams with different transverse and longitudinal wavenumbers, and are generated using a programmable spatial light modulator. The attenuation-resistant frozen waves demonstrated here address the problem of propagation losses in absorbing media. This development can be beneficial for many applications in particle micro-manipulation, data communications, remote sensing, and imaging. PMID:27519067

  3. Experiences with frozen blood products in the Netherlands military.

    PubMed

    Lelkens, C C M; Koning, J G; de Kort, B; Floot, I B G; Noorman, F

    2006-06-01

    For peacekeeping and peace enforcing missions abroad the Netherlands Armed Forces decided to use universal donor frozen blood products in addition to liquid products. This article describes our experiences with the frozen blood inventory, with special attention to quality control. It is shown that all thawed (washed) blood products are in compliance with international regulations and guidelines. By means of the -80 degrees C frozen stock of red cells, plasma and platelets readily available after thaw (and wash), we can now safely reduce shipments and abandon the backup 'walking' blood bank, without compromising the availability of blood products in theatre. PMID:16815757

  4. Generating attenuation-resistant frozen waves in absorbing fluid.

    PubMed

    Dorrah, Ahmed H; Zamboni-Rached, Michel; Mojahedi, Mo

    2016-08-15

    We demonstrate a class of nondiffracting beams, called frozen waves, with a central spot that can be made to maintain a predefined intensity profile while propagating in an absorbing fluid. Frozen waves are composed of Bessel beams with different transverse and longitudinal wavenumbers, and are generated using a programmable spatial light modulator. The attenuation-resistant frozen waves demonstrated here address the problem of propagation losses in absorbing media. This development can be beneficial for many applications in particle micro-manipulation, data communications, remote sensing, and imaging.

  5. The effect on perioperative bleeding of placental extraction from an exteriorized uterus during caesarean section.

    PubMed

    Xiao, Cheng Wei; Climan, Allan B; Abenhaim, Haim A

    2014-05-01

    Objectif : Évaluer l’effet d’une technique parallèle en matière de césarienne (dans le cadre de laquelle l’extraction du placenta est menée pendant que l’utérus est extériorisé) sur les saignements périopératoires. Méthodes : Nous avons mené une étude de cohorte appariée rétrospective au moyen de données obtenues par l’intermédiaire d’une analyse de dossiers. Le groupe 1 était composé de femmes qui avaient subi une césarienne menée au moyen de la technique du retrait du placenta pendant que l’utérus était extériorisé, tandis que le groupe 2 était composé de femmes qui avaient subi une césarienne menée au moyen de la méthode conventionnelle de retrait du placenta d’un utérus non extériorisé. Les femmes de chacun de ces groupes ont été appariées en fonction du nombre de césariennes préalables, des indications ayant mené à la césarienne et de l’âge gestationnel. Le critère d’évaluation principal était la différence entre les concentrations en hémoglobine préopératoire et postopératoire. Parmi les critères d’évaluation secondaires, on trouvait l’incidence de la transfusion sanguine, la perte sanguine estimée (PSE), la durée opératoire, l’incidence de l’endométrite postopératoire et la durée de l’hospitalisation. Résultats : Au total, 90 dossiers ont été analysés (45 par groupe). Les caractéristiques cliniques de base étaient similaires dans les deux groupes. Lorsque nous avons comparé la baisse moyenne de la concentration en hémoglobine chez les femmes ayant subi une extraction du placenta menée à partir d’un utérus extériorisé et chez celles qui avaient subi une extraction conventionnelle du placenta, nous avons constaté une différence de l’ordre de 22 % (13,2 g/l dans le groupe 1 vs 16,9 g/l dans le groupe 2, P = 0,016). En ce qui concerne les critères d’évaluation secondaires, les femmes du groupe 1 ont subi une PSE moyenne moindre (531,1 ml vs 691,1 ml, P < 0,05) et une chirurgie de plus courte durée moyenne (28,0 minutes vs 40,5 minutes, P < 0,05). Conclusion : L’extériorisation de l’utérus avant le retrait du placenta au cours de la césarienne pourrait atténuer les saignements peropératoires et les saignements postopératoires immédiats, par comparaison avec la technique conventionnelle. La tenue d’autres études au sujet de cette technique s’avère indiquée.

  6. A Primer on Population Health Management and Its Perioperative Application.

    PubMed

    Boudreaux, Arthur M; Vetter, Thomas R

    2016-07-01

    The movement toward value-based payment models, driven by governmental policies, federal statutes, and market forces, is propelling the importance of effectively managing the health of populations to the forefront in the United States and other developed countries. However, for many anesthesiologists, population health management is a new or even foreign concept. A primer on population health management and its potential perioperative application is thus presented here. Although it certainly continues to evolve, population health management can be broadly defined as the specific policies, programs, and interventions directed at optimizing population health. The Population Health Alliance has created a particularly cogent conceptual framework and interconnected and very useful population health process model, which together identify the key components of population health and its management. Population health management provides a useful rationale for patients, providers, payers, and policymakers to move collectively away from the traditional system of individual, siloed providers to a more integrated, coordinated, team-based approach, thus creating a holistic view of the patient population. The goal of population health management is to keep the targeted patient population as healthy as possible, thus minimizing the need for costly interventions such as emergency department visits, acute hospitalizations, laboratory testing and imaging, and diagnostic and therapeutic procedures. Population health management strategies are increasingly more important to leaders of health care systems as the health of populations for which they care, especially in a strong cost risk-sharing environment, must be optimized. Most population health management efforts rely on a patient-centric team approach, coordination of care, effective communication, robust outcomes data analysis, and continuous quality improvement. Anesthesiologists have an opportunity to help lead these efforts in

  7. Peri-operative biology in primary breast cancer: a credible therapeutic target.

    PubMed

    Love, Richard R; Love, Susan M

    2016-04-01

    Over the last 25 years, there has been a growing body of basic science, modeling, and clinical data suggesting that the peri-operative period in the treatment of primary breast cancer is dynamic and can be manipulated to improve long-term outcomes. Clinical data have demonstrated early peaks of hazards for recurrence and emphasized the relationship of these to peri-operative events. More recently, clinical trial data with surgical oophorectomy at different times in the menstrual cycle, peri-operative progesterone, and anti-inflammatory drugs suggest that interventional studies are particularly well justified, given the increasing recognition of the costs both financially and clinically of current systemic regimens.

  8. Anaphylactic shock caused by intramuscular injection of midazolam during the perioperative period: a case report

    PubMed Central

    Sin, Yeong Hun; Lee, Soo Kyung

    2016-01-01

    Although anaphylactic shock during the perioperative period is rare, it can be lethal due to severe cardiovascular and respiratory collapse. Midazolam is generally used as premedication for relieving anxiety about the operation, and the danger of anaphylactic shock after intramuscular injection is not widely recognized. We report the first case of anaphylactic shock occurring during the perioperative period after intramuscular injection of midazolam. Since anaphylactic shock after intramuscular injection can be of slow onset, the operation should be delayed if an anaphylactic reaction is suspected, even if the symptoms are limited. In addition, anesthesiologists should be prepared for the occurrence of anaphylaxis at any time in the perioperative period. PMID:27703633

  9. The perioperative management of a patient with complex single ventricle physiology and pheochromocytoma.

    PubMed

    Sparks, J William; Seefelder, Christian; Shamberger, Robert C; McGowan, Francis X

    2005-04-01

    Pheochromocytoma is associated with intense physiologic effects of alpha- and beta-adrenergic stimulation from catecholamine secretion. Perioperative management for these patients includes alpha-adrenergic receptor blockade, intravascular volume replacement, and, if necessary, beta-adrenergic receptor blockade. Significant perioperative changes in preload and afterload, fluid status, heart rate and rhythm, and inotropy can occur and may be contrary to anesthetic management goals for patients with certain conditions of congenital heart disease. We report the perioperative management with doxazosin of a patient with single ventricle physiology and cavo-pulmonary and aorto-pulmonary lung perfusion who presented for resection of a pheochromocytoma.

  10. What is the role of absorption atelectasis in the genesis of perioperative pulmonary collapse?

    PubMed

    Joyce, C J; Baker, A B

    1995-12-01

    During anaesthesia the combination of breathing at low lung volume, the administration of nitrous oxide and high inspired oxygen concentrations produces conditions that favour absorption atelectasis. Measures such as adding nitrogen to the inspired mixture and avoiding high inspired oxygen concentrations would reduce the amount of perioperative atelectasis if gas absorption was important in the genesis of perioperative pulmonary collapse. Experimental results demonstrate that these measures do not protect against atelectasis. This indicates that absorption atelectasis does not play a significant role in the genesis of perioperative pulmonary collapse. Compression atelectasis may be the underlying mechanism. PMID:8669602

  11. Perioperative Glycemic Control in Plastic Surgery: Review and Discussion of an Institutional Protocol.

    PubMed

    Dortch, John D; Eck, Dustin L; Ladlie, Beth; TerKonda, Sarvam P

    2016-07-01

    Perioperative hyperglycemia is a well-known risk factor for surgical morbidity such as wound healing, infection, and prolonged hospitalization. This association has been reported for a number of surgical subspecialties, including plastic surgery. Specialty-specific guidelines have become increasingly available in the literature. Currently, glucose management guidelines for plastic surgery are lacking. Recognizing that multiple approaches exist for perioperative glucose, protocol-based models provide the necessary structure and guidance for approaching glycemic control. In this article, we review the influence of diabetes on outcomes in plastic surgery patients and propose a practical approach to perioperative blood glucose management based on current Endocrine Society and Mayo Clinic institutional guidelines. PMID:27301370

  12. Perioperative sleep apnea: a real problem or did we invent a new disease?

    PubMed Central

    Zaremba, Sebastian; Mojica, James E.; Eikermann, Matthias

    2016-01-01

    Depending on the subpopulation, obstructive sleep apnea (OSA) can affect more than 75% of surgical patients. An increasing body of evidence supports the association between OSA  and perioperative complications, but some data indicate important perioperative outcomes do not differ between patients with and without OSA. In this review we will provide an overview of the pathophysiology of sleep apnea and the risk factors for perioperative complications related to sleep apnea. We also discuss a clinical algorithm for the identification and management of OSA patients facing surgery. PMID:27006758

  13. Therapeutic surfactant-stripped frozen micelles

    PubMed Central

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

    2016-01-01

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

  14. Therapeutic surfactant-stripped frozen micelles

    NASA Astrophysics Data System (ADS)

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

    2016-05-01

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

  15. [Role of anesthesiologist in prevention of perioperative infection].

    PubMed

    Shime, Nobuaki

    2014-03-01

    Perioprative infection has a significant impact on outcome of surgical patients. Anesthesiologists have roles in reducing infection by application of appropriate prophylactic measures. Hand hygiene is a prerequisite when contacting patients in the operating room. Bundled-preventive approaches should be applied during insertion of intravascular lines, specifically central venous lines. Application of appropriate skin preparation and/or dressings with antiseptics is important. Appropriate selection of antimicrobials depending on surgeries and patients' background, and avoidance of periopeative hypothermia are significant preventive measures for surgical wound infection. To reduce postoperative pneumonia including ventilator-associated pneumonia, avoidance of aspiration during intubation process or mechanical ventilation is necessary. Tracheal tube with a subglottic secretion drainage port might be applied in patients anticipated to receive longer period of postoperative mechanical ventilation and to have a greater risk of postoperative pneumonia.

  16. Perioperative ischemic injury after coronary bypass graft surgery

    SciTech Connect

    Li, W.; Hanelin, L.G.; Riggins, R.C.; Agnew, R.C.; Annest, L.S.; Anderson, R.P.

    1985-07-01

    Two hundred twelve patients who underwent isolated coronary bypass graft surgery were prospectively evaluated for perioperative ischemic injury. All patients underwent preoperative and postoperative testing with technetium 99m pyrophosphate first-pass ventriculography combined with myocardial uptake scans, 12-lead electrocardiography, and serial creatinine phosphokinase MB determination. Fifteen percent of the patients had ischemic injury with at least two test results positive, but only 4 percent had positive results of all three tests. No single test proved adequate. Enzyme levels were highly sensitive and had value as a screening test. The electrocardiogram was specific but only moderately sensitive. The single best test was the radionuclide scan with good sensitivity and no false-positive results. All three tests are required to rigorously diagnose ischemic injury.

  17. Brugada syndrome and its relevance in the perioperative period

    PubMed Central

    Sorajja, Dan; Ramakrishna, Harish; Poterack, A. Karl; Shen, Win-Kuang; Mookadam, Farouk

    2015-01-01

    Brugada syndrome is an autosomal dominant genetic disorder associated with an increased risk of sudden cardiac death, as well as ventricular tachyarrhythmias. The defective cardiac sodium channels result in usual electrocardiographic findings of a coved-type ST elevation in precordial leads V1 to V3. The majority of patients have uncomplicated courses with anesthesia, surgery, and invasive procedures. However there is risk of worsening ST elevation and ventricular arrhythmias due to perioperative medications, surgical insult, electrolyte abnormalities, fever, autonomic nervous system tone, as well as other perturbations. Given the increasing numbers of patients with inherited conduction disorders presenting for non-cardiac surgery that are at risk of sudden cardiac death, safe anesthetic management depends upon a detailed knowledge of these conditions. PMID:26139749

  18. Perioperative employee annual evaluations: a 30-second process.

    PubMed

    Olmstead, John; Falcone, Deborah; Lopez, Jacy; Sharpe, Lorraine; Michna, Jody

    2012-12-01

    In response to complaints about the annual evaluation tool used at The Community Hospital in Munster, Indiana, the surgical services management team created a tool to rate the perioperative RNs on skills pertinent to the surgical services department. The hospital-wide evaluation tool uses vague criteria, which are regularly challenged by employees who disagree with their manager's evaluation. The new Surgical Services Employee Evaluation takes a manager approximately 30 seconds to complete and can be added to the generic hospital evaluation form to make the employee evaluation more accurate and meaningful. The tool evaluates three major categories: teamwork, patient care, and job preparation. Use of this additional tool has greatly reduced postevaluation employee complaints, and the tool is now being used in other departments, with slight department-specific variations. Employees now express less frustration with annual evaluations, and managers report a high degree of satisfaction with the tool because it helps them in the difficult task of employee evaluation and counseling.

  19. [Disease-related malnutrition and its influence on perioperative outcome].

    PubMed

    Grecu, Irina; Grinţescu, Ioana; Tulbure, D

    2007-01-01

    Disease-related malnutrition is highly prevalent among surgical patients and has important deleterious effects on postoperative outcome: increased complications rate, length of hospital stay, mortality and costs. Malnutrition (equivalent with undernutrition in the surgical patients) can be present already on admission, could rapidly develop or aggravate during hospital stay. The determination of malnutrition in this high-risk group of patients in multifactorial: decreased intake (anorexia, gastrointestinal symptoms, prolonged perioperative fasting) and increased demands (hyper-catabolism due to underlying disease, surgical stress, eventual postoperative complications). The identification of patients at nutritional risk by screening on admission and whenever the patient situation changes throughout hospitalization is the first, mandatory step for developing an accurate nutritional care plan in these patients, in order to positively influence postoperative outcome.

  20. A perioperative education program for pediatric patients and their parents.

    PubMed

    Adams, Holly A

    2011-04-01

    Preparing pediatric patients for surgery is crucial to positive patient and parent experiences. Through preoperative screening, observation, and postoperative feedback, clinical staff nurses at the Yellowstone Surgery Center (YSC) in Billings, Montana, identified a need to provide increased information to pediatric patients and their parents regarding the surgical process and postoperative expectations for recovery. The director of nursing developed a program for patients that includes preoperative education and a hands-on experience. The YSC Kids program is a customizable program that includes nine initiatives designed specifically for children. The program has been shown to successfully educate pediatric patients and their parents about the entire perioperative process, thus easing their anxiety about an unfamiliar situation.

  1. Award for Excellence in Perioperative Nursing--AORN's ultimate prize.

    PubMed

    Voss, S J

    1992-12-01

    Excellence should be part of our daily practice. Through sharing of knowledge, ideas, and information, private excellence is transformed into public excellence and deserves recognition. AORN recognizes that many individuals have and do make a difference in their individual practice settings as well as by their national influence. The importance of recognizing members for their contributions to perioperative nursing is evidenced by the addition of the two new awards and the many other individual awards given by the Association. The importance of peer recognition and participation in the selection process for the awards cannot be underestimated. The Award for Excellence Committee encourages your continued involvement in the nomination process. Excellence is not just for a chosen few! It is something each of us is capable of doing each day. What we need to do now is to recognize it in ourselves and others and to accord those who display this quality the recognition they deserve.

  2. [Use of aztreonam in the perioperative prevention in burned patients].

    PubMed

    Fasano, D; Palù, P; Papadia, F

    1990-01-01

    The perioperative short-term prophylaxis is often used in burned patients. The basic of an adequate choice of the antibiotics is the knowledge of the kind of bacteria present in the burned areas. Because of the quality and the diversity of the bacteria, it is generally necessary to use an antibiotic combination chosen on the basis of the latest antibiogram. The Authors refer their experience of 15 cases treated with combination of aztreonam-oxacillin (10 cases) and aztreonam-tobramycin (5 cases) chosen on the basis of the latest antibiograms performed some days before surgery. The antibiotics were administered intravenously 1 hour before surgery. Three subsequent administrations every 8 hours followed. The microbiological and clinical results were positive. No systemic septic complication was reported and a global take of the skin graft was observed. PMID:2151911

  3. A review of perioperative glucose control in the neurosurgical population.

    PubMed

    Atkins, Joshua H; Smith, David S

    2009-11-01

    Significant fluctuations in serum glucose levels accompany the stress response of surgery or acute injury and may be associated with vascular or neurologic morbidity. Maintenance of euglycemia with intensive insulin therapy (IIT) continues to be investigated as a therapeutic intervention to decrease morbidity associated with derangements in glucose metabolism. Hypoglycemia is a common side effect of IIT with potential for significant morbidity, especially in the neurologically injured patient. Differences in cerebral versus systemic glucose metabolism, the time course of cerebral response to injury, and heterogeneity of pathophysiology in neurosurgical patient populations are important to consider in evaluating the risks and benefits of IIT. While extremes of glucose levels are to be avoided, there are little data to support specific use of IIT for maintenance of euglycemia in the perioperative management of neurosurgical patients. Existing data are summarized and reviewed in this context. PMID:20144389

  4. Hot climate and perioperative outcome in elderly patients

    PubMed Central

    Gautam, Parshotam Lal; Kathuria, Sunit; Chhabra, Sunita

    2011-01-01

    Background: It is well known that heat wave is a major cause of weather related mortality in extreme of ages. While auditing our hospital mortality record, we found higher surgical mortality in the months of summer season which inspired us to look into the impact of hot climate in elderly surgical patients. Materials and Methods: An observational prospective cohort study was undertaken to study the impact of hot climate on elderly (age > 60 yrs) surgical patients over one year when outside temperature was more than 20°C. 98 elderly patients requiring general anaesthesia for surgery were enrolled. Patients were grouped on the basis of peak outdoor temperature with a cut off value of 30°C. Group I- when peak outdoor temperature ranged between 20-30°C (comfortable zone) and Group II - when peak outdoor temperature ranged above 30°C. To reduce the bias, inclusion and exclusion criterion were defined. Meteorological factors, patient characteristics, surgical risk factors and other related data were noted. Data was analyzed using student's‘t’ and z-test for statistical significance. Results: There were statistically significant complications and prolonged hospital stay in group II as compared to I (13.21±6.44 Vs 9.81±3.54 days, P value =0.01) on univariate analysis. High risk patients had more complications in hot weather. Stepwise multivariate regression analysis showed higher adverse impact of poor physical and cardiac status than hot climate. Conclusion: Hot and humid weather adversely affect the perioperative outcome in elderly surgical patients. Patients with poor reserves are at greater perioperative risk during hot and humid climate. PMID:21814372

  5. Perioperative Outcomes of Robotic Versus Laparoscopic Hysterectomy for Benign Disease

    PubMed Central

    As-Sanie, Sawsan; Smorgick, Noam; Song, Arleen H.; Advincula, Arnold P.

    2013-01-01

    Background and Objectives: We compared the perioperative outcomes of hysterectomy performed by robotic (RH) versus laparoscopic (LH) routes for benign indications using the Dindo-Clavien scale for classification of the surgical complications. Methods: Retrospective chart review of all patients who underwent robotic (n=288) and laparoscopic (n=257) hysterectomies by minimally invasive surgeons at the University of Michigan from March 2001 until June 2010. Results: Age, body mass index, operative time, and estimated blood loss were not statistically different between groups. The RH subgroup had a larger uterine weight (LH 186.4±130.6 g vs RH 234.9±193.9 g, P=.001), higher prevalence of severe adhesions (13.2% vs 23.3%, respectively, P=.003), and stage III–IV endometriosis (4.7% vs 15.3%, respectively, P<.05). There were no differences in the rates of Dindo-Clavien grade I, grade II, and grade III surgical complications between the RH and LH groups (9.7%, 13.2%, and 3.1%, respectively, in the RH group vs 6.2%, 9.3%, and 5.8%, respectively, in the LH group, P>.05). However, the rates of urinary tract infection were higher in the RH group (LH 2.7% vs RH 6.9%, P=.02), whereas the conversion to laparotomy rate was higher in the LH group (LH 6.2% vs RH 1.7%, P=.007). Conclusions: Perioperative outcomes for laparoscopic and robotic hysterectomy for benign indications appear to be equivalent. PMID:23743379

  6. Perioperative coagulation assessment of patients undergoing major elective orthopedic surgery.

    PubMed

    Spiezia, Luca; Vasques, Francesco; Behr, Astrid; Campello, Elena; Maggiolo, Sara; Berizzi, Antonio; Gavasso, Sabrina; Woodhams, Barry; Biancari, Fausto; Simioni, Paolo

    2016-09-01

    Traditional coagulative parameters are of limited use in identifying perioperative coagulopathy occurring in patients undergoing major elective orthopedic surgery (MEOS). The aim of our study was to evaluate the coagulation changes in patients undergoing MEOS and to facilitate an early detection of perioperative coagulopathy in patients experiencing major intraoperative bleeding. We enrolled 40 consecutive patients (M/F 10/30, age range 34-90 years) who underwent MEOS at the Orthopedic Unit of the Padua University Hospital, Italy, between January 2014 and January 2015. Blood samples were obtained at the following time points: T0-pre: 30 min before surgery; T0-post: 30 min after the end of the procedure; T1: morning of the first postoperative day; T2: 7 ± 2 days after surgery. Patients who experienced an intraoperative blood loss ≥250 mL/h were considered as cases. Routine coagulative parameters, thromboelastometry and thrombin generation (TG) profiles were evaluated. At baseline, a significantly lower platelet count and FIBTEM MCF/AUC were observed in patents with excessive bleeding (p < 0.05 and 0.02/0.01, respectively). At T0-post and T1 intervals, cases showed hypocoagulation characterized by a significantly low platelet count (p = 0.001), prolonged CFT INTEM/EXTEM, reduction of alpha-angle and MaxV INTEM/EXTEM, MCF and AUC INTEM/EXTEM/FIBTEM (p < 0.05 in all comparisons). The only TG parameter standing out between study groups was time to peak at T0-pre. A low platelet count and fibrinogen activity were associated with significant intraoperative bleeding in patients undergoing MEOS. Thromboelastometry performed by ROTEM(®) identifies patients with coagulopathy. PMID:26951189

  7. View of the highway, approach to the Frozen Lake switchback ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    View of the highway, approach to the Frozen Lake switchback curve, looking east. Proposed realignment will shift the road slightly to the south (right) - Beartooth Highway, Red Lodge, Montana to Cooke City, Montana, Cody, Park County, WY

  8. Cholera associated with imported frozen coconut milk--Maryland, 1991.

    PubMed

    1991-12-13

    During August 1991, three cases of cholera in Maryland were associated with the consumption of frozen coconut milk imported from Asia. Following an investigation, the product was recalled, and no other cases have been reported. PMID:1961175

  9. [Hygienic evaluation of frozen and canned Pacific saury (Cololabis saira)].

    PubMed

    Shul'gin, Iu P

    2004-01-01

    The storage of frozen Pacific saury (Cololabis saira) and the cans prepared from the latter in the refrigerator was examined for its impact on their quality. Changes in the parameters of proteins and lipids were studied in the samples of frozen Pacific saury during storage and of the cans prepared from the fish. The relative food value of the frozen fish was determined by biological tests using the infusoria Tetrachymena pyriformis. It was established that storage of frozen Pacific saury led to flesh protein and lipid degradation whose depth determined the loss of the food value of the fish. The results of biological tests fully correlate with the data of chemical analysis in assessing the quality of raw fish stored in the refrigerator. PMID:15197858

  10. Frozen Embryos May Boost Pregnancy Odds for Some Women

    MedlinePlus

    ... embryos is generally preferred over frozen embryos for in vitro fertilization (IVF). But, some evidence has suggested that using ... Services, or federal policy. More Health News on: Assisted Reproductive Technology Recent Health News Related MedlinePlus Health Topics Assisted ...

  11. View of the highway, from above the switchbacks between Frozen ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    View of the highway, from above the switchbacks between Frozen Lake and Bar Drift, looking northeast, showing the retained alignment across the Beartooth Plateau - Beartooth Highway, Red Lodge, Montana to Cooke City, Montana, Cody, Park County, WY

  12. View of the highway, at the Frozen Lake switchback curve, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    View of the highway, at the Frozen Lake switchback curve, looking northwest. The proposed realignment would be just to the southeast (right) of the existing alignment - Beartooth Highway, Red Lodge, Montana to Cooke City, Montana, Cody, Park County, WY

  13. View of the highway, from above the switchbacks between Frozen ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    View of the highway, from above the switchbacks between Frozen Lake and Bar Drift, looking south, showing the setting and retained alignment - Beartooth Highway, Red Lodge, Montana to Cooke City, Montana, Cody, Park County, WY

  14. View of the highway, lower west summit switchbacks between Frozen ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    View of the highway, lower west summit switchbacks between Frozen Lake and Bar Drift, looking northwest, showing retained alignment - Beartooth Highway, Red Lodge, Montana to Cooke City, Montana, Cody, Park County, WY

  15. View of the highway, from the switchbacks above Frozen Lake ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    View of the highway, from the switchbacks above Frozen Lake (in midground), looking southwest, showing the general setting and retained switchback alignments - Beartooth Highway, Red Lodge, Montana to Cooke City, Montana, Cody, Park County, WY

  16. View of the highway, from just north of the frozen ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    View of the highway, from just north of the frozen Lake switchback, looking northwest, showing the retained alignment - Beartooth Highway, Red Lodge, Montana to Cooke City, Montana, Cody, Park County, WY

  17. Photolysis of frozen iodate salts as a source of active iodine in the polar environment

    NASA Astrophysics Data System (ADS)

    Gálvez, Óscar; Baeza-Romero, M. Teresa; Sanz, Mikel; Saiz-Lopez, Alfonso

    2016-10-01

    Reactive halogens play a key role in the oxidation capacity of the polar troposphere. However, sources and mechanisms, particularly those involving active iodine, are still poorly understood. In this paper, the photolysis of an atmospherically relevant frozen iodate salt has been experimentally studied using infrared (IR) spectroscopy. The samples were generated at low temperatures in the presence of different amounts of water. The IR spectra have confirmed that, under near-ultraviolet-visible (UV-Vis) radiation, iodate is efficiently photolysed. The integrated IR absorption coefficient of the iodate anion on the band at 750 cm-1 has been measured to be A = 9.8 ± 0.5 × 10-17 cm molecule-1. The photolysis rate of the ammonium iodate salt was measured by monitoring the decay of ammonium or iodate IR bands (1430 and 750 cm-1 respectively) in the presence of a solar simulator. The absorption cross section of the liquid solutions of ammonium iodate at wavelengths relevant for the troposphere (250 to 400 nm) has been obtained and used to estimate the photolytic quantum yield for the frozen salt. Finally, using an atmospheric model, constrained with the experimental data, we suggest that the photolysis of iodate in frozen salt can potentially provide a pathway for the release of active iodine to the polar atmosphere.

  18. Modification of fresh-frozen plasma transfusion practices through educational intervention.

    PubMed

    Barnette, R E; Fish, D J; Eisenstaedt, R S

    1990-01-01

    The effect of an educational program designed to address misconceptions about the perioperative transfusion of fresh-frozen plasma (FFP) was examined. Results of a baseline audit of FFP use were compared to those of a study subsequent to the educational process. Statistical analysis of the data revealed that the decrease in the number of patients transfused with FFP, from 32 of 2077 operative cases in Group A (baseline) to 18 of 2540 operative cases in Group B (after education), was significant (p less than 0.01). Analysis of the justifications given for transfusion of FFP revealed that the increase in acceptable indications from 47 percent in Group A to 78 percent in Group B was also significant (p less than 0.05). There was no significant difference between the two groups in units of FFP transfused per patient (Group A, 3.66 +/- 3.2, vs. Group B, 2.47 +/- 1.7) or red cells (Group A, 2.84 +/- 5.2, vs. Group B, 5.22 +/- 4.4), and the patterns of platelet transfusion were similar in the two groups. There was a significant difference in the postoperative partial thromboplastin time (Group A, 38.2 +/- 8.7 vs. Group B, 56.3 +/- 24 seconds, p less than 0.01) but no significant difference in postoperative prothrombin time (Group A, 14.1 +/- 2.6 vs. Group B, 15.4 +/- 3.3 seconds). It can be concluded that an educational program designed to address misconceptions in transfusion practice can alter physician performance and thereby reduce the inappropriate use of FFP.

  19. Elemental distribution and sample integrity comparison of freeze-dried and frozen-hydrated biological tissue samples with nuclear microprobe

    NASA Astrophysics Data System (ADS)

    Vavpetič, P.; Vogel-Mikuš, K.; Jeromel, L.; Ogrinc Potočnik, N.; Pongrac, P.; Drobne, D.; Pipan Tkalec, Ž.; Novak, S.; Kos, M.; Koren, Š.; Regvar, M.; Pelicon, P.

    2015-04-01

    The analysis of biological samples in frozen-hydrated state with micro-PIXE technique at Jožef Stefan Institute (JSI) nuclear microprobe has matured to a point that enables us to measure and examine frozen tissue samples routinely as a standard research method. Cryotome-cut slice of frozen-hydrated biological sample is mounted between two thin foils and positioned on the sample holder. The temperature of the cold stage in the measuring chamber is kept below 130 K throughout the insertion of the samples and the proton beam exposure. Matrix composition of frozen-hydrated tissue is consisted mostly of ice. Sample deterioration during proton beam exposure is monitored during the experiment, as both Elastic Backscattering Spectrometry (EBS) and Scanning Transmission Ion Microscopy (STIM) in on-off axis geometry are recorded together with the events in two PIXE detectors and backscattered ions from the chopper in a single list-mode file. The aim of this experiment was to determine differences and similarities between two kinds of biological sample preparation techniques for micro-PIXE analysis, namely freeze-drying and frozen-hydrated sample preparation in order to evaluate the improvements in the elemental localisation of the latter technique if any. In the presented work, a standard micro-PIXE configuration for tissue mapping at JSI was used with five detection systems operating in parallel, with proton beam cross section of 1.0 × 1.0 μm2 and a beam current of 100 pA. The comparison of the resulting elemental distributions measured at the biological tissue prepared in the frozen-hydrated and in the freeze-dried state revealed differences in elemental distribution of particular elements at the cellular level due to the morphology alteration in particular tissue compartments induced either by water removal in the lyophilisation process or by unsatisfactory preparation of samples for cutting and mounting during the shock-freezing phase of sample preparation.

  20. A retrospective study of single frozen-thawed blastocyst transfer

    PubMed Central

    Ryu, Eun Kyung; Song, Seung Hyun; Yoon, San Hyun; Lim, Kyung Sil; Lee, Won Don; Lim, Jin Ho

    2016-01-01

    Objective To study the clinical outcomes of single frozen-thawed blastocyst transfer cycles according to the hatching status of frozen-thawed blastocysts. Methods Frozen-thawed blastocysts were divided into three groups according to their hatching status as follows: less-than-expanded blastocyst (≤EdB), hatching blastocyst (HgB), and hatched blastocyst (HdB). The female age and infertility factors of each group were evaluated. The quality of the single frozen-thawed blastocyst was also graded as grade A, tightly packed inner cell mass (ICM) and many cells organized in the trophectoderm epithelium (TE); grade B, several and loose ICM and TE; and grade C, very few ICM and a few cells in the TE. The clinical pregnancy and implantation rate were compared between each group. The data were analyzed by either t-test or chi-square analysis. Results There were no statistically significant differences in average female ages, infertility factors, or the distribution of blastocyst grades A, B, and C in each group. There was no significant difference in the clinical pregnancy and implantation rate of each group according to their blastocyst grade. However, there was a significant difference in the clinical pregnancy and implantation rate between each group. In the HdB group, the clinical pregnancy and implantation rate were similar regardless of the blastocyst quality. Conclusion There was an effect on the clinical outcomes depending on whether the blastocyst hatched during single frozen-thawed blastocyst transfer. When performing single frozen-thawed blastocyst transfer, the hatching status of the frozen-thawed blastocyst may be a more important parameter for clinical outcomes than the quality of the frozen-thawed blastocyst. PMID:27358829