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At least 181 records · Page 10Linked to original sources
PubMed2004

Computer-assisted fluoroscopic navigation of pedicle screw insertion: an in vivo feasibility study.

BACKGROUND: Accurate placement of pedicle screws is difficult. PATIENTS AND METHODS: We evaluated the feasibility and accuracy of pedicle screw insertion assisted by a real-time, 2-dimensional (2D) image-guided navigation system in 12 patients who underwent thoraco-lumbar and/or lumbar stabilization. 66 pedicle screws were inserted either by senior spine surgeons or residents. The accuracy of positioning of the screws was evaluated using postoperative plain radiographs and thin-cut CT. RESULTS: 61 of the 66 screws were inserted successfully. 5 screw insertions showed structural violations: 4 on the medial and 1 on the lateral pedicle wall. The accuracy was higher in the sagittal plane than in the axial plain. There was no difference between the surgical error rates caused by the senior surgeons and the residents. INTERPRETATION: Using computer-assisted 2D fluoroscopic image navigation, it is possible to achieve reliable and accurate pedicle screw insertion during low thoracic and lumbar spinal surgery.

Adult↗
PubMed1991

Anatomy of the orbital septum and associated eyelid connective tissues. Implications for ptosis surgery.

The anatomy of the orbital septum and associated eyelid connective tissues was examined using cadaver dissection, histologic sections, surgical observations, and special radiologic imaging. The embryologic development of the eyelid connective tissues was also reviewed. Examination revealed a distinct layer of fibroadipose tissue in the eyelid and eyebrow posterior to the orbicularis and frontalis muscles, and anterior to the orbital septum. Fibrous septa within the submuscular fibroadipose tissue become contiguous with more compact lamellae of the orbital septum posteriorly imparting a multilayered quality to the orbital septum. Fat within the fibroadipose layer anterior to the orbital septum may be mistaken for the preaponeurotic fat pad by the unwary surgeon and may lead to surgical error. The orbital septum and the levator aponeurosis were found to join 2 to 5 mm above the superior tarsal border (average, 3.4 mm). Recommendations for ptosis surgery based on these anatomic principles are given.

Adipose Tissue↗
PubMedDate not supplied

The thoracolumbar and lumbosacral transitional junctions.

Correct dermatome identification is essential to reduce nomenclature and surgical errors, to improve neurologic correlation, and to produce accurate statistics regarding low-back problems. The phylogenetic category of the spine must be known and junctional transitional vertebrae within the column properly identified and localized. This article emphasizes the appearances of, and the different positions of, transitional vertebrae at the thoracolumbar and lumbosacral junctions in the vertebral sequence depending on the phylogenetic category of the patient. It describes three additional characteristics of these anomalous vertebrae. Suggestions are made to eliminate the confusion and mistakes produced by the presence of these frequent variants.

Humans↗
PubMed1999

Real-time 3-D model-based navigation system for endoscopic paranasal sinus surgery.

This paper presents a three-dimensional (3-D)-model-based navigation system for endoscopic sinus surgery treating paranasal sinusitis. Endoscopic surgery is becoming more common because of its low invasiveness. Its problem with disorientation, however, is one of the toughest barriers for the novice and may lead even an expert to commit serious surgical errors, e.g., causing cerebrospinal fluid (CSF) leakage or blinding the patient. To prevent such complications and optimize training, our system aids in navigation by showing a single perspective view of the patient and the endoscope models. This virtual endoscope has a viewing cone with a simulated light to indicate the viewing direction and visual field in real-time. The system's three clipping planes automatically follow the endoscope and help keep the surgeon aware of the endoscope's actual position. An experiment comparing the system to conventional navigation using a triplanar display showed that the perspective view was referenced very frequently, giving a positive impressions, while the triplanar display was almost completely ignored, apparently because it was too difficult to interpret immediately.

Adult↗
PubMed2000

Computer- and robot-assisted total knee replacement: analysis of a new surgical procedure.

This paper describes a nonstandard procedure for total knee replacement (TKR), based on the use of modern tools such as computers, electronic sensors, and robots, to achieve accurate and optimal implant results. The intervention is planned on a standard PC connected to the CT scanner. Dedicated software shows the surgeon limb alignment and knee status and assists in the choice of the best prosthesis. The intervention is then performed with a new device and surgical procedure. At first the femur and the tibia are fixed to the operating table with a special clamp and the knee bones are exposed with the standard technique; then the surgeon digitizes the shape of the joint and the computer transfers the planned surgical strategy to a dedicated surgical robot. Resections are performed by the surgeon on a constrained guide held by the robot. In this paper we summarize the main results on the system performances, and discuss the clinical implications of this new technology in the operating room. Preliminary experiments on cadavers and volunteers show that this methodology can improve the accuracy of the implant to 2.5 mm and 20, reduce operating time and surgical errors, and may represent a challenging alternative methodology for TKR.

Arthroplasty, Replacement, Knee↗
PubMed2001

Freud's struggle with misogyny: homosexuality and guilt in the dream of Irma's injection.

The highly condensed dream element trimethylamin is central to the dream of Irma's injection. After a brief review of the medical literature on timethylamine (TMA), it is suggested that two important meanings of this chemical and its properties lie in its disguised reference to disparaging views of women, as well as to Freud's homosexual connection to Wilhelm Fliess. Freud's misogynistic and homosexual impulses were stimulated by Fliess's recent surgical error committed while operating on Freud's patient Emma Eckstein. Evidence is presented that the collaboration between Freud and Fliess in performing an aggressive act toward a woman was for Freud an enactment of a childhood situation in which he and his nephew John had ganged up on John's sister Pauline. The later relationship between Freud, Jung, and Sabina Spielrein is seen as an additional reenactment of this childhood triangle. An examination of Freud's associations to and analysis of the Irma dream, as well as some of his later relationships with women, indicates that guilt and the wish to make reparation were also prominent themes in Freud's inner life.

Austria↗
PubMed1994

Applications of image-directed robotics in otolaryngologic surgery.

This report will evaluate the feasibility of applying image-directed robotic technology to the field of otolaryngologic surgery. Image-directed robotic surgery uses a three-dimensional image to guide a robot in the removal of tissue. To demonstrate the future use of image-directed robotics in otolaryngologic surgery, five antrostomies will be performed on temporal bones. The accuracy of the surgical defect will be measured. It is the goal of this pilot study to achieve an average surgical error of less than 1.0 mm. Future applications of image-directed robotic surgery will be presented, along with technical modifications, and future areas of research necessary to adapt this technique to otology and rhinosinus surgery.

Equipment Design↗
PubMed1981

Dislocation following total hip replacement.

An analysis of 142 dislocations from a multicentre study of 6774 total hip replacements is reported. The incidence of dislocation was 2.1 per cent. Patients with neuromuscular disorder, those in a confused mental state, and those undergoing revision operations are at special risk. The commonest surgical error, present in nearly half the patients, was placing the acetabular cup too vertically or too anteverted. A less common fault was placing the femoral component too anteverted. Neither the original pathology nor the approach to the hip appeared to affect the likelihood of dislocation. The dislocations were divided into early and late, single and recurrent, and the success rate of treatment is described in these groups. One hundred and eleven patients (78.2 per cent) eventually obtained stability. Of those with a single dislocation, 62 per cent remained stable after a single manipulation. Thirty-four per cent of the patients required an open operation to achieve stability and it is suggested that, in many cases, open reduction alone is not enough; the mechanical fault needs to be corrected.

Acetabulum↗
PubMed1998

Open reduction, internal fixation and fibular autografting for neglected fracture of the femoral neck.

Neglected fractures of the femoral neck, common in young adults in underdeveloped countries, may be complicated by nonunion or avascular necrosis (AVN). We treated 52 cases by open reduction, fixation by compression screw and a free fibular graft. The mean delay between injury and operation was 5.1 months. Of 40 fractures assessed at a mean of 58.8 months (24 to 153), 38 were found to be united and two, owing to surgical errors, were not. Seven of eight heads which were avascular before operation revascularised without collapse, while seven others developed AVN after the procedure. At the last follow-up considerable collapse was apparent in five femoral heads, and 11 hips had developed coxa vara. The fibular graft had fractured in four cases. The hip had been penetrated by the screw in six cases and by the graft in three. Hip function was excellent in seven patients, good in 21 and fair in seven. Five patients had poor results. Incorporation of the fibular graft was seen after four years: in many cases the graft had been almost completely resorbed. We recommend this procedure for the treatment of neglected fractures of the neck of the femur in young adults to reduce resorption of the neck, AVN and nonunion.

Adolescent↗
PubMed2006

The Thompson hemiarthroplasty: a new problem for an old favourite.

The Thompson hemiarthroplasty is a popular hip prosthesis. We present two case reports highlighting a significant alteration in the design of the implant which compromised the success of the operations. In recent years the manufacturing process of this prosthesis has changed, with a resultant increase in the volume of the stem of 10 ml. It is essential that manufacturers inform orthopaedic surgeons of any alteration in the design of the implant and supply compatible instrumentation to minimise surgical errors. Surgeons must remain vigilant when checking the compatibility of the trial and definitive prostheses.

Aged↗
PubMed1976

Detection of a deficit in visual discrimination of pattern following lesions of anterior cortex: role of type of motivation.

6 albino rats were trained under appetitive motivation to perform diametrically opposed visual discriminations of pattern via opposite eyes. Small lesions were subsequently placed unilaterally in anterior neocortex. Following a period of post-surgical recovery, subjects were re-trained on the diammetrically opposed discriminations in alternating 10-trial blocks. Every subject made more post-surgical errors on the discrimination mediated by the eye contralateral to the lesion. Since albino rats have virtually complete decussation of the visual system, this indicates selective impairment in mediation of performance of pattern discrimination in the part of the lesioned hemispheres. Thus, findings previously obtained in studies involving aversive motivation are general to appetitively motivated tasks.

Animals↗
PubMed1975

Postoperative chylothorax. Six cases in 2,500 operations, with a survey of the world literature.

We have systematically reviewed the literature concerning iatrogenic chylothorax and shall report our personal observations on the subject. Despite an increasing number of thoracic operations, injuries to the thoracic duct are infrequent. Cardiovascular and esophageal procedures are the most frequent causes of chylothorax. Malformations of the thoracic duct and other organs of the mediastinum have often been involved in lymphatic injury. Consequently, we believe that a complicating chylothorax may result from varied causes rather than solely from a surgical error.

Adolescent↗
PubMed2001

[Results of surgical correction of congenital talipes equinovarus].

Different surgical procedures in the treatment of clubfoot were analyzed, especially in correlation to over-correction and inadequate correction. Indications for surgery, surgical errors and their influence on outcome were assessed. 82 children (28 females and 54 males) with 130 congenital equinovarus underwent surgery between 1988 and 1994. Age at the time of operation ranged from 6 to 13 months (average: 9 months). Posterior release (i.e. partial subtalar release) was conducted in 68 cases of clubfeet and complete subtalar release in 62 cases. During follow-up 44 children with 64 clubfeet were reviewed. Magone's criteria were used to assess final results. 15 (23%) feet showed very good results, 26 (41%)--good results, 14 (22%)--satisfactory and 9 (14%)--poor or no correction.

Adolescent↗
PubMed2003

Recent research on vasectomy techniques.

Vasectomy is a commonly used, highly effective method for the control of fertility in the human male. It is almost always performed as an outpatient procedure, is safer than tubal occlusion and has few side effects. The number of people relying on vasectomy as a method of contraception varies widely from country to country. Though vasectomy is highly effective, failures may occur due to re-canalization of the vas, surgical error, anatomical variants or failure of contraception during the post-operative waiting period. One of the disadvantages of this technique is that sperm are present in the posterior end of the vas following surgery and hence patients have to use alternative methods of contraception for a waiting period of 12 weeks to 15 weeks before relying on a vasectomy for contraception. This review summarizes recent research on vasectomy conducted by Family Health International, USA.

Adult↗
PubMed1991

[Intestinal malrotations in the adult].

The paper reports a case of intestinal malrotation in an adult patient with an anomalous location in the left hypochondrium of the cecum and vermiform appendix. The patient underwent explorative laparotomy for peritonitis due to acute appendicitis. Following a review of the literature, the anomaly was classified in embryological terms as a union defect during the third developmental stage of the umbilical loop. Attention is focused on the importance of an exact knowledge of the embryology of intestinal rotation in order to avoid technical surgical errors. In conclusion, the value of giving the patient precise iconographic documents is stressed in order to inform the surgeon who may have to operate on the patient's abdomen in the future.

Adult↗
PubMed1991

[Infectious spondylodiscitis after a cure for genital prolapse. 5 cases].

Bacterial osteitis of the discs and the vertebrae is rare after fixing the uterus to the promontary of the sacrum. Only 30 cases have been reported in the literature. Twelve cases were found in a Rheumatology Unit over a period of 12 years from 1975-1987. The initial symptoms of septic osteitis were low back pain or sciatica, and fever. They were confirmed by radiological evidence. Bacteriological diagnosis was obtained in every case by fine needle aspiration of the disco-vertebral space retrieving staphylococci or gram-negative bacilli. The same agent was found in blood cultures in four or five cases. Potentiating pathogenic factors include urinary tract infections, prosthetic material, and surgical errors.

Adult↗
PubMed1990

[Compartment syndrome in fractures of the shin].

Compartment syndrome represents the most serious complication in the treatment of the fractures of the shin. In the period 1979-1987 17 patients with variously developed form of the compartment syndrome were treated at the Orthopaedic clinic of the Institute for In-service Education of Physicians. 7 patients, i. e. 40 per cent were transported from other clinics. There were 8 open fractures in the group, i. e. 47 per cent, and they were classified according to Allgöwer. All patients were primarily operated on for the fracture of the shin and the compartment syndrome occurred in 11 cases after plate osteosynthesis and in 6 cases as a result of the implementation of an external fixation device. Early fasciotomy in the interval up to two hours after the manifestation of the syndrome was done only in two patients, in three cases fasciotomy was not done at all. From the viewpoint of the types of decompression bilateral incision was done in five cases and parafibular decompression in 7 cases. Restitutio ad integrum after the syndrome does not exist. Results of the treatment range from the healing with the defect of soft tissues to the amputation which was performed in two patients. In the evaluation of surgical errors resulting in the development of the syndrome primary closure of operational wound ranks the first place. In the evaluation of the general biological condition of the organism in 66 per cent polyglobulia and hypalbuminemy were found as an expression of a poor biological condition of the organism and chronic hypoxy. The necessity was stressed of the evaluation of the condition of soft tissues and their contamination and their adequate treatment. The possibility was pointed out of hyperbaric oxygenation as a still neglected component of the causal therapy.

Aged↗