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At least 1,801 records · Page 100Linked to original sources
PubMed2006

Protecting staff against airborne viral particles: in vivo efficiency of laser masks.

Laser masks are used to prevent inhalation of viral particles during laser surgery. A crossover trial was performed in eight volunteers to compare the ability of a surgical mask and a laser mask with that of an FFP2 respirator to filter airborne dust particles. The surgical and laser masks were tested when worn normally and when they were taped to the face. The mean reductions in particle counts were 3.0 fold [95% confidence interval (95% CI) 1.8-4.2] for the untaped surgical mask, 3.8 fold (95% CI 2.9-4.6) for the untaped laser mask, 7.5 fold (95% CI 6.5-8.5) for the taped surgical mask, 15.6 fold (95% CI 13.5-17.8) for the taped laser mask, and 102.6 fold (95% CI 41.2-164.1) for the FFP2 half-face respirator. The laser mask provided significantly less protection than the FFP2 respirator (P=0.02), and only marginally more protection than the surgical mask. The continued use of laser masks for respiratory protection is questionable. Taping masks to the face only provided a small improvement in protection.

Cross-Over Studies↗
PubMed2005

Functional representation of the finger and face in the human somatosensory cortex: intraoperative intrinsic optical imaging.

We applied the intrinsic optical imaging technique to the human primary somatosensory cortex during brain tumor/epilepsy surgery for nine patients. The cortical surface was illuminated with a Xenon light through an operating microscope, and the reflected light, which passed through a 605 nm bandpass filter, was detected by a CCD camera-based optical imaging system. Individual electrical stimulation of five digits induced changes in the reflected light intensities. Visualizing the intrinsic optical responses, we constructed maps of finger representation in Brodmann's area 1. In the maps, response areas of Digits I to V were sequentially aligned along the central sulcus in the crown of the postcentral gyrus from the latero-inferior region (Digit I) to the medio-superior region (Digit V). The neighboring response areas partially overlapped each other, as previously described in the monkey somatosensory cortex. Similar results were obtained in the face region with stimulation of the three branches of the trigeminal nerve. These results suggest that the overlap of the response areas is a common feature in the somatosensory cortex not only in monkeys, but also in humans.

Adult↗
PubMed2005

Thromboembolism in plastic surgery.

Thromboembolism is a dreaded complication of surgery in multiple disciplines, including plastic surgery, and deep venous thrombosis and pulmonary embolus cause significant morbidity, even death. This article provides methods for understanding and preventing deep venous thrombosis and pulmonary embolus in plastic surgery.

Abdominal Wall↗
PubMed2006

Filter-protected carotid stenting via a minimal cervical access with transitory aspirated reversed flow during initial passage of the target lesion.

PURPOSE: To evaluate the preliminary results of filter-protected carotid artery stenting (CAS) via a minimal cervical access, with temporary common carotid artery (CCA) occlusion and aspiration in selected high-risk candidates for carotid endarterectomy. METHODS: Since February 2002, 26 patients (17 men; mean age 73.7 years, range 54-98) at high surgical risk according to the SAPPHIRE eligibility criteria underwent 29 transcervical CAS procedures under filter protection. Under general anesthesia, a 6-F short introducer sheath was directly mounted in the CCA through a small (2-4 cm) laterocervical cutdown. The CCA was briefly clamped, and blood was aspirated while the filter device was positioned above the target lesion. With the filter in place and the clamp released, nitinol stents were deployed under filter protection. Hemostasis was achieved by direct suture. RESULTS: Twenty-eight (96%) interventions were technically successful; 1 complex lesion could not be crossed and was converted to surgery. Mean clamping time was 1.7 (range 1.0-3.5) minutes. Combined 30-day stroke/mortality was 0%. Ultrasound surveillance demonstrated a < 60% asymptomatic in-stent restenosis in 1 (4%) patient with radiation-induced arteritis after 28 months. During a mean follow-up of 11.6 months (range 3-38), 1 (4%) minor ipsilateral stroke was noted at 6 months in a patient whose antiplatelet therapy was transitorily interrupted. CONCLUSION: Our preliminary observations from this small early experience suggest that this variant CAS technique is feasible and probably diminishes the neuroembolic risk during initial navigation of the ICA target stenosis.

Aged↗
PubMed1988

[Current role of partial interruption of the inferior vena cava. Apropos of 100 cases].

In reference to a personal series of 100 partial interruptions of the inferior vena cava (74 clips, 11 Mobin-Uddin umbrellas, 15 Greenfiled's filters), the authors analyze the criteria of choice in various procedures where the mortality, morbidity and sequellae remain low. In light of these results, the current place of surgery in the prevention of pulmonary embolism is discussed, in cases where anticoagulant therapy is contraindicated, inadequate or has failed.

Constriction↗
PubMed1995

[Adsorption of volatile anesthetics on activated charcoal. Efficiency of an experimental filter during low-flow circuit ventilation].

The inclusion of charcoal filters in the anaesthetic low-flow systems contributes to the acceleration of the kinetics of isoflurane (Forane). In fifty-four subjects, scheduled for extra- and intracranial surgery, ventilated with a low-flow system (Ohmeda Excel OAV7750 with rebreathing cassette) with a mean total flow of 0.7 1/min, the experimental charcoal cartridge showed: (a) a good adsorbent power (awakening within 5-6 minutes from the inclusion of the cartridge into the circuit) and (b) efficiency (adsorbent power unchanged until the sixth application). The use of charcoal during low-flow anaesthesia is both useful and economical.

Adolescent↗
PubMed1985

Impairment of myocardial function induced by particulate contamination of cardioplegic solutions.

The U.S. Pharmacopoeia defines acceptable limits of particle contamination for intravenous solutions. Used conventionally, these solutions are filtered by the lungs, and there are few reports of particle-induced tissue injury to the systemic circulation. We have used an isolated rat heart model to assess whether unfiltered direct intraarterial administration of cardioplegic solutions, as in open-heart surgery, can be damaging to the myocardium. An intravenous solution of U.S. commercial manufacture was selected for evaluation. Particle-counting revealed this solution to be well within the U.S.P. limits. Direct intracoronary infusion of this solution at 20 degrees C and at constant pressure led to an approximate 75% reduction in coronary flow over 20 min. Filtration through a membrane of 0.8-micron porosity largely prevented this reduction of coronary flow. In studies with multidose cardioplegia (3-min infusions every 30 min), hearts given filtered solution recovered almost 90% of their preischemic functional capacity after 3 hr of hypothermic (20 degrees C) ischemic arrest. Hearts given an identical unfiltered solution essentially failed to recover despite the particle counts having conformed to the U.S.P. limit. This functional result was supported by measurement of creatine kinase leakage, which was significantly higher in the unfiltered group. These studies provide an argument for revision of U.S.P. particle limits when applied to intraarterially administered solutions; in particular, we believe that equipment for cardioplegic infusion into coronary arteries should incorporate a 0.8-micron in-line filter.

Animals↗
PubMed1992

Analysis of trauma intubations.

The timing of trauma patient intubation is dependent on clinical presentation and clinician judgment. We sought to correlate the timing of intubation with the presenting of physiologic parameters and clinical outcome to identify potential quality assurance audit filters. Patients (n = 82) were grouped by timing of intubation: PREHOSPITAL, paramedic intubation; IMMEDIATE, within 10 minutes of arrival; DELAYED, beyond 10 minutes but within 2 hours of arrival; and NONURGENT, beyond 2 hours or at the time of surgery. While mean revised trauma scores and Glasgow Coma Scale (GCS) scores differed for the groups, the mean length of hospital stay and the incidence of aspiration pneumonia were not significantly different. In the DELAYED group, 80% of those who developed aspiration pneumonia had a GCS < or = 13. Patients in the NONURGENT group were older and commonly presented with tachypnea. The survival rate for the NONURGENT group was lower than predicted by the TRISS method (P = .004). A GCS < or = 13 and age greater than 50 years with presenting respiratory rates of more than 25 breaths/min represent potential trauma intubation audit filters.

Adolescent↗
PubMed1984

Intraoperative evoked potential monitoring of the spinal cord: enhanced stability of cortical recordings.

Intraoperative EP monitoring of spinal cord function depends upon a quickly obtained, reproducible EP. The records must be obtained in a hostile environment where artifacts and other sources of electrical noise cannot easily be eliminated: records are obtained continuously without interrupting the surgery. We studied EP reproducibility by measuring cortical EP amplitude range and latency range within individual patients. Reproducibility was enhanced by several changes in the stimulus and recording parameters: (1) Bipolar recording near the vertex (Cz-Pz, E1-E2) eliminated a significant amount of the artifacts and random variations seen in referential recordings. Bipolar recordings sacrifice some amplitude but the improved reproducibility is worthwhile. (2) Restricted filters (especially 30-3000 Hz) improve reproducibility still further, compared to the traditional open filters (1-1000 Hz). (3) Fast stimulation rates improve monitoring up to rates of about 5 stimuli/sec. At even faster rates too much amplitude attenuation usually occurs. Using these techniques stable intraoperative EPs were recorded from all 115 patients except those in whom EPs were abnormal even before surgery. Advantages and disadvantages compared to epidural recording techniques were discussed. Several further observations were made, including (1) monitoring could be done equally as well with stimulation either at the peroneal or at the posterior tibial nerve; (2) balanced nitrous oxide and narcotic anesthesia did attenuate EPs by about 60%, although this is not so much as to interfere seriously with monitoring.

Adolescent↗
PubMed2004

Percutaneous treatment of carotid stenosis with protection system: preliminary experience.

PURPOSE: To assess the feasibility, safety, and efficacy of carotid artery stenting with filter device. MATERIALS AND METHODS: Between May 2001 and July 2002, a total of 96 consecutive patients (100 lesions) who presented with symptomatic >70% diameter stenosis, asymptomatic >90% diameter stenosis or post-endarterectomy as well as post-radiotherapy hemodynamically significant stenosis underwent carotid artery stenting with filter protection at our institute. The mean age of the patients was 72 (range 51-91). There were 22 female (23%), and 74 male (77%). Of the 96 patients, 62 patients (65%) did not filled the NASCET surgical criteria and 24 (26%) were classified as ASA 4. All the patients underwent pretreatment with antiplatelet agents. All procedures were performed with a standardized monitoring system by a multidisciplinary team. Filtration system for cerebral protection was consistently used. Outcome measures were procedural atheroembolic events, including all-stroke and death rates up to 30 days. RESULTS: A protection system type "TRAP" (Microvena, Italy) or a protection system type "EPIFILTER" (Boston Scientific, USA) were employed in 28% and 67% of cases, respectively. In the remaining 5% it was not possible to cross the stenosis with the filter. The stent placement was achieved in 95 of the procedures (95%). In 86% of cases a primary stenting technique was performed, with balloon pre-dilation of the lesion and subsequent stent advancement through the stenosis accounting for 9% of cases. At the time of protection system removal, 21 filter (21%) showed presence of macroscopic particles. We recorded 8 (8%) homolateral neurological events: two major strokes, one minor stroke and five TIAs (all the patients with TIA fully recovered within 2 hours). General complications (5%) included one lesion of the median nerve, two groin haematomas (one with disability for the patient, and one requiring surgery), one myocardial infarct and one lower limb ischaemia requiring surgical intervention. All major complications (4%) (two major strokes, one myocardial infarct and one lesion of the median nerve) occurred within the first 31 cases, the 69 following procedures not showing any neurological or non-neurological major events. At 30 days all patient were still alive. CONCLUSIONS: Filter protection during carotid artery stenting seems technically feasible as well as reasonably safe and effective. The EPIFILTER system turned out to be of easier employment due to its "monorail" system and because it does not usually need a catheter of dedicated recovery. Further studies in larger groups of patients are required to best characterize criteria guiding the choice for the right protection system.

Aged↗
PubMed2006

Nine-year experience with insertion of vena cava filters in the intensive care unit.

BACKGROUND: Vena cava filter insertion (VCF) is traditionally performed in a radiology suite or in the operating room. We reviewed our experience of bedside VCF insertion in the intensive care unit (ICU) performed by general surgeons. METHODS: A prospective, observational study of bedside VCF insertion in the ICU was performed by general surgeons between February 1996 and June 2005. Demographic data and procedural complications were recorded. RESULTS: Four hundred three patients underwent bedside VCF insertion. Complications included 1 groin hematoma, 2 misplacements, and a right ventricular perforation from a dilator requiring surgical repair. DVT occurred in 38 patients (8.5%); 14 occurred at the insertion site. There were 2 pulmonary embolisms (<1%) after VCF. Contrast-related renal failure occurred in 2 of the first 35 patients; carbon dioxide gas is now used for contrast in high-risk patients. CONCLUSIONS: Bedside insertion of VCF in the ICU by surgeons is safe and effective.

Adult↗
PubMedDate not supplied

Pediatric cardiopulmonary bypass devices: trends in device use for cardiopulmonary bypass and postcardiotomy support.

Cardiopulmonary bypass (CPB) devices and techniques have continuously evolved. We have conducted surveys that chronicle the changes in CPB devices and techniques used at North American pediatric cardiac surgery centers since 1989. The aim of this article is to describe trends in cardiopulmonary bypass device use during cardiac surgery and changes in the devices used for extracorporeal life support (ECLS) following cardiac surgery for pediatric patients. The diffusion of innovation in pediatric cardiovascular surgery has not been solely driven by the availability of scientific evidence to support change but rather it has often been related to other factors that influence clinicians willingness to change including; tradition, ease of use, and cost related pressures. The current CPB systems used for cardiac surgery are more homogenous than in previous years. Most centers use a heparin coated or modified surface system comprised of a "hard shell" open venous reservoir, a roller pump, a hollow fiber membrane oxygenator, and arterial line filter. ECLS systems comprised of hollow fiber oxygenators and centrifugal pumps for are gradually replacing the classical ECLS circuit, servo regulated roller pumps and silicone rubber membranes. Nearly 40% of centers use these alternate components in their ECLS systems. Costs, utility, safety and measurable benefit to the patient should guide decisions related to device selection.

Cardiopulmonary Bypass↗
PubMed2004

[Another profession in the Ottoman period dealing with pharmaceutics: surgery].

We have realized in many documents that in the Ottoman period surgeons were involved in pharmaceutics as much as physicians and herbalists. Surgeons employed by the state ordered more drugs than physicians, and it is interesting that in their order list there were mostly singular drugs instead of ready-made ones. In addition to drugs used by surgeons in preparing ointments and plasters, pans and filters were utilized in the process of production, and earthenware pots, tin and wooden boxes with various kinds of paper were ordered for the purpose of packaging. We have determined that most of the single drugs placed onto the lists of surgeons were "ointment of rust" that dries the pus, and "red ointment" that is good for all kinds of pus. The preparation of the ointments were specified in detail in books of surgery (Cerrahnames)We have observed that parallel to the Regulation of 1826, surgeons were given the title of pharmacist when they were appointed to military bodies. 100 kurus (piaster) were paid to surgeons for performing surgery and 50 kurus for preparing drugs, which is another important document indicating that surgeons were more responsible than physicians in preparing drugs.

General Surgery↗
PubMed2001

Carotid angioplasty and stenting: are they therapeutic alternatives?

Clinical trials have shown that carotid surgery prevents stroke, but also has a significant risk of morbidity. Percutaneous transluminal angioplasty and stenting (endovascular treatment) can also be used to treat carotid stenosis and have the advantage of avoiding general anaesthesia, cranial nerve injury and the discomforts of surgery. However, there are several potential complications of endovascular treatment, including intimal dissection and plaque rupture, and the long-term consequences of restenosis. More embolic signals are detected during and immediately after carotid angioplasty than during carotid surgery, although a randomised comparison showed no difference in neuropsychological outcomes. The large published case series of carotid endovascular treatment suggest a similar major morbidity rate to surgery, but a small single centre randomised trial reported very poor results in stented patients. Trial data from the much larger Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS) has been more encouraging. Results are available from 504 patients with carotid stenosis randomised to surgery or endovascular treatment. Endovascular treatment was carried out by percutaneous transluminal angioplasty using balloon catheters with the adjunct use of stents in 22%. Audited safety analysis by intention to treat showed no difference in the outcome measure of disabling stroke or death within 30 days of treatment, but the rate of treatment related death or stroke lasting more than seven days was relatively high in both groups (endovascular treatment 10%, surgery 9.9%). Minor complications, particularly cranial nerve palsy and haematoma were significantly less frequent in the endovascular group, but restenosis was significantly more common. Both treatments appeared equally effective at preventing stroke recurrence with no difference in the rates of stroke during follow-up for up to 3 years. Techniques of carotid angioplasty and stenting improved over the course of CAVATAS, and new designs of stents, filters and protection devices are being developed. Further large, multicentre randomised trials are therefore being started which will evaluate primary stenting of carotid artery stenosis in patients with cerebrovascular disease. Until the results are available, it will remain uncertain whether angioplasty and stenting are safe and effective therapeutic alternatives to surgery.

Angioplasty, Balloon↗
PubMedDate not supplied

Expulsive choroidal effusion: case report of a rare complication of intraocular surgery.

A case of expulsive choroidal effusion occurring during extracapsular cataract extraction in a 75 year old woman is presented. The episode occurred at the time of insertion of the pseudophake into the ciliary sulcus. The woman had pre-existent filtering bleb and was hypertensive, factors which may have contributed to the episode. Although this is dramatic occurrence, it needs to be distinguished from expulsive choroidal hemorrhage which carries a much worse porgnosis. In this instant, management was expectant and patient attained 6/12 with over-refraction. It is recommended that patients who may be at risk for expulsive choroidal effusion should have in the bag pseudophake fixation rather than sulcus fixation to obviate pressure on the circular vascular arcade.

Aged↗
PubMed1994

Filtration surgery in rabbits treated with diclofenac or prednisolone acetate.

We performed filtration surgery in one eye of each of 28 rabbits. Either a nonsteroid (diclofenac) or a steroid (prednisolone acetate) was given as a postoperative antiinflammatory agent. On no examination day was there a significant difference in the intraocular pressure of the rabbits that had received diclofenac as contrasted with those that had received prednisolone acetate (P > .05, Student's t-test). Neither was there, based on log-rank life-table analysis, any significant difference between the two groups in terms of filtering bleb survival (P = .484). Finally, there were no significant differences on any examination day between the two groups in terms of bleb height or conjunctival injection (P > .05, Mann-Whitney U-test). We conclude that in this rabbit model for filtration surgery, the postoperative antiinflammatory effect of diclofenac was similar to that of prednisolone acetate. Because a nonsteroidal agent such as diclofenac that could provide an antiinflammatory effect sufficient to allow optimal bleb survival in humans, without the level of potential side effects of corticosteroids, might be clinically useful, further studies may be warranted.

Animals↗
PubMed1995

One-year follow-up results of combined mitomycin C trabeculectomy and extracapsular cataract extraction.

PURPOSE: When patients with glaucoma require cataract surgery, combined procedures offer important advantages over cataract surgery alone. Because mitomycin C has improved the success rate of a trabeculectomy in patients at high risk for filtration failure, the authors investigated whether it also would increase the survival rate of functioning filters in combined procedures. METHODS: Patients with both cataract and glaucoma underwent combined mitomycin C trabeculectomy, extracapsular cataract extraction, and intraocular lens implantation. Mitomycin C (0.5 mg/ml) was applied topically to the trabeculectomy site for 5 minutes before the cataract extraction. Intraocular pressure (IOP), visual acuity, and astigmatism were measured preoperatively and postoperatively. One-year results are available for 74 patients. RESULTS: At 1 year, 54 (73%) of 74 patients had IOPs of 15 mmHg or less without glaucoma medications. Visual acuity was 20/40 or better in 44 (60%) of 74 patients. Ten (15%) patients had a shift of more than 2 diopters of astigmatism against the rule compared with preoperative values. No notable corneal epithelial toxicity was present. Postoperative symptomatic hypotony with the wound construction occurred in 3 (4%) of 74 patients, with 1 patient requiring surgical revision. Other potential complications of mitomycin C include endothelial toxicity (1 patient had decreased vision due to endothelial folds) and wound stability (1 patient had wound rupture after direct ocular trauma). CONCLUSION: The 1-year survival rate of a functioning trabeculectomy using mitomycin C in combined glaucoma and cataract surgery is encouraging. The longer-term benefits and possible adverse effects of mitomycin C in combined procedures are unknown and continue to be investigated.

Adult↗
PubMed2006

Thromboprophylaxis for acetabular injuries in the UK What prophylaxis is used?

Due to chronic underfunding and the absence of a comprehensive and coordinated national approach to the management of acetabular trauma throughout the UK, patients can incur prolonged recumbancy. We have performed a postal questionnaire to establish the current clinical practice in the specialist pelvic and acetabular units throughout the UK, with respect to time to surgery from injury, thromboprophylaxis, and surveillance. We have identified 21 units, and 37 surgeons in the NHS who deal with acetabular trauma. The mean time to surgery from injury in the UK is 8.5 days (range 2-19 days). Mechanical thromboprophylaxis was used in 67% (14) of the units. No unit routinely uses prophylactic IVC filters. Chemical thromboprophylaxis is routinely used in 100% (21) of the units. Ninety-five percent (20) used prophylactic doses of LDH or LMWH. Clinical surveillance alone for thromboembolism is employed in 90% (19) of the units. Only 2 (10%) units routinely perform radiological surveillance with ultrasound Doppler, pre-operatively. Currently there is no published directory of dedicated pelvic and acetabular surgeons in the UK. There is no general consensus on the approach to thromboprophylaxis and surveillance in acetabular trauma in the UK. There is no consensus approach to thromboprophylaxis and surveillance in the literature.

Acetabulum↗

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