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At least 289 records · Page 16Linked to original sources
PubMed1983

[Rectum frame and positioning for abdominoperineal surgery].

The patient's positioning is of paramount importance in case of rectal surgery. It must allow any type of operation, planned or not (amputation, anterior resection, pulltrough) while providing good facilities for the two stages - abdominal and perineal - particularly in case of a two teams procedure. The ringed frame meets those requirements: it includes an oblique semi-circled frame, with hooks, and can be adjusted to the operating table through two steel stands. First used for the surgery of cancer of the rectum (894 cases operated), the position described has been adopted as well for low mechanical anastomosis in cases of colonic procedures, colpohystere it includes an oblique semi-circled frame, with hooks, and can be adjusted to the operating table through two steel stends. First used for the surgery of cancer of the rectum (894 cases operated), the position described has been adopted as well for low mechanical anastomosis in cases of colonic procedures, colpohystere it includes an oblique semi-circled frame, with hooks, and can be adjusted to the operating table through two steel stends. First used for the surgery of cancer of the rectum (894 cases operated), the position described has been adopted as well for low mechanical anastomosis in cases of colonic procedures, colpohysterectomies and total cystectomies.

Abdomen↗
PubMed2006

I can C clearly now the rail has gone!

Accurate intra-operative imaging is vital in orthopaedic pelvic surgery in order to achieve precise reduction of fractures and correct positioning of osteotomies. Radiological assessment is carried out, in most centres, using standard C-arm fluoroscopy. A limitation of this technique is that it is not always possible to obtain accurate images in all planes due to the presence of radiopaque materials on the operating table. One such example is the 45 degrees oblique view, which is frequently obscured by the presence of a metal rail on the operating table. We report on a practical solution; the development of a unique 360 degrees radiolucent table by placing a sheet of Perspex material between two standard operating tables, which allows for perfect radiological exposure of the pelvis in all planes.

Equipment Design↗
PubMed1996

Intraoperative pressure sore prevention.

It was once believed that pressure sores were a ward based, nursing problem. However, operating tables are relatively hard and the anaesthetised patient is at particular risk for a number of reasons with the overall incidence of pressure sore formation during operation identified at 12%. Unfortunately in the past very few pressure relieving devices have been available for use in this particular area. The main problems encountered by patients whilst in the operating theatre arise because of the pressures between the patient and the operating table, mainly because of the patient's own weight but also that exerted by the surgeon. A limited number of studies have been carried out on the incidence of theatre induced pressure sores. Others have focused on actual pressures created by operating tables and the factors which may influence an increase in those pressures. Some authors have also researched the effectiveness of a number of pressure relieving devices specifically designed for use in the operating theatre.

Beds↗
PubMed2004

Current state of ergonomics of operating rooms of Dutch hospitals in the endoscopic era.

Laparoscopic procedures are mostly performed in operating rooms which have been designed for conventional surgery. The ergonomic layout of these operating rooms is not suited for endoscopic surgery. This study reports on the current state of ergonomics of Dutch operating rooms for laparoscopic surgery. Number of trolleys, presence of ceiling-mounted booms, and number, positioning and size of monitors were recorded. The floor surface of operating rooms and lowest and highest positions of operating tables were documented. Positioning of the surgical team and monitors during laparoscopic surgery were assessed. Twenty-nine hospitals participated in this study. The average number of trolleys per hospital was 2.4. The mean height of the center of the monitors was 163 cm. Average floor surface of operating rooms was 37.45 m 2 . Only one of the 29 hospitals had a ceiling-mounted boom. The height of operating tables varied between 725 and 1215 mm. The floor space of current operating rooms is too small to allow use of space occupying technological systems. Less than 4% of operating rooms are equipped with permanent monitors mounted on booms. Operating tables cannot be lowered to a position which allows an ergonomic posture of the surgical team.

Journal Article↗
PubMed2003

Principles of image processing in digital chest radiography.

Image processing has a major impact on image quality and diagnostic performance of digital chest radiographs. Goals of processing are to reduce the dynamic range of the image data to capture the full range of attenuation differences between lungs and mediastinum, to improve the modulation transfer function to optimize spatial resolution, to enhance structural contrast, and to suppress image noise. Image processing comprises look-up table operations and spatial filtering. Look-up table operations allow for automated signal normalization and arbitrary choice of image gradation. The most simple and still widely applied spatial filtering algorithms are based on unsharp masking. Various modifications were introduced for dynamic range reduction and MTF restoration. More elaborate and more effective are multi-scale frequency processing algorithms. They are based on the subdivision of an image in multiple frequency bands according to its structural composition. This allows for a wide range of image manipulations including a size-independent enhancement of low-contrast structures. Principles of the various algorithms will be explained and their impact on image appearance will be illustrated by clinical examples. Optimum and sub-optimum parameter settings are discussed and pitfalls will be explained.

Humans↗
PubMed1983

The anatomical shape of the airway during endotracheal intubation.

The shape of the airway during endotracheal intubation was studied from lateral radiographs of patients lying supine on the operating table, with the neck in the normal, extended and flexed position. A computer programme calculated the anterior contour of the tube and the posterior contour of the airway as mean values of the original contours on the radiographs. The mean configuration of the airway in intubated individuals was then presented in a standard coordinate system. The results were compared with the shape of the airway in the same patients before intubation. This study and a previous one (1) have provided relevant data concerning airway anatomy that can be used in standardized testing of tube deformation forces. Our results also showed that patients were routinely placed on the operating table with the head in an unnecessarily extended position. Such a position may partly obstruct the blood flow in the vertebral arteries. An improvement in operating table design is desirable to facilitate optimal positioning of the patient's head during routine surgery.

Adult↗
PubMed1995

[Intraoperative anaphylaxis to latex in pregnancy].

CASE REPORT: A 31-year-old pregnant woman had to undergo emergency abdominal surgery due to acute intestinal obstruction. The patient's preoperative history demonstrated multiple allergies as well as abdominal trauma several years before. The physical examination--including sonography of the two fetuses--showed no pathological signs. Anaesthesia was induced intravenously with the operating table tilted to the left side, using routine precautions pre-oxygenation, and rapid sequence intubation, and was maintained unproblematically. About 20 min after the onset of surgery, hypotension, tachycardia, and a drop in oxygen saturation appeared. Volume substitution and the application of vasoactive drugs failed to stabilise the haemodynamic situation. Elevation of the pregnant uterus and increased left tilzing of the operating table did not lead to improvement. The development of eyelid edema led to the diagnosis of an anaphylactic reaction. The patient was treated successfully with epinephrine, antihistamines, and corticosteroids (prednisolone). The suspicion of latex-related allergy was verified postoperatively by radio-allergen-sorbent test (RAST) and prick and scratch tests. DISCUSSION: The unspecific symptoms primarily led to the diagnosis of a prostacycline (liberated from the intestines)-induced, so-called eventration syndrome or aorto-caval compression syndrome, respectively, caused by the pregnant uterus [2, 7, 16, 17]. The initial therapeutic failure and the eyelid edema led to the correct diagnosis of an allergic reaction. Besides the application of epinephrine, which was indicated in spite of its vasoconstrictive effect on the smooth muscle of the uterus, immediate left-side-down positioning of the operating table, and sufficient volume replacement were decisive for haemodynamic stabilisation and maintenance of an adequate perfusion pressure of the uterus [7, 8, 13, 15]. Because of the non-specificity of RAST screening, the cutaneous tests had great significance in confirming the diagnosis of latex-related allergy [3, 18, 24]. CONCLUSIONS: Due to the obviously increasing number of latex-related allergies, especially in atopic persons and patients with frequent latex exposure, the patient's exact history is highly significant [4, 7, 18-20]. This includes--because of suspected cross-reactions--questions concerning allergic reactions to bananas and chestnuts [1, 16, 24]. If a latex-related allergy is suspected, all latex- or rubber-containing materials have to be consequently avoided. Because of the suspected allergies by inhalation via rubber-containing masks or tracheal tubes, these devices also have to be avoided and replaced, possibly by silicone materials [1, 4, 5, 16]. Premedication with H1- and H2-antagonists (dimetindene and cimetidine) and glucocorticoids (administered 12h before surgery and given twice) is indicated [5, 19, 12, 21]. In cases of latex allergy, the above-mentioned basic therapeutic measures have to be undertaken even in pregnancy, including immediate replacement of all latex-containing materials. The diagnosis of latex allergy should be verified by cutaneous testing [4, 18, 24].

Adult↗
PubMed1996

Use of an adjustable, transportable, radiolucent spinal immobilization device in the comprehensive management of cervical spine instability. Technical note.

In this report the authors describe a device that consists of a transportable, radiolucent board that couples to a standard halo head ring. The board provides continuous cervical spine immobilization during all phases of acute medical treatment of cervical spine instability, including closed reduction, transport, radiographic imaging, and operative procedures. By combining the advantages of several existing systems, this immobilization device facilitates and improves the safety of comprehensive acute management of cervical spinal instability by eliminating the need for patient transfer from stretcher to radiography machine to operating table. Its radiolucent construction and its compatibility with standard operating tables allow unencumbered surgical access and ample room for biplanar fluoroscopy, thereby also facilitating operative procedures, particularly the placement of internal spinal fixation.

Cervical Vertebrae↗
PubMed1991

Development of the operating computerized tomographic scanner system for neurosurgery.

A computerized tomographic (CT) scanner system for intraoperative imaging is presented. The system consists of the following: 1) CT scanner with a mobile gantry, 2) digitally controlled operating table with central processing unit (CPU) and encoder unit; the table can be controlled by the scanner computer as accurately as the scanner bed, and 3) exclusively designed head fixation devices. It allows us to scan the patient on the operating table in the operating room pre-operatively, intra-operatively and immediately after surgery.

Computer Systems↗
PubMed2005

[Quantitative assessment of pressure relief at the sacral area in adults lying supine on the operating room table].

BACKGROUND: It is important to prevent development of the pressure ulcers in patients undergoing lengthy surgery, particularly at areas of skin overlying bony prominences. This study was designed to investigate distribution of the interface pressure (IP) over the body area (from the head to pelvic area) in supine adults and also evaluate the ability of a polyurethane-made cushion to reduce the IP at their sacral area. METHODS: Utilizing a recently developed device to measure the IP (ERGO-CHECK, ABW Co., Germany), we evaluated distribution of the IP (estimated per 3 x 4 cm2 area) over the body area in healthy volunteers (n=31) and patients under general anesthesia (n=6) lying supine on the operating room (OR) table. RESULTS: In all the subjects, the highest IP was generated at the sacrum; 62.5 +/- 23.8 (mean +/- SD) and 35.7 +/- 5.5 mmHg in the volunteers and patients, respectively. The polyurethane-made, "doughnut" cushion (5 cm in thickness) inserted between the pelvic area and the OR table significantly reduced (P < 0.05) the IP at the sacrum in both groups: the IPs after the insertion in the volunteers and patients were 35.1 +/- 11.1 and 25.6 +/- 6.5 mmHg, respectively. In addition, the insertion significantly reduced (P < 0.05) the high-risk area (i.e., area of IP > 32 mmHg) in both groups. CONCLUSIONS: Quantitative assessment of the IP would be useful in evaluating precisely the effectiveness of various types of pillows, cushions, or mattresses designed to reduce the IP.

Beds↗
PubMed1996

Bilateral anterior pubic osteotomy in bladder exstrophy closure.

PURPOSE: We report our clinical experience with anterior pelvic osteotomy in 16 patients who underwent surgery for bladder exstrophy. The technique and its difficulties are discussed. MATERIALS AND METHODS: Anterior pelvic osteotomy of the superior ramus of the public bone is a simple and efficient method to facilitate symphyseal approximation and abdominal wall closure without or with low tension on the suture lines in neonates who undergo surgery for bladder exstrophy. Older children in whom surgery has been delayed can also benefit from this method. Compared to other methods of osteotomy in exstrophy surgery it does not require additional incisions, nor does the patient need to be repositioned on the operating table. A successful operation does not depend on any particular orthopedic skills and it can easily be done by the pediatric urologist. RESULTS: Immediate postoperative results regarding abdominal wall closure were excellent in all 16 patients. However, major postoperative complications developed in 2 patients. Despite antibiotic prophylaxis a severe soft tissue infection developed in 1 child, resulting in complete bladder dehiscence. In another patient an obturator nerve injury resulted in transient palsy, which resolved completely. While the first complication was not related to osteotomy, the second was osteotomy related. CONCLUSIONS: Bilateral superior ramotomy of the pubic bones is a new alternative, easily performed technique to optimize bladder exstrophy surgery in children.

Bladder Exstrophy↗
PubMed1998

Investigation of intraoperative brain deformation using a 1.5-T interventional MR system: preliminary results.

All image-guided neurosurgical systems that we are aware of assume that the head and its contents behave as a rigid body. It is important to measure intraoperative brain deformation (brain shift) to provide some indication of the application accuracy of image-guided surgical systems, and also to provide data to develop and validate nonrigid registration algorithms to correct for such deformation. We are collecting data from patients undergoing neurosurgery in a high-field (1.5 T) interventional magnetic resonance (MR) scanner. High-contrast and high-resolution gradient-echo MR image volumes are collected immediately prior to surgery, during surgery, and at the end of surgery, with the patient intubated and lying on the operating table in the operative position. In this paper we report initial results from six patients: one freehand biopsy, one stereotactic functional procedure, and four resections. We investigate intraoperative brain deformation by examining threshold boundary overlays and difference images and by measuring ventricular volume. We also present preliminary results obtained using a nonrigid registration algorithm to quantify deformation. We found that some cases had much greater deformation than others, and also that, regardless of the procedure, there was very little deformation of the midline, the tentorium, the hemisphere contralateral to the procedure, and ipsilateral structures except those that are within 1 cm of the lesion or are gravitationally above the surgical site.

Adult↗
PubMedDate not supplied

Management of patellar subluxation. A modification of Hauser's technique.

Patellar subluxation is one of the most common causes of internal derangement of the knee in young individuals. Most surgical techniques mandate entrance into the knee joint and require prolonged postoperative immobilization. The result may be excessive postoperative synovitis and occasionally, hemarthrosis. Prolonged postoperative immobilization results in joint stiffness. The authors propose a modification of Hauser's technique which allows tailored correction of the abnormal vector forces applied to the patella, simple adjustment of the tension in the extensor mechanism, creates patellar stability, and permits rapid return of knee motion. A new tibial corticocancellous window is created in a manner similar to Hauser's technique. The cancellous defect is deepened by curettage and the transferred tibial tubercle is then inverted, inserted through the window, and tamped into the graft bed thereby gradually increasing tension in the tendon. The cancellous and cortical bone from the window is then tamped in behind the patella tendon, buttressing the tendon, and permitting the knee a full unguarded range of motion on the operating table. In 23 operations in 22 patients, with a follow-up of 35.4 months and a mean patient age of 18.7 years, all patellae were stable. All but one patient achieved full range of motion. Younger patients with minimal or absent preoperative patellofemoral chondromalacia had uniformly good results.

Follow-Up Studies↗
PubMed1991

[Laparoscopy in acute pancreatitis in previously operated-on patients].

The results of laparoscopy performed in 108 patients with acute pancreatitis previously operated on the abdominal organs and anterior abdominal wall are analysed. The technique of investigation has its peculiarities: choice of the points for introduction of a manipulator and laparoscope, circumscribed pneumoperitoneum, moving of a patient on the operating table. In previously operated patients, laparoscopy is not contraindicated, but it should be performed by an experienced endoscopist. Operated on were 16 patients. Nine died. There were no complications and lethal outcomes related to laparoscopy.

Abdominal Muscles↗
PubMed1995

[Highlateral approach to the lesions around the upper cervical vertebrae and foramen magnum].

In the present paper, we describe the surgical techniques of high lateral cervical approach and its feasibility for the excision of tumors located in the ventral or lateral aspect of the upper cervical vertebrae and of the craniovertebral junction. The patient is positioned laterally on the operating table, but the operator's position and the skin incision are slightly altered depending on the location of the tumor. When the lesion is situated below C1, the ipsilateral shoulder is pulled down toward the back. The operator stands rostral to the head. The attachment of the sternocleidomastoid muscle to the mastoid is detached and reflected anteriorly through a retroauricular curved skin incision. The posterior cervical muscles such as the splenius capitis, longissimus capitis, semi-spinalis capitis are detached from the occipit and retracted posteriorly. At this point, the transverse process of C1 and the articular facet of the vertebrae of C2-C4 are identified by palpation. According to the tumor location, the muscles attached to the relevant transverse processes and facets are divided and reflected posteriorly. Through careful dissection, the cervical nerve roots and the vertebral artery are exposed. The root sleeves as well as thecal sac may be exposed by resecting the posterior two-thirds of the superior and inferior articular facets and the adjacent laminae of the vertebrae. In case the whole facet was removed, an iliac bone graft is placed between the remaining transverse processes and the laminae above and below for fixation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗