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At least 325 records · Page 18Linked to original sources
PubMed2002

Beginning angiography: a step-by-step guide.

Procedures in radiology are still very much learnt as an apprenticeship. While there is no substitute for hands-on practice and the one-to-one teaching of an experienced consultant, it has been our experience that learning is significantly facilitated by the availability of simple, easy-to-follow, relevant notes for pre-reading, especially in the difficult and potentially hazardous area of angiography. However, we have had surprising difficulty in finding an introductory text that is suitable for the teaching of angiography to new, never-seen-it-before trainees. We have therefore developed a short, simple, illustrated manual within our department for introducing angiography to first-year registrars, which we present in this article. We hope trainees will find it of use for providing an overview of the principles and the basic techniques involved prior to beginning formal training in this challenging and rewarding specialty.

Angiography↗
PubMed2003

From classical sternotomy to truly endoscopic mitral valve surgery: a step by step procedure.

BACKGROUND: There is an increasing tendency towards minimally invasive valve surgery and various surgical techniques have been proposed to realise this goal. The aim of the present study was to describe our current surgical technique and clinical experience with respect to an endoscopic technique that allows the surgeon to perform an operation through a series of small intercostal ports. METHODS: After a learning experience with thoracoscopic left internal mammary to left anterior descending coronary artery bypass surgery, we adopted the endocardiopulmonary bypass technique to perform mitral valve surgery. The technique requires exclusive use of video-assisted surgery and control by transoesophageal echocardiography (TEE). Surgery requires long instruments and extra-corporeal knot tying. Between February 1997 and November 2001, 259 patients were operated on. Mitral valve repair was performed in 190 of them. One patient had a redo procedure using this approach to correct a paravalvular leak, but all other procedures were primary interventions. RESULTS: In all patients, surgery was performed using a 2 inch working port and two additional half-inch trocar-ports. Five patients required a conversion to median sternotomy: three because of inadequate size of the femoral vessels and two because of intraoperative aortic dissection. Hospital mortality included two patients, and seven patients required late reoperation (four of these were as a result of endocarditis). CONCLUSIONS: Endoscopic mitral valve surgery is demanding, but feasible. Once the appropriate skills are acquired, both patient and surgeon can enjoy the benefits of this exciting new technique.

Journal Article↗
PubMed2001

One-step vs two-step procedure in dynamic graciloplasty.

OBJECTIVE: Dynamic graciloplasty, a proven treatment for end-stage faecal incontinence, requires transposition of the gracilis muscle around the anal canal and implantation of a pulse generator and intramuscular electrodes. In view of the risk of infection around the implanted material the implantation was initially not performed in combination with the perineal procedure but 6 weeks later. Sparing the patients an extra operation, however, might be justified if morbidity is not increased. This study aimed to compare the combined single-stage with the two-stage procedures. PATIENTS AND METHODS: Two groups of 13 patients were admitted to this prospective, matched control study according to waiting list ranking. They were matched for age, gender and aetiology. Group I had transposition and transplantation combined, group II underwent these procedures separately with a 6-week interval. Continence, manometry, stimulation parameters, quality of life results and adverse events were recorded. RESULTS: After a mean 521-day follow up infection rates were comparable in both groups, as were continence rates, morbidity, anal manometry, stimulation parameters and quality of life. CONCLUSION: Outcome, morbidity and quality of life seem to be comparable. A single procedure avoids the need for an extra admission and operation, so the one-stage approach should be the standard procedure in dynamic graciloplasty.

Clinical Trial↗
PubMedDate not supplied

Pulmonary alveolar proteinosis: step-by-step perioperative care of whole lung lavage procedure.

BACKGROUND: Pulmonary alveolar proteinosis is a rare disease characterized by the accumulation of surfactant-like material within the alveolar spaces that causes progressive respiratory failure. Improvement can be achieved with whole lung lavage. OBJECTIVE: Our objective was to conduct a study of the feasibility of treating pulmonary alveolar proteinosis in a community hospital. METHODS: Five patients were treated. We assessed procedure pulmonary functions. RESULTS: No major sequelae occurred. Each lung was lavaged with 12 to 20 L of normal saline in cycles of 970 +/- 150 mL each (mean +/- standard deviation), over 106 +/- 49 minutes. Extubation was performed when compliance of the lavaged lung was restored. All patients showed subjective improvement. Resting and exercise oxygen saturation improved within 1 week after the lavage. A significant improvement was also noted in forced expiratory volume in 1 second, forced vital capacity, and maximal oxygen uptake, whereas total lung capacity and carbon monoxide single-breath diffusion capacity remained unchanged. CONCLUSION: Although retrospective and based on a small sample size, our results suggest that whole lung lavage may be performed safely even in medical centers that have limited experience, if strict adherence to a protocol is maintained.

Adult↗
PubMed1993

Peer-based HIV risk assessment: a step-by-step guide through the teachable moment.

Peer educators in HIV prevention have influence with other students beyond the narrowly defined traditional activities of workshop presentations of outreach projects. Training HIV prevention peer educators to be prepared for the "teachable moments" when other students seek their assistance on assessing risk for HIV infection is a necessary new emphasis in the training curriculum. HIV risk assessment can be approached as an educational intervention that requires interpersonal skills, but does not cross the invisible barrier into "counseling."

Curriculum↗
PubMed2004

Pure laparoscopic right donor nephrectomy: step-by-step approach.

BACKGROUND AND PURPOSE: Debate surrounds laparoscopic kidney procurement for right donor nephrectomy. We detail our pure laparoscopic technique of right kidney retrieval. TECHNIQUE: We use a four-port transperitoneal approach and extract the kidney through a low Pfannenstiel incision. Important elements include: (1) dividing the triangular ligament; (2) identifying the vena cava early; (3) minimizing ureteral dissection; (4) mobilizing the kidney within Gerota's fascia; (5) dissecting the renal artery behind the vena cava; (6) cutting the extraction incision to the peritoneum; (7) applying a Hem-o-Lok and single metal clip on the artery; (8) placing the Endo-TA stapler on the renal vein adjacent to the vena cava; (9) cutting the vessels without clips/staples on the kidney side; and (10) retrieving the kidney manually. RESULTS AND CONCLUSIONS: This is a reliable method of right pure laparoscopic donor nephrectomy that maximizes donor benefit and cost-effectiveness. Right laparoscopic nephrectomy is likely easier with this technique and should not be avoided if it is the preferred kidney for transplantation.

Humans↗