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At least 397 records · Page 22Linked to original sources
PubMed1979

[Venous pressure in the expulsive hemorrhages and loss of the vitreous (author's transl)].

It is insisted in the importance of the rising venous pressure as a cause of concause of the loss of the vitreous and the expulsive hemorrhages. We remind a simple way of measuring the venous pressure clinically and we recommend the inclined position of the patient as a prophylactic way to avoid the venous hyperpressure. While we do not have the operative tables that allow us to perform that inclination as low as oculists are used to operate sitting and with microscope, we suggest a simple way to obtain the inclination in a common low stretcher, with a triangular pillow. Some details are also advised, so the general anesthesia does not rise the venous pressure. The article specially pointing out the importance of the venous pressure, expressely omits the reminding of the surgical rules assigned to prevent the vitreous complications, because they are already known and exposed by the authors in other publications.

Cataract Extraction↗
PubMed1999

Per-operative retinoscopy as a predictor of final post-operative refraction.

PURPOSE: To assess the accuracy of streak retinoscopy performed at the end of cataract surgery as a predictor of final post-operative error. METHOD: Retinoscopy was performed on 68 patients as they lay on the operating table after routine cataract extraction and intraocular lens implantation. In each case the predicted post-operative refraction by biometry and the retinoscopy at the end of the operation were compared with the 6 week post-operative subjective refraction. RESULTS: The retinoscopy had a mean difference of 0.6 D (standard deviation of 0.5 D). The post-operative refraction predicted by biometric measurements had a mean difference of 1.6 D (standard deviation 0.6 D). When corrected for systematic error, 8% of patients were found to have an error of greater than 2 D as predicted by pre-operative biometry. Prediction by retinoscopy made no error greater than 2 D. The accuracy in the retinoscopic prediction of post-operative refraction was significantly better than the biometry using the F-test (p = 0.001). CONCLUSION: Retinoscopy at the end of cataract surgery may be a valuable tool to alert the surgeon to an unexpected refractive error. This would enable immediate intraocular lens exchange, if required.

Biometry↗
PubMed1998

Unreamed intramedullary nailing of acute femoral shaft fractures using a traction device without fracture table.

The authors present a simple distraction apparatus that makes it possible to perform nonreamed intramedullary nailing of the femur on a normal operating table. Nonreamed intramedullary (IM) nails were inserted in 24 femoral shaft fractures using this device. The setup time of this device was 60% shorter compared with a stratified group of 28 femoral nailings performed using the fracture table. The authors feel that this device is a safe and effective alternative to using a fracture table. It is especially useful in the polytrauma patient where the additional lesions can be treated without the need for patient transfer to another table.

Adult↗
PubMed1988

Gastro-oesophageal reflux in halothane anaesthetized sheep. The effects of feeding and positioning.

The frequency of gastro-oesophageal reflux (GOR) in sheep anaesthetized with halothane was reduced by withholding food and water for 24 hours. The total reflux volume increased. The effect of body position on GOR was studied by inclining the operating table at angles to the horizontal and positioning the head up or down on sand bags. The operative positions investigated were: right and left lateral recumbency with head down, dorsal recumbency with head down and right lateral recumbency with head up. Least GOR occurred when the sheep was in right lateral recumbency with a head up tilt and the body inclined at 20 degrees from the horizontal. A cuffed oesophageal drainage tube increased the incidence of GOR but prevented the chances of the aspiration of rumen material.

Anesthesia, General↗
PubMed1990

[Medical or surgical castration in prostatic cancer? Experience of 100 orchiectomies].

The mean age of 100 patients who underwent orchiectomy for carcinoma of the prostate was 76.4 years. 50% of the patients had distant metastases. Almost all had a locally advanced tumour. 49 patients were operated by orchiectomy only. On 51 occasions, a transurethral resection of the prostate was carried out under the same anesthesia. In 22 patients, operation of the prostate was done without previous planning, "because the patient was already on the operating table". Mean stay in hospital varied from 11.2 to 15.6 days, depending on the extent of the operative treatment. Social factors were the most important reason for prolonged hospitalization. Patients who are offered castration in the treatment of prostatic cancer have a great latent need for medical service and social care.

Aged↗
PubMed1996

[Percutaneous puncture in hepatic echinococcosis].

This is a report on a case of severe anaphylactic shock and hemorrhage following liver puncture with diagnostic purpose. Based on literature data and personal experience, percutaneous puncture of a parasitic expanding cyst, done with diagnostic and therapeutic purpose, is discarded, assuming the method as an error of art. Its performing using updated imaging techniques--echography and computerized tomography--by no means reduce the risk of anaphylactic shock and secondary echinococcosis. In the event of being accidentally done, emergency operation followed by chemotherapy to preclude secondary echinococcosis is recommended. In cases with unspecified diagnosis, puncture under echographic control is done on the operating table with urgent cytological assessment of the punctate. The demonstration of echinococcosis is an indication for immediate operation. The percutaneous method is used in handling nonparasitic cysts.

Adult↗
PubMed2003

Tumor resection in a shared-resource magnetic resonance operating room: experience at the University of Cincinnati.

INTRODUCTION: At the University of Cincinnati, we have developed a shared-resource magnetic resonance operating suite that facilitates performance of both neurosurgical and diagnostic procedures in a single unit. METHODS: The shared-resource magnetic resonance operating suite utilizes a Hitachi AIRIS II, 0.3-T, vertical field, open MRI unit located in the MROR. This magnet can be used for both diagnostic and interventional procedures. The addition of a rotating-operating table permits neurosurgical procedures to be performed outside of the 5-G line using standard neurosurgical equipment and operating microscopes. RESULTS: We review our results with the shared-resource magnetic resonance operating room including the tabulated results from 30 transsphenoidal procedures and 63 glioma procedures. In addition, 2832 diagnostic procedures have been performed in the first 4 years of use. CONCLUSION: The shared-resource intraoperative MRI facility produces high-quality intraoperative imaging studies, equal to those of high-resolution magnets, and is valuable in enabling the surgeon to achieve the planned degree of resection of glioma and pituitary tumors. The ability to perform diagnostic procedures in a shared unit has been a cost-effective solution for our institution.

Brain Neoplasms↗
PubMed2001

Evaluation of the usability of two types of image display systems, during laparoscopy.

BACKGROUND: This study was performed to assess the optimal display location of a flat-screen monitor for laparoscopy. It was also performed to assess the posture (objective), opinion, and preference (subjective) of subjects using a flat-screen monitor positioned in the optimal display location and a cathode-ray tube monitor on a tower next to the operating table (current situation). METHODS: Twelve surgeons performed cholecystectomies using the two display systems alternately. The postures of the operator and the assistant were assessed by an infrared video analysis system. RESULTS: The posture of the assistant is significantly better when using a flat-screen monitor [more neutral head flexions (p = 0.036) and neutral neck torsions (p = 0.012)]. No significant differences were found for the posture of the operator. The operators and assistants felt more comfortable when using a flat-screen monitor (p = 0.008) and they preferred this display to the use of a monitor on a tower. CONCLUSIONS: The use of flat-screen monitors is better for the physical and psychological comfort of the users, even though the technical performance is inferior in comparison with that of regular monitors.

Cholecystectomy↗
PubMed1990

Hepatic transplantation with the aid of the iron intern retractor.

In the majority of centers, orthotopic liver transplantation at any given time involves a team of four: the surgeon and the first, second, and third assistants. As a result, considerable skilled manpower must be available around the clock. Furthermore, the presence of four surgeons and an instrument nurse creates considerable crowding around the operating table. Although various mechanical devices have been occasionally employed by various teams for the purpose of solving these problems, no single instrument has been reported as truly helpful. During the past year, the Iron Intern, a table-mounted surgical robot that replaces up to two of the human assistants during the liver transplantation recipient operation, has been successfully employed at the University of Pittsburgh. The instrument is easy to use and versatile enough to be satisfactory under any circumstances. We believe this device is a real breakthrough in streamlining orthotopic liver transplantation.

Humans↗
PubMed1975

Aneurysm of the pars membranacea of the interventricular septum.

Six cases of aneurysmal formation of the pars membranacea septi (AMS) are presented. Three cases associated with a ventricular septal defect (VSD) and one with VSD, prolapse of the right aortic cusp and aorto-right ventricular fistula, were operated on and the aneurysm, unsuspected preoperatively, was found at the operating table. Two cases, both with aortic coarctation (CA), have been diagnosed on the basis of selective angiocardiography and operated solely for resection of the coarctation. In three patients a mild pulmonary infundibular pressure gradient was present at catheterization. This anomaly is considered rare. It has been reported to complicate surgery, may not require surgery, and is considered by some to be a prelude to spontaneous closure of a VSD. The English medical literature concerning aneurysm of the membranous septum has been reviewed and our opinions on the management of these patients are presented. Including our own six patients, we are aware of approximately one hundred and sixty five reported cases, with possibly an additional 16 cases to be added.

Adolescent↗
PubMed1979

[Indication margins for pulmonary embolectomy].

Pulmonary embolectomy is the most effective form of treatment in acute, massive pulmonary embolism. Persistent cardio-respiratory failure, in spite of intensive medical therapy, presents a clear indication for embolectomy. A relative indication is given with the occlusion of more than 50% of the pulmonary arterial tree, especially in the case of beginning circulatory failure and contraindications to fibrinolytic therapy. Preoperative angiography is essential and should be performed whenever possible. A dramatic deterioration of the patient's condition may, however, require a prior reestablishment of sufficient circulation with relief of the right ventricle. According to the clarity of symptoms, either immediate thoracotomy or peripheral canulation and partial cardio-pulmonary bypass with subsequent angiography on the operating table should be preferred. Even a long resuscitation with persistently dilated, non-reactive pupils does not exclude operative success, and justifies neither the ommission nor the premature discontinuance of a resolute and consistent therapy.

Acute Disease↗
PubMed1994

[Ventilation method plan in daily operations--a practical study].

On three days each we measured particles and airborne bacteria in ten ventilated operating theatres. Modern air conditioning systems achieved a significant reduction of air-pollution. Vertical systems proved to be more effective than horizontal systems. Workday conditions made several problems: During high personal activity a body exhaust system was not able to reduce the concentration of airborne bacteria; doors near the operating table and objects in the airstream had a negative effect; there was more personal than necessary in the operating theatres; some activities took place without a specific purpose and resulted in raised particle and bacteria contamination; early clearing of materials, before the operation ended, increased turbulences and door movements. A short break in personal activity before the first skin cut is recommended to reduce high air contamination due to the preparation of the operating room and the patient. One of the ventilation systems was insufficiently operated by personal. We recommend continuous measurement of particles near the operating field in order to control the input of airborne particles and bacteria into the wound.

Air Conditioning↗
PubMed1975

[The surgical strategy in cases of arterio-venous aneurysms of the posterior fossa. A propos of 3 cases].

Three cases of strictly subtentorial arteriovenous aneurysm (out of 55 intracranial malformations of this kind) are presented, with special reference to surgical tactics and technics: the pros and cons of different positions on the operating table, search for afferent pedicles whose clipping may suffice, necessity of routine use of bipolar coagulation, use of the operating microscope, and continuous intraoperative checking of vital data by the anesthetist. These lesions are operable and should therefore be looked for.

Adult↗
PubMed2006

Changes in the iliac crest-lumbar relationship from standing to prone.

BACKGROUND CONTEXT: It is known that positioning patients on the Jackson and Andrews operative tables causes changes in lumbar lordosis and pelvic rotation. However, it is unknown if the relationship between the iliac crest and underlying lumbar levels, in particular the L4-L5 interspace, changes from standing to prone on these tables. PURPOSE: To assess the changes in the relationship between the iliac crests and lumbar spinal levels from standing to prone on two different operative positions using the Jackson and Andrews frames. STUDY DESIGN/SETTING: Comparative analysis of iliac crest position relative to spinal levels in the preoperative standing position and while positioned on the Jackson and Andrews frames. PATIENT SAMPLE: 48 randomly selected patients who underwent spinal surgery on either the Jackson or Andrews frame. OUTCOME MEASURES: Imaging. METHOD: Comparative measurements were made of the preoperative and intraoperative plain lateral lumbar radiographs. The location of the superior border of the iliac crest relative to the L4 lumbar spine level was compared between radiographs. RESULTS: Preoperatively, the iliac crest aligned with L4/L4-L5 spinal level in 79.2% of the 48 patients compared with 85.5% of intraoperative cases (p=.59). Intraoperative iliac crest level aligned with the L4/L4-L5 level in 80.8% and 90.9% of the patients on the Andrews and Jackson tables respectively (p=.43). Thirty-four patients (70.8%) demonstrated no change in iliac crest alignment between intraoperative and preoperative radiographs. There was a trend for the iliac crest to shift cephalad with operative positioning. CONCLUSION: Approximately 30% of patients demonstrated changes in the relationship between the iliac crest and lumbar levels between standing and positioning prone. The intraoperative position of the iliac crest aligned more accurately with the L4/L4-L5 spine level on the Jackson and Andrews frame compared with preoperative standing radiographs respectively. Further biomechanical studies should investigate the implication for lumbopelvic fixation.

Adult↗
PubMed1996

Absorption of glycine irrigating solution during endoscopic transanal resection of rectal tumors.

PURPOSE: This study was undertaken to evaluate the potential metabolic complications of 1.5 percent glycine irrigating solution during endoscopic transanal resection (ETAR) of rectal tumors. METHODS: Thirteen consecutive frail patients (mean age, 81 (range, 57-91) years) undergoing 18 ETAR were prospectively studied from July 1993 to January 1995. Indications for ETAR included palliation of advanced rectal cancer (12 patients) and an extensive villous tumor (1 patient). A 27-French two-way Iglesias resectoscope was used. Packed cell volume, blood glucose, and serum concentrations of sodium, potassium, and creatinine were measured before, during (at 45 minutes), and after (at 6 and 24 hours) ETAR. Plasma concentration of glycine and hemoglobin levels were both measured preoperatively and at 45 minutes and 24 hours, respectively. Variables studied included resection time, volume and rate of irrigating fluid, height of irrigating fluid bag above operating table, resectate weight, occurrence of intraperitoneal and extraperitoneal perforation, blood loss, and clinical symptoms. RESULTS: Two patients were excluded. Mean operating time was 456 minutes. A mean of 192.3 liters of irrigant was infused into the rectum. Mean irrigation rate was 43,330 ml/minutes. Mean height of irrigating fluid bag was 692 cm. Extraperitoneal perforation occurred in two patients. Blood loss exceeded 200 ml in four patients, one of whom complained of nausea (operating time, 110 minutes). Mean rise in p-glycine at 45 minutes (10,028 mol/l; 387 percent of preoperative values) was significant (P = 0.006). Changes in packed cell volume, b-hemoglobin, b-glucose, s-sodium, and s-creatinine levels were not significant. There was significant correlation between p-glycine and s-creatinine levels at six hours (P = 0.033), between p-glycine levels and fall in s-sodium at 24 hours (P = 0.037), and between levels of b-hemoglobin and packed cell volume at 24 hours (P = 0.0004). There was a positive linear correlation between p-glycine and operating time (r = 0.7; P = 0.0026) and between p-glycine and volume of irrigating fluid (r = 0.5; P = 0.0386). CONCLUSIONS: Operating time best predicts increase of p-glycine in ETAR.

Adsorption↗
PubMed1984

Hearing conservation in acoustic neurilemmoma surgery via the retrosigmoid approach.

Hearing conservation in acoustic neurilemmoma surgery is possible in approximately 50% of patients whose tumors measure 15 mm or less in size (medial to the porus acusticus) and whose speech discrimination score in the ear with the tumor is 80% or better. The concepts of total tumor removal and maximum sparing of adjacent normal neural tissue are consistent with efforts to retain cochlear function. A retrosigmoid approach is favored over the middle cranial fossa approach because of the superior exposure and less morbidity. An operating table capable of 35-degree side rotation is used. It allows the majority of patients with acoustic neurilemmoma to be operated on in the horizontal supine position. The posterior lip of the internal auditory canal is removed to within approximately 1.5 mm of the falciform crest. Tumors not extending to the fundus afford an ideal situation for total removal, early identification of the seventh cranial nerve, and conservation of hearing. The CO2 laser is a useful surgical tool with its properties of vaporization, cutting, and coagulation.

Hearing Loss↗
PubMed1989

Complications after total hip replacement. The contralateral limb.

Six patients who had a total hip replacement, as well as a trochanteric osteotomy, while they were in the lateral decubitus position had complications involving the contralateral side. The complications included transient paresthesias, massive swelling of the thigh with myonecrosis, acute renal failure secondary to myoglobinuria, and arterial insufficiency that resulted in a below-the-knee amputation. In order to elucidate the causes of the complications, the external pressure of the contralateral femoral triangle and the blood flow to the contralateral foot were monitored intraoperatively in seventeen patients. The results supported the postulate that pressure at the groin is increased intraoperatively and that this can cause vascular compromise. Other proposed causes of the complications were pre-existing vascular disease, obesity, the lateral decubitus position of the patient on the operating table, and the use of hypotensive anesthesia. We found several techniques that may minimize complications in the contralateral limb during operations on the hip.

Adult↗
PubMed1981

Hip surgery: an aid to lateral positioning.

A new operating table accessory is described, the object of which is to assist in restraining the pelvis in the lateral position for operations such as total hip replacement without impeding venous drainage from the site of operation.

Hip Joint↗