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At least 505 records · Page 28Linked to original sources
PubMed1997

Secobarbital in humans discriminating triazolam under two-response and novel-response procedures.

Humans were trained to discriminate the benzodiazepine triazolam (0.32 mg/70 kg) from placebo under a two-response (drug vs. placebo) drug discrimination procedure. Dose-effect curves for several drugs were then determined in a crossover design using the two-response procedure and a 'novel-response procedure' that provided a novel-appropriate response for drugs unlike triazolam or placebo. Three subjects were tested with triazolam (0.1-0.32 mg/70 kg), the barbiturate secobarbital (56-177 mg/70 kg), and caffeine (320 and 560 mg/70 kg). Triazolam dose dependently increased triazolam-appropriate responding under both procedures and generally did not occasion novel-appropriate responding under the novel-response procedure. Secobarbital substituted for triazolam in the two-response procedure and dose-dependently increased novel-appropriate responding as well as occasioned some triazolam-appropriate responding in the novel-response procedure. Caffeine generally occasioned placebo-appropriate responding under the two-response procedure and a mix of novel- and placebo-appropriate responding under the novel-response procedure. Triazolam and secobarbital produced qualitatively similar self-reported drug effects. These results suggest that the novel-response procedure for human drug discrimination may enhance the pharmacological selectivity of triazolam- and placebo-appropriate responding.

Adult↗
PubMed2001

A separate procedure of fusion and activation in an ear fibroblast nuclear transfer program improves preimplantation development of bovine reconstituted oocytes.

This study was conducted to examine whether preimplantation development of bovine ("HanWoo," Bos Taurus corcanae) oocytes reconstituted with ear fibroblasts could be improved by a modified procedure of fusion and activation. In Experiment 1, enucleated oocytes were reconstituted with ear fibroblast by a combined procedure of electric fusion and activation at either 24 or 28 hours after IVM. The 28 hours reconstitution yielded more blastocysts (4% vs. 21%, P = 0.0025) and higher ratio of blastocysts per 2-cell embryos (0.05 vs. 0.25, P = 0.003) than the 24 hours. In Experiment 2, enucleated oocytes were reconstituted by one of the three fusion and activation protocols; 1) a combined procedure of electric fusion and activation at 28 hours after IVM, 2) a combined procedure of electric fusion and chemical activation at 28 hours, and 3) a separate procedure of electric fusion at 24 hours and chemical activation at 28 hours. When compared two combined procedures, chemical activation with 5 microM ionomycin for 4 minutes did not promote embryo development and significantly reduced the fusion rate (42% vs. 53%, P = 0.0395). However, significant (P < 0.0113) increases in the development to 2-cell (90% vs. 70 to 74%) and blastocyst (47% vs. 7 to 13%) stages and in the ratio of blastocysts per 2-cell embryos (0.52 vs. 0.11 to 0.18) were obtained by a separate procedure of electric fusion and chemical activation than by the combined procedures. This separate protocol did not reduce the fusion rate compared with the combined procedures (58%). In conclusion, improved development of oocytes reconstituted with ear fibroblasts was achieved by undergoing a separate procedure of electric fusion and chemical activation 4 hours apart.

Animals↗
PubMed2003

Procedural pain in newborns at risk for neurologic impairment.

In the past decade, our knowledge of pain in newborn infants has advanced considerably. However, infants at significant risk for neurologic impairment (NI) have been systematically excluded from almost all research on pain in neonates. The objectives of this study were to compare: (a). the nature, frequency and prevalence of painful procedures, (b). analgesics and sedatives administered, and (c). the relationship between painful procedures and analgesia for neonates at risk for NI. One hundred and ninety-four infants at high (cohort A, n=67), moderate (cohort B, n=59) and low (cohort C, n=68) risk for NI from two tertiary level Neonatal Intensive Care Unit's in Canada were included in a retrospective cohort study on the first 7 days of life. Data were collected from medical records and analyzed using chi-square, ANOVA and regression approaches. All cohorts had a mean of >10 painful procedures per day during the first 2 days of life. There was an interaction effect between cohort group and day of life (F(5,188)=2.13, P<0.06) with cohort A having significantly more painful procedures on day 1 (F(2,191)=4.79, P<0.009). There was no statistical difference in the number of infants who received continuous infusion (F(2,20)=1.9, P=0.13) or bolus (F(2,20)=1.3, P=0.25) opioids or sedatives (F(2,20)=0.45, P=0.84) by cohort over the 7 day period. There was a statistical difference in bolus opioid administration for days 1 (P<0.05) and 2 (P<0.001) with less than 10% of infants in cohort A receiving bolus opioids compared with approximately 22-33% of infants in cohorts B and C. There was a statistically significant correlation between painful procedures and analgesic use (r=0.29, P<0.001), although significant associations existed for cohorts B and C only. The number of painful procedures and study site primarily accounted for the variance (61% in cohort B and 35% in cohort C) in analgesic use, while in cohort A, only study site contributed to the variance (16%). Neonates at the highest risk for NI had the greatest number of painful procedures and the least amount of opioids administered during the first day of life. There was no relationship between painful procedures and analgesic use in this group. As these infants are vulnerable to pain and its consequences, the rational underlying health professional strategies regarding painful procedures and analgesic use for procedural pain in this population urgently awaits exploration.

Analgesics, Opioid↗
PubMed2006

Powers of multiple-testing procedures for identification of genes significantly differentially expressed in microarray experiments.

Because of the high operation costs involved in microarray experiments, the determination of the number of replicates required to detect a gene significantly differentially expressed in a given multiple-testing procedure is of considerable significance. Calculation of power/replicate numbers required in multiple-testing procedures provides design guidance for microarray experiments. Based on this model and by choice of a multiple-testing procedure, expression noises based on permutation resampling can be considerably minimized. The method for mixture distribution model is suitable to various microarray data types obtained from single noise sources, or from multiple noise sources. By using the biological replicate number required in microarray experiments for a given power or by determining the power required to detect a gene significantly differentially expressed, given the sample size, or the best multiple-testing method can be chosen. As an example, a single-distribution model of t-statistic was fitted to an observed microarray dataset of 3 000 genes responsive to stroke in rat, and then used to calculate powers of four popular multiple-testing procedures to detect a gene of an expression change D. The results show that the B-procedure had the lowest power to detect a gene of small change among the multiple-testing procedures, whereas the BH-procedure had the highest power. However, all multiple-testing procedures had the same power to identify a gene having the largest change. Similar to a single test, the power of the BH-procedure to detect a small change does not vary as the number of genes increases, but powers of the other three multiple-testing procedures decline as the number of genes increases.

Gene Expression Profiling↗
PubMed1997

Impact of arterial surgery and balloon angioplasty on amputation: a population-based study of 1155 procedures between 1973 and 1992.

BACKGROUND: Limited population-based data are available on trends in the incidence of arterial surgery, balloon angioplasty, and amputation for arterial occlusive disease of the legs over the past two decades. METHODS: We identified all elective and emergency arterial operations, balloon angioplasty procedures, and amputations performed for all residents of a defined community, Olmsted County, Minn., between 1973 and 1992. We focused on gender mix, type of procedure, and secular trends in utilization. RESULTS: A total of 1155 procedures were performed, including 733 arterial surgical procedures, 59 balloon angioplasty procedures, and 363 amputations (288 major and 75 minor). Emergency procedures were performed in 12%. Suprainguinal inflow procedures were the most common arterial reconstruction (60%) compared with infrainguinal procedures (40%). The incidence of all revascularization procedures increased in the first decade but reached a plateau after 1985. Utilization rates of revascularization procedures from 1988 to 1992 were higher for men (141.9/100,000 person-years [p-yr]) than women (57.4/100,000 p-yr.). Angioplasty (17.0/100,000 p-yr) rates lagged behind surgery until 1985, but tripled in the past 10 years and have not yet reached a plateau. Although minor amputation rates remain unchanged in 20 years, major amputation rates have been reduced by 50% from 36.7/100,000 p-yr between 1973 and 1977 to 19.0/100,000 p-yr from 1988 to 1992. CONCLUSIONS: From this long-term population-based analysis (1973 to 1992), we conclude that increased vascular surgery and balloon angioplasty rates have coincided with a significant reduction in major amputation rates in the past 10 years.

Adult↗
PubMedDate not supplied

Left and right atrial transport function after the Maze procedure for atrial fibrillation: an echocardiographic Doppler follow-up study.

OBJECTIVES: We evaluated atrial transport function after the Maze procedure in long-term follow-up and compared left and right atrial function in Maze patients with that of healthy age-matched controls using echo Doppler techniques. BACKGROUND: The Maze procedure is designed to eliminate atrial fibrillation, restore normal sinus rhythm, and preserve atrial contraction. Initial data indicate that atrial transport function is restored in most patients undergoing the Maze procedure. The long-term echo Doppler evaluation of patients after the Maze procedure has not been well described. METHODS: We performed pulsed-wave Doppler and two-dimensional echocardiographic studies on 31 patients (24 men, mean age 53.8 years) who underwent the Maze procedure and who had a follow-up study greater than 3 months (mean 16.5 months) after the procedure. Measurements included peak left ventricular and right ventricular inflow A-wave velocity, maximum and minimum left atrial and right atrial areas, and fractional area change of the left and right atria. Results were compared with those obtained from 15 age-matched control subjects (11 men, mean age 53.8 years). RESULTS: Twenty-two patients (71%) had left atrial function shown by the presence of left ventricular inflow A-wave, and 25 patients (81%) had right atrial function shown by the presence of right ventricular inflow A-wave on Doppler echocardiography. The left ventricular inflow A-wave velocity was significantly lower than that of age-matched controls (37.5 +/- 15.5 versus 61.0 +/- 13.9 cm/sec; p < 0.001), whereas the right ventricular inflow A-wave velocity did not significantly differ between patients and control subjects (35.4 +/- 9.9 versus 35.3 +/- 4.9 cm/sec; p = Not significant). Although left and right atrial areas decreased significantly after the procedure, there was no significant change in the fractional area change which was smaller in Maze patients than control individuals. CONCLUSIONS: (1) In long-term follow-up of 16.5 months after the Maze procedure, left atrial systolic function was preserved in 71% of our patients and right atrial systolic function was preserved in 81%; (2) the left ventricular inflow peak A-wave velocity after Maze is considerably less than that in age-matched controls; and (3) left and right atrial sizes decreased after the procedure with no change in the fractional area change. These findings suggest that the Maze procedure is effective in restoring atrial function in the majority of patients; however, restored function is less than in control individuals.

Adult↗
PubMedDate not supplied

The number of procedures required to eliminate positioning nystagmus in benign paroxysmal positional vertigo.

AIM: To evaluate the number of weekly canalith repositioning procedures needed to eliminate positioning nystagmus in patients with benign paroxysmal positional vertigo and to verify influences of canalithiasis or cupulolithiasis and/or semicircular canal involvement. STUDY DESIGN: clinical prospective with transversal cohort. MATERIAL AND METHOD: Sixty patients with benign paroxysmal positional vertigo were consecutively selected according to each combination of canalithiasis or cupulolithiasis with semicircular canal involvement. Patients were treated by means of canalith repositioning procedures repeated weekly until the elimination of the positioning nystagmus. Analysis of Variance was used to verify differences between the variables. RESULTS: An average of 2.13 procedures (from 1 to 8) was needed to eliminate the positioning nystagmus. Canalithiasis required an average of 1.53 procedures, while cupulolithiasis needed 2.92 procedures (p=0.0002). An average of two procedures was needed to eliminate the positioning nystagmus in cases with posterior canal involvement, 2.39 procedures in cases with anterior canal involvement and 2.07 procedures in cases with lateral canal involvement (p=0.5213). CONCLUSIONS: From one to eight weekly canalith repositioning procedures were needed, with an average of two, to eliminate positioning nystagmus in benign paroxysmal positional vertigo. Cupulolithiasis requires a greater number of procedures than canalithiasis to eliminate positioning nystagmus. Semicircular canal involvement didn't influence the number of therapeutic maneuvers.

Adolescent↗
PubMed2000

The procedural validity of retrospective case note diagnosis.

OBJECTIVE: Deriving diagnoses from retrospective case note examination is a common practice in psychiatric research. The Operational Criteria (OPCRIT) diagnostic checklist is essentially a checklist built up of operational criteria defined by a comprehensive glossary and is designed to assign reliable diagnoses from case notes. However, the validity of such a procedure compared with procedures involving prospective assessment has never been tested. We examined the procedural validity of the OPCRIT diagnostic system in relation to four other diagnostic procedures mostly employing prospectively gathered information. METHOD: Three experienced psychopathology raters rated the case notes and clinical abstracts, using the OPCRIT method of diagnostic assignment, of 50 subjects who had participated in an early procedural validity study as an adjunct to the DSM-IV Field Trial for psychotic disorders. The setting was the Early Psychosis Prevention and Intervention Centre (EPPIC), which focuses on first episode psychosis. RESULTS: The pairwise concordance with the other procedures for DSM-III-R diagnoses assigned by OPCRIT using ratings derived from either the clinical abstracts or the case notes was found to be only poor to moderate when compared with the pairwise concordance of the four other procedures. The per cent agreement between OPCRIT clinical abstracts diagnoses and the other procedures ranged from 49% to 60% with kappa values between 0.30 and 0.45, and for OPCRIT case note diagnoses and the other procedures the per cent agreement range was between 44% and 57% and the kappa values were between 0.35 and 0.49. CONCLUSIONS: The procedural validity of diagnoses assigned via the application of checklists of operational criteria to case notes and clinical abstracts alone is unacceptably poor. Such sources need to be buttressed by other data, particularly direct patient interview and informant material.

Adolescent↗
PubMed2003

Factors associated with practice of procedures in pediatric-related areas among certified pediatricians.

BACKGROUND: Medical care in pediatric-related areas in which physicians other than pediatricians, such as surgeons, otolaryngologists, ophthalmologists, orthopedists and dermatologists, can also participate is one of the fields of pediatric primary care. Independent factors associated with the practice of specific procedures in pediatric-related areas by certified pediatricians in Japan were evaluated. METHODS: Data were collected from a nationwide survey of 1116 pediatricians who were selected by systematic sampling from the list of certificated members of the Japan Pediatric Society. The survey included questions relating to full- or part-time practice, types of practice setting, practice with or without pediatric subspecialty interest, numbers of procedures performed among 15 procedures in pediatric-related areas, and attitude toward practice of those procedures. RESULTS: Of 79% of respondents, 73% were analyzed (n=810). Among 15 procedures in pediatric-related areas, seven procedures performed by more than 30% of certificated pediatricians were evaluated. In comparison with certified pediatricians who annually performed three or less procedures (n=410), certified pediatricians who annually performed four or more procedures (n=400) were more likely to be young and male, working full-time and in a general hospital setting, practicing with a pediatric subspecialty interest. In multiple logistic regression analyses, young age (odds ratio [OR]: 0.8 per 10 years of age; 95% CI: 0.6-0.9), positive attitude toward practice (OR: 1.7; 95% CI: 1.6-1.9), male (OR: 1.7; 95% CI: 1.1-2.5), full-time practice (OR: 3.2; 95% CI: 1.5-6.9), and practice in general hospital setting (OR: 1.7; 95% CI: 1.2-2.4) were independently associated with more extensive practice of procedures in pediatric-related areas. CONCLUSIONS: A positive attitude toward medical care in pediatric-related areas is one of the most important factors associated with practice of procedures in these areas. An educational strategy for pediatricians to keep their motivation high for improved medical care in these areas should be planned in Japan.

Adult↗
PubMed2002

Teaching ultrasound-guided invasive procedures in fetal medicine: learning curves with and without an electronic guidance system.

OBJECTIVE: To compare the learning curves of inexperienced junior obstetrics/gynecology registrars for ultrasound-guided invasive procedures on a training model, with and without an electronic guidance system. STUDY DESIGN: Four junior registrars performed their first 100 procedures on a training model with a new electronic guidance system, and four other junior registrars performed their first 100 procedures on the same training model without using the guidance system. All procedures were performed using a free-hand technique. We evaluated the quality of the procedure, which we defined as the time spent with the entire needle clearly visualized on the screen over the total duration of the procedure. We constructed learning curves for the eight junior registrars for comparative analysis. RESULTS: Quality of the procedure increased over time for all trainees. The learning curves were significantly steeper for trainees using the electronic guidance system. Trainees using the electronic guidance system performed better in the middle of their learning curve (procedures 25-75). All trainees reached the same level of quality by the end of their 100 procedures. CONCLUSIONS: The automated electronic guidance system helps faster learning but, after 100 procedures on a training model, both groups reached the same level of quality.

Amniocentesis↗
PubMed2000

Confidence of academic general internists and family physicians to teach ambulatory procedures.

OBJECTIVE: To evaluate and compare the readiness of academic general internal medicine physicians and academic family medicine physicians to perform and teach 13 common ambulatory procedures. DESIGN: Mailed survey. SETTING: Internal medicine and family medicine residency training programs associated with 35 medical schools in 9 eastern states. PARTICIPANTS: Convenience sample of full-time teaching faculty. MEASUREMENTS AND MAIN RESULTS: A total of 331 general internists and 271 family physicians returned completed questionnaires, with response rates of 57% and 65%, respectively. Academic generalists ranked most of the ambulatory procedures as important for primary care physicians to perform; however, they infrequently performed or taught many of the procedures. Overall, compared with family physicians, general internists performed and taught fewer procedures, received less training, and were less confident in their ability to teach these procedures. Physicians' confidence to teach a procedure was strongly associated with training to perform the procedure and performing or precepting a procedure at least 10 times per year. CONCLUSIONS: Many academic general internists do not perform or precept common adult ambulatory procedures. To ensure that residents have the opportunity to learn routine ambulatory procedures, training programs may need to recruit qualified faculty, train current faculty, or arrange for academic specialists or community physicians to teach these skills.

Adult↗
PubMed1994

The relation between the volume of coronary angioplasty procedures at hospitals treating Medicare beneficiaries and short-term mortality.

BACKGROUND: Previous studies have found that hospitals at which more procedures, such as coronary-artery bypass grafting (CABG) and other vascular surgery, are performed have lower rates of mortality related to these procedures than hospitals where fewer such procedures are performed. METHODS: We examined the relation between the number of percutaneous transluminal coronary angioplasty (PTCA) procedures performed at hospitals (volume) and short-term mortality in a population of 217,836 Medicare beneficiaries 65 years of age or older who underwent angioplasty in the United States from 1987 through 1990. RESULTS: The unadjusted in-hospital mortality among patients who underwent PTCA increased from 2.5 percent among the 10 percent of patients treated in hospitals with the highest volume of such procedures to 3.9 percent among the 10 percent of patients treated in hospitals with the lowest volume. The rate of bypass surgery after PTCA also increased, from 2.8 percent among patients in the highest-volume hospitals to 5.3 percent among those in the lowest-volume hospitals. Higher rates of mortality and CABG persisted in all the groups of patients treated in hospitals that performed fewer than 100 angioplasty procedures per year in Medicare beneficiaries; this volume in Medicare beneficiaries can be extrapolated to an overall annual volume of 200 to 400 angioplasty procedures. In a logistic-regression model, the volume of PTCA procedures at a hospital was found to be a highly significant predictor of in-hospital mortality (P < 0.001). These results suggest that if the hospitals with the lowest volume had achieved the experience and technical results of the highest-volume hospitals, 381 fewer patients would have undergone CABG and there would have been 300 fewer in-hospital deaths in the population we studied. CONCLUSIONS: Hospitals that perform more PTCA procedures have lower short-term mortality rates after the procedure. These data provide evidence in support of the regionalization of angioplasty services.

Aged↗
PubMed2000

Activities and procedures performed by nurse practitioners in emergency care settings.

INTRODUCTION: Although nurse practitioners (NPs) have been practicing in emergency care (EC) settings for at least 25 years, little is known about the activities and procedures they perform. METHODS: A questionnaire was sent by either by E-mail or US mail to a convenience sample of 96 subjects. These 96 NPs were instructed to duplicate the questionnaire and distribute it to other NPs they may know who also work in EC settings. The questionnaire contained 71 activities and procedures obtained from Clinical Procedures in Emergency Medicine by Roberts and Hedges. The NPs were asked to rate the 71 activities and procedures according to the frequency with which they performed them, where they learned to perform them, and how important they believe it is that NPs in EC settings know how to perform them. RESULTS: Seventy-two NPs in EC settings responded. Fifty percent (n = 36) or more had performed 35 of the 71 activities and procedures. Almost every NP (n = 71) had used fluorescein staining, and only 3 procedures--culdocentesis, venous cutdown, and insertion of pins for skeletal traction--had never been performed. The majority of NPs learned to perform each of the activities and procedures through on-the-job training and continuing education courses. Fifty percent or more identified 56 activities and procedures as being important for NPs to know how to perform in EC settings. DISCUSSION: The results of this study indicate that whereas 50% or more of the NPs in EC settings had performed 35 out of 71 activities and procedures, 50% or more indicated that a larger skill set of 56 activities and procedures is believed to be needed for practice.

Adult↗
PubMed2003

Family presence during cardiopulmonary resuscitation and invasive procedures: practices of critical care and emergency nurses.

BACKGROUND: Increasingly, patients' families are remaining with them during cardiopulmonary resuscitation and invasive procedures, but this practice remains controversial and little is known about the practices of critical care and emergency nurses related to family presence. OBJECTIVE: To identify the policies, preferences, and practices of critical care and emergency nurses for having patients' families present during resuscitation and invasive procedures. METHODS: A 30-item survey was mailed to a random sample of 1500 members of the American Association Of Critical-Care Nurses and 1500 members of the Emergency Nurses Association. RESULTS: Among the 984 respondents, 5% worked on units with written policies allowing family presence during both resuscitation and invasive procedures and 45% and 51%, respectively, worked on units that allowed it without written policies during resuscitation or during invasive procedures. Some respondents preferred written policies allowing family presence (37% for resuscitation, 35% for invasive procedures), whereas others preferred unwritten policies allowing it (39% for resuscitation, 41% for invasive procedures). Many respondents had taken family members to the bedside (36% for resuscitation, 44% for invasive procedures) or would do so in the future (21% for resuscitation, 18% for invasive procedures), and family members often asked to be present (31% for resuscitation, 61% for invasive procedures). CONCLUSIONS: Nearly all respondents have no written policies for family presence yet most have done (or would do) it, prefer it be allowed, and are confronted with requests from family members to be present. Written policies or guidelines for family presence during resuscitation and invasive procedures are recommended.

Adult↗
PubMed2000

Timing and scheduling of endoscopic procedures.

BACKGROUND: The aim of the present analysis is to compare the costs associated with different schemes of scheduling tests and to develop recommendations concerning the most cost-effective means for timing individual endoscopic procedures. METHODS: The diagnostic costs of three competing strategies to schedule various radiologic and endoscopic procedures in patients with jaundice or gastrointestinal hemorrhage are compared by computer models using a Monte Carlo simulation. In strategy 1, the evaluation is started with the most promising procedure and proceeds with the next most promising procedure in case of a normal finding. In strategy 2, physicians adhere to a rigid sequence of diagnostic tests that starts with the least expensive procedure and advances through progressively more expensive procedures. In strategy 3, all promising tests are scheduled at the onset without waiting for test results to decide in favor or against individual procedures. In the Monte Carlo simulation, two hypothetical populations of 5000 inpatients or outpatients are subjected to each strategy. RESULTS: Unless one particular diagnosis is suspected with a high a priori probability, a rigid sequence of advancing from less to more expensive and invasive procedures provides the cheapest diagnostic strategy. In case of limited access to endoscopy and long waiting times, the cheapest work-up may include simultaneous scheduling of complementary procedures without waiting for intermediate test results. Strategy 1 of starting with the most promising test procedure becomes the least expensive option, if the prior probability assigned to the most likely diagnosis exceeds a threshold between 40% and 70%, depending on the type of test needed to make the diagnosis. CONCLUSIONS: An expeditious diagnostic evaluation or an evaluation that is guided primarily by medical considerations is more likely to result in low healthcare costs.

Aged↗
PubMed2001

Corneal triple procedure.

Corneal diseases subject to keratoplasty are often combined with a certain degree of cataract. Therefore, appropriate strategies for the management of cataract are mandatory. One strategy is a sequential procedure performing cataract surgery after keratoplasty. Though this procedure enables us to estimate IOL power accurately, there are several drawbacks including multiple procedures, slow visual rehabilitation and endothelial damage during cataract surgery. On the other hand, triple procedure, consisting of penetrating keratoplasty, extracapsular lens extraction and IOL implantation, has several advantages, such as single procedure, rapid visual rehabilitation and no additional endothelial trauma. How-ever, open sky procedure may be accompanied by uncontrollable vitreous pressure followed by posterior capsule rupture and difficulty of IOL implantation, while the worst outcome may be expulsive hemorrhage. Combined core vitrectomy preceding corneal trephination is contrived to solve this problem. This procedure is simply performed from a single sclerotomy 3.5-4.01 mm posterior to the corneal limbus with a vitreous cutter under the external pressure to the eye, and vitreous pressure is sufficiently lowered to allow the following procedures to be done very safely. Another problem with triple procedure is the calculation of IOL power. This problem is caused by unpredictable keratometer readings after keratoplasty. Several methods for calculating IOL power in triple procedure are also discussed.

Cataract Extraction↗
PubMed1997

The application of minimal access procedures in infants, children, and young adults with pediatric malignancies.

OBJECTIVE: In this study, we sought analysis of minimal access procedures in pediatric and young adult oncology patients. METHODS: Between 1990 and 1997, 84 patients underwent 93 minimal access procedures. Clinical, pathological, and operative details were analyzed. RESULTS: There were 32 females and 52 males with a median age of 14 years (range 3 months to 31 years). The median body weight was 50 kg (range 6-94 kg). There were 47 thoracoscopic procedures and 46 laparoscopic procedures. Laparoscopic procedures included liver biopsy (21), diagnostic tumor biopsy (13), lymph node biopsy (4), cholecystectomy (4), oophoropexy (3), and kidney biopsy (1). Median hospital stay was 2 days (range 1-14 days). Six patients had their procedure converted to an open procedure (13%). Thoracoscopic procedures included diagnostic lung biopsy (22), mediastinal mass biopsy or resection (4), pleural biopsy (5), and pleurodesis (4). Eleven were converted to open thoracotomy (23%). Median hospital stay was 4 days (range 2-35 days). There were two complications after laparoscopy (4%) and three disease-related deaths. There were six complications after thoracoscopy (13%), and three disease-related deaths. Adequate tissue was obtained in all biopsy procedures. CONCLUSIONS: Children with cancer require operations for diagnosis and staging. Minimal access procedures are safe and effective and allow adjuvant therapy to begin earlier.

Adolescent↗
PubMed2002

Chair-side procedure for connecting transpalatal arches with palatal implants.

The present investigation examined a chair-side procedure for connecting a transpalatal arch (TPA) with palatal implants, which does not involve any laboratory work. This new technique was compared with the standard procedure in terms of the number of steps, the time required, and the cost. The total chair-side time needed with the standard procedure was 38 minutes, with the material costs amounting to [symbol: see text] 159.6. With the chair-side procedure the total time required was 55 minutes, and the cost of the material totalled [symbol: see text] 34.1. The chair-side procedure was derived from orthodontic treatment concepts and is independent of laboratory input. Its major advantage is that it does not require transfers, which necessitate additional steps. These steps, which are inevitable with the standard procedure, resulted in an unexpectedly high cost level and increased the total cost. The difference in the cost of the material between the two procedures amounted to [symbol: see text] 125.5 and timewise the difference was 17 minutes. Whilst TPA-implant connections can be made with both the standard and chair-side procedures, the standard procedure, although taking considerably less chair-side time, was four times more expensive than the chair-side procedure.

Costs and Cost Analysis↗