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At least 523 records · Page 29Linked to original sources
PubMed1991

[Treatment of mitral valve stenosis in pregnant women by the method of balloon valvuloplasty].

Catheter-balloon mitral valvuloplasty was performed in 7 females with rheumatic mitral stenosis on the 19th-32nd week of pregnancy. Four patients were operated on with signs of cardiac insufficiency, two--in a state of pulmonary pre-edema. Edema of the lungs in one patient continued developing on the operating table. The results of the treatment were good in all cases. The area of the mitral orifice increased from 0.9-1.75 to 2.4-3.5 cm2. The pressure gradient between the left atrium and the left ventricle dropped from 25-40 to 2-8 mm Hg. This was attended by the disappearance of the diastolic murmur and the clinical manifestations of stasis in pulmonary circulation in all patients. The development of mitral regurgitation after the operation was not encountered in any of the patients. The period of roentgenoscopy lasted 17.5 min. on the average. Screens were used to protect the fetus from the direct effect of the X-rays. Pregnancy ended in delivery in 6 patients; spontaneous labor at term occurred in 4, cesarean section had to be performed in one patient with placenta previa; one woman gave birth to twins on the 36th week of pregnancy. All the babies were healthy. Catheter-balloon valvulotomy does not yield to closed mitral commissurotomy in efficacy. The fact that it is only mildly injurious and does not need general anesthesia make this intervention preferable for pregnant women suffering from mitral stenosis.

Adult↗
PubMed1976

Multiple sequential femoral tibial grafting for severe ischemia.

For the past decade a common procedure used to salvage severely ischemic limbs has been autogenous vein bypass grafting to the distal popliteal artery or, if the popliteal trifurcation is occluded, to one of the tibial-peroneal branches. Reported limb salvage rate and long-term graft function varies considerably but in most series is low. To increase graft flow and to decrease resistance in femoral-poplitical-tibial grafts and thereby to perfuse the ischemic foot more effectively, we have employed multiple sequential anastomoses of a single vein graft to distal branches--a technique similar to that used occasionally in aortocoronary bypass grafting. The autogenous vein graft alone, or in combination with bovine heterograft, has been used in six patients with gangrenous toes or far advanced ischemia and in one patient with severe claudication. Multiple anastomoses below the knee were carried out in each patient. Anastomosis has been to a blind popliteal segment, then to a tibial or peroneal in four patients, to both tibials in another two patients, and to both tibials and the peroneal in one patient. Flow rates measured on the operating table clearly demonstrated a significant increase in flow through the graft with each additional anastomosis. There has been a greater response to surgery with return of pulses, warmth of the foot, and rapid healing as compared with previous patients having single femoral-tibial anastomoses. One failure occurred acutely from a technical problem early in the series; one failed at 3 months in a patient with pancreatic cancer and another patient died 2 weeks after operation of a myocardial infarct.

Adult↗
PubMed1997

[Retroperitoneal laparoscopic adrenalectomy. The 3-trocar surgical technic].

Laparoscopic adrenalectomy (LA), introduced in surgical practice quite recently, proves to be an effective method for treating diseases of the adrenal gland on account of the good visualization provided, in conjunction with all additional advantages of laparoscopic surgery, such as reduced traumatism, postoperative pain alleviation, shortened hospital stay and the like. Two patients presenting Cushing's syndrome are subjected to retroperitoneal laparoscopic adrenalectomy (RLA). With the patient in lumbotomy position on the operating table, a retroperitoneal space is created using a balloon dissector (Ethicon). The optics is introduced after placing a 10 mm balloon trocar (Origin). Under visual control two additional 10 mm trocars are placed along the course of lumbotomy line, accordingly along the anterior and posterior axillary lines. Next blunt dissection of the adrenal gland is done, and a clip applied to v. centralis. The adrenal gland is removed through one of the trocars, and the operation terminates after hemostasis and insertion of a drainage tube. The patients are discharged on the 4th postoperative day in a good general condition, mobilized, well fed with restored passage. In conclusion, the assumption is warranted that the early experience with RLA is encouraging as a safe and considerably less traumatic surgical procedure for operative management of diseases of the adrenal glands.

Adrenalectomy↗
PubMed2001

Videolaparoscopic cholecystectomy. Analysis of the clinical and functional aspects of mechanical lifting of the abdominal wall.

BACKGROUND: Mechanical lifting of the abdominal wall, a method based on traction and consequent elevation of the abdominal wall, is an alternative procedure to create enough intra-abdominal space necessary for videolaparoscopic surgery, dispensing the need for intraperitoneal gas insufflation. OBJECTIVE: This study aims to evaluate the technical feasibility of this procedure to carry out a videolaparoscopic cholecystectomy, while analyzing the clinical and functional aspects of this technique. PATIENTS AND METHODS: In the Digestive Tract Surgery Discipline of the Medical School at the University of São Paulo, São Paulo, SP, Brazil, was created the equipment to perform videolaparoscopic surgery using this method. The equipment has two sections: an external part which consisted of a frame attached to the operating table, inside which there is a sliding steel cable, moved by a ratched which is located at the lower end of one of the frame rods; the internal rod, the support, has an "L" shape, and its horizontal branch is made up of three turning rods and which is connected to the steel cable after insertion into the abdominal cavity. Ten patients underwent videolaparoscopic cholecystectomy using this equipment. The time taken to install the equipment, the operating area characteristics, the interference from the lifting equipment on surgical movements and on the intra-operative cholangiography, the measurements made of the force used during traction and extension of the abdominal wall elevation, and the medication required for postoperative analgesia were all evaluated. RESULTS: There were no intra-operative complications, and in none of the cases was it found necessary to convert to open surgery. We considered the insertion a safe and uncomplicated procedure, and the traction system efficient. Apart from the elevation of the abdominal wall, the distribution of the viscera inside the abdominal cavity is fundamental for the operating area. Depending on the position of the epigastric trocar, the lifting equipment can interfere with the surgical instruments mobility. It may be necessary to reposition the support to perform the intra-operative cholangiography. The tensional force applied to the peritoneal surface by the lifting rods is small, and no additional postoperative pain was observed using this procedure. CONCLUSION: These results show that using the equipment described in this study, mechanical lifting of the abdominal wall is a feasible alternative for undertaking videolaparoscopic cholecystectomy.

Abdominal Muscles↗
PubMed2003

[Application of spiral CT and post-image processing technique in the staging of central lung cancer].

OBJECTIVE: To assess image processing techniques including multiplanar reconstruction (MPR), volume rendering technique (VRT) and spiral CT angiography (SCTA) in the staging of central lung cancer (CLC), with transverse image, pathology and findings on the operation table as comparison. METHODS: Forty-six suspected CLC received spiral CT examination, on basis of prospective randomization, by a Picker 6 000 scanner. Contrast medium was injected at a rate of 4 ml/s with a power injector. The study volume done in a single breath-hold was from the aortic arch to the inferior pulmonary veins, using 3-mm collimation, pitch of 1.0 and reconstruction at 1-mm interval. Six patients were excluded after operation. Transverse CT scans, MPR and VR images were studied in a double-blind way by 3 experienced radiologists, with the findings compared with the surgical and pathological results. RESULTS: Post-processing image was more accurate than transverse CT scan in T categories (95.7% vs 82.6%), chi(2) = 4.039, P = 0.044. Four cases of N3 category on transverse CT scans were not proved by surgical or pathological results. The sensitivity, specificity and accuracy rates in N categories were 75.0% (12/16), 26.9% (7/26) and 45.2% (19/42). The accuracy rate of staging was 58.7% (27/46) by transverse CT scans and 67.4% (31/46) by post-processing images (chi(2) = 0.746, P = 0.338). CONCLUSION: Post-processing image is more accurate than transverse image in T categorizing.

Adult↗
PubMed2000

Experience with various 3-dimensional navigation systems in head and neck surgery.

OBJECTIVE: To evaluate the benefits and difficulties encountered when using various 3-dimensional (3-D) navigation systems in head and neck procedures. DESIGN: Five different navigation systems were used for preoperative planning and intraoperative 3-D navigation in procedures at the paranasal sinuses, the frontal and lateral skull bases, and the petrous bone. INTERVENTION: Intraoperative 3-D localizing systems (position-sensitive mechanical arms, infrared cameras, etc) demand reliable patient fixation on the operating table. We achieved this by developing a noninvasive head holder. Other systems allow patient movements by using magnetic digitizing technology (ARTMA System) and sophisticated programming. RESULT: Having surpassed an initial learning curve, we now achieve an accuracy of 1 to 2 mm regularly. Especially in paranasal and frontal basal surgery, all navigation systems used provide valuable positioning information during surgery. In particular for revision or tumor surgery, decisive benefits resulted from use of these systems: shorter overall operation time; safer manipulation near delicate structures; and reliable identification of the skull base even in patients with bleeding, scarring, or missing anatomical landmarks. CONCLUSIONS: We performed approximately 250 operations with different systems and introduced navigation at the lateral skull base and the petrous bone with mechanical, optic, and magnetic digitizers. In these anatomical areas, navigation was used successfully; the technical challenge is greatest at the lateral skull base, however.

Endoscopes↗
PubMed2004

Use of the prone oblique position in surgery for posterior fossa lesions.

BACKGROUND: The lateral suboccipital approach has been conventionally performed with the lateral, park-bench, or sitting position and the midline suboccipital approach has been performed in the prone position. We attempt to show the advantages of the prone oblique position in the surgery for posterior fossa lesions. METHODS: Twenty-two patients with posterior fossa lesions underwent surgery in the prone oblique position. The patients were fixed in the prone position while the operating table was rotated to raise the patient's shoulder. The surgeon sat beside the downward-shifted contralateral shoulder of the patient. With the lateral suboccipital approach, the neck of the patient was rotated to the side of the lesion. With the midline suboccipital approach, the neck was not rotated. FINDINGS: With the lateral suboccipital approach, this position spread the transverse axis of the suboccipital triangle and eliminated the interference of the patient's shoulder, providing an operative field that is wider than the lateral position or park bench position in all cases. With the midline suboccipital approach, this position enabled the surgeon to operate on lesions located in the upper half of the posterior fossa, such as fourth ventricular lesions or infratentorial lesions, without the need for a looking up posture with overhanging of the operative microscope. CONCLUSION: The prone oblique position offers the operator a panoramic view of the posterior fossa.

Adolescent↗
PubMed1979

Perforated stress ulcer in infants: a silent threat.

Stress ulcer has become an important clinical entity and its two major complications--bleeding and perforation--are among the most baffling problems, in terms of management, in clinical practice. Perforation, though the less common of the two, is perhaps the most formidable particularly when this occurs in a very sick infant. Four such infants (cyanotic heart disease, gastroenteritis and two severe pneumonias) all developed this severe complication of their illness and after surgery two survived. Two of these infants presented with bleeding prior to perforation of their stress ulcer. The perforation diagnosis was initially not apparent and was first made after radiological examination. Clinical signs of peritonitis were absent as these infants were too sick for such signs to be elicited. All four ulcers were situated in the posterior wall of the duodenum. Two of these infants developed cardiac complications on the operating table, the cause of which was not very clear. It may have been due to the debilitation of these babies with the additional effect of anesthesia perhaps leading to myocardial toxicity. It is therefore recommended that: all sick infants on steroid therapy be placed on prophylactic antacids; abdominal girth measurements be taken frequently in sick infants to appreciate any unexplained increase in girth; such increase in abdominal girth must be evaluated with an upright abdominal x-ray; operative closure of the perforation must be simple and expedient.

Duodenal Ulcer↗
PubMed1995

The Trendelenburg position: a review of current slants about head down tilt.

The steep head down tilt surgical posture, popularized in the 1870s by Trendelenburg as a means of improving access to pelvic pathology and espoused by the American physiologist, Walter Cannon, during World War I as a resuscitative position with which to treat shock, has a history of widespread, ritualistic acceptance. An awake patient placed in steep head down tilt usually objects to the posture after only a short time. Now recognized as potentially harmful in the presence of cardiac, pulmonary, ocular, and central nervous system pathology and essentially useless for vascular resuscitation, steep tilt should be limited to selected circumstances in which alternatives are unacceptable. Shallow head down tilt, a more recent variety, also offers serious questions about its surgical usefulness as well as its applicability for patients with diseased hearts, lungs, and heads. As an aid to resuscitative procedures, the contoured supine position offers assets that merit serious consideration. Means of restraining a tilted patient on an operating table include wristlets, shoulder braces, and bent knees with ankle restraints. Considerations that aid in the selection of head down tilt are presented, as is a plea for the abandonment of the Trendelenburg eponym and a suggestion for future investigation.

Head-Down Tilt↗
PubMed1995

Implication of anaesthesiologists' varying location during surgery.

Anecdote indicates anaesthesiologists in the operating room are not invariably at the head of the operating table beside their equipment. The validity of this was investigated by a nationally distributed questionnaire. The results support the anecdotal evidence. The behaviour can be justified so supports a recommendation for appropriate visibility of information displays. Whether such action would improve patient safety is debatable.

Anesthesiology↗
PubMed1998

[Recurrent laryngeal nerve paralysis after thyroid gland operations. Etiology and consequences].

In the period of 1 January 1990 to 31 December 1996 the thyroidectomy cases we performed were immediately followed by vocal cord evaluation using a flexible bronchoscope while the patient was still on the operating table. If an obvious cord paralysis was discovered, an exploration of the recurrent laryngeal nerve, to the level of the larynx, was performed. If the nerve was found to be intact, no further measures were taken. A severed nerve underwent suture repair. If an otolaryngologist diagnosed a vocal cord paralysis 1-5 days after surgery, a reoperation was recommended except in the cases where postoperative bronchoscopy had shown an easily mobile cord or the recurrent nerve was completely dissected during the operation. Within this 7-year period, we performed 3492 thyroidectomy operations. The diagnosis of subsequent unilateral postoperative vocal cord paralysis occurred in 48 cases. In 33 of these cases the status of the nerve in the surgical field was known: 4 patients had an intact nerve proved by complete dissection during thyroidectomy, in two patients the lesions of the nerve were detected intraoperatively (1 transsection, 1 partial resection), and 27 cases were followed by reoperation. Of the 33 patients mentioned above, in 19 instances the recurrent laryngeal nerve was found to be intact; 3 displayed signs of local trauma, and 11 were found to be severed with total discontinuity. Those patients with an intact nerve, or local nerve trauma only, went on to develop normal function within 6 months in 20 (91%) of 22 cases. Of the 11 with a severed nerve, 8 showed "autoparalysis" with good voice within 4-8 months, after suture repair in 10 cases. The patient with partial resection had no repair of the nerve. If immediate postoperative evaluation showed mobility of the vocal cords but a paralysis was detected later by an otolaryngologist and repeat intervention was not done, vocal cord function was spontaneously restored in 9 of 11 patients. Four patients refused reoperation. From 1990 to 1991, the recurrent laryngeal nerve was not always dissected during our thyroidectomy operations. However, this was done routinely from 1991 to 1996. Routine intraoperative dissection of the vocal cord nerve reduced the rate of postoperative cord paralysis from 2.0% to 1.2%. It also reduced the frequency of intraoperative nerve injury with total discontinuity from 0.58% to 0.23%.

Follow-Up Studies↗
PubMed2002

Choroid plexus papillomas of the cerebellopontine angle.

The cerebellopontine angle (CPA) is a rare site for the growth of choroid plexus papilloma (CPP). The clinicoradiological diagnosis of this tumor in the CPA is difficult because of the nonspecific clinical presentation and radiological features. Five cases of choriod plexus papilloma (3 males, 2 females) operated upon at this center are reviewed. All the cases were operated upon by retromastoid suboccipital craniectomy. As they all presented with a typical CPA syndrome without any distinctive radiological feature, a clinicoradiological diagnosis of CPP could not be reached in any of these. The diagnosis of CPP could only be suspected at the operation table and established on histopathological examination. Two patients developed recurrences at the primary site following surgery. One patient developed recurrence twice despite gross total excision of tumor in each sitting. Subsequently, this patient remained symptom free for a follow-up period of 1 year. Another patient developed recurrence 2 years following surgery, but he died due to septicemia and aspiration pneumonitis. Therefore definitive surgery could not be performed. Radiotherapy was offered to one of the patients having residual mass post operatively, to render her symptom free for a 4 year follow-up. The remaining two patients have also showed progressive improvement in their symptoms following surgery for 4 years on follow-up. Hydrocephalus was a common feature in all the cases preoperatively, but only one required shunt CSF diversion, because of rapid deterioration in visual equity. In all other cases, hydrocephalus was managed conservatively. Surgery remains the main modality of treatment for CPP, both for primary and recurrent tumors, but radiotherapy may have a role in cases of recurrence, which are quite frequent.

Adult↗
PubMed2006

Laparoscopic Roux-en-Y gastric bypass in patients with congenital malrotation.

Bariatric surgery is the only solution for morbidly obese individuals who desire to lose weight and maintain it and have failed to do so by non-surgical means. As the incidence of morbid obesity rises, laparoscopic Roux-en-Y gastric bypass (LRYGBP) is increasingly performed. With the increase in bariatrics, the chances of discovering aberrant anatomy at the operating-table also increase. We present two cases of LRYGBP in patients with intestinal malrotation, which is a congenital anomaly caused by failure of the intestines to rotate and fixate at 270 degrees during embryonic development. It occurs in one out of every 500 births in the United States, accounting for 5% of all intestinal obstructions. To this date, only three reports have been published describing the incidental finding of congenital malrotation during the initial laparoscopic exploration for gastric bypass. We found that the operation can still be performed laparoscopically in such patients, with some modifications to the standard technique.

Adult↗
PubMed1995

Risk of airborne transmission in an operating theatre containing four ultraclean air units.

This study shows that a single, large, operating theatre (barn) containing four ultraclean operating units (cabins), was highly effective in reducing the number of airborne bacteria in the operating fields providing all occupied ultraclean cabins were functioning correctly. The air flows and bacterial counts during operations within the cabins met the current standard for ultraclean systems (HTM 2025 1994) and there was no evidence of mixing of air between cabins. It is, however, recommended that air flows are regularly checked for compliance with the standard. If failure occurs in any single ultraclean unit, surgery in that cabin should cease as contaminated air may enter from the barn and surrounding cabins. Routine microbiological sampling should not be necessary providing there is no evidence of filter leakage. An operating theatre with several ultraclean operating tables in a single room would appear to be a viable proposition for the future. Considerable savings are likely in revenue costs as much of the air is reused and support services are shared.

Air Microbiology↗
PubMed1999

Robotics and systems technology for advanced endoscopic procedures: experiences in general surgery.

The advent of endoscopic techniques changed surgery in many regards. This paper intends to describe an overview about technologies to facilitate endoscopic surgery. The systems described have been developed for the use in general surgery, but an easy application also in the field of cardiac surgery seems realistic. The introduction of system technology and robotic technology enables today to design a highly ergonomic solo-surgery platform. To relief the surgeon from fatigue we developed a new chair dedicated to the functional needs of endoscopic surgery. The foot pedals for high frequency, suction and irrigation are integrated into the basis of the chair. The chair is driven by electric motors controlled with an additional foot pedal joystick to achieve the desired position in the OR. A major enhancement for endoscopic technology is the introduction of robotic technology to design assisting devices for solo-surgery and manipulators for microsurgical instrumentation. A further step in the employment of robotic technology is the design of 'master-slave manipulators' to provide the surgeon with additional degrees of freedom of instrumentation. In 1996 a first prototype of an endoscopic manipulator system. named ARTEMIS, could be used in experimental applications. The system consists of a user station (master) and an instrument station (slave). The surgeon sits at a console which integrates endoscopic monitors, communication facilities and two master devices to control the two slave arms which are mounted to the operating table. Clinical use of the system, however, will require further development in the area of slave mechanics and the control system. Finally the implementation of telecommunication technology in combination with robotic instruments will open new frontiers, such as teleconsulting, teleassistance and telemanipulation.

Equipment Design↗
PubMed1991

Ultraviolet radiation compared to an ultra-clean air enclosure. Comparison of air bacteria counts in operating rooms.

Clean air in the operating room is important during joint replacement surgery. We compared monochromatic ultraviolet radiation of 254 nm with the use of a Charnley-Howorth air enclosure by bacterial air-sampling during 113 total hip arthroplasties. Air samples were taken continuously at the edge of the wound and every 15 minutes at a site 130 cm from the operating table. We also tested the effect of occlusive clothing for all personnel. Ultraviolet light was more efficient than the ultra-clean air enclosure, and occlusive clothing on its own or in combination also produced improvement. The implications of these findings are discussed.

Air Microbiology↗
PubMedDate not supplied

Applications of robotics in surgery.

The end of the 20th century brought an increased use of computerized technology in medicine and surgery. The development of robotic surgical systems opened new approaches in general and cardiac surgery. Two leading robotic companies, Computer Motion, Inc. and Intuitive Surgical, Inc. have developed the Zeus and Da Vinci respectively, as very effective tools for surgeons to use. Both of them consist of a surgeon console, located far from the operating table, and three robotic arms, which reproduce inside the patient's body the movements performed by the surgeon at the console. The advantages of robotic surgery over laparoscopy and open surgery include: better eye-hand coordination, tremor filtration, steadiness of camera, 3-D vision, motion scale, more degrees of freedom for instruments etc. Of course, there are also some disadvantages, like the lack of tactile feedback, long time of set up, long learning curve, high cost etc. However, the advantages seem to overcome the disadvantages and more and more operations are conducted using robots. The impact of robotics in surgery is therefore very promising and in the future it will probably open even more new ways in the surgical practice and education both in Romania and across the globe.

Forecasting↗
PubMed2004

Support surfaces for pressure ulcer prevention.

BACKGROUND: Pressure ulcers (also known as bedsores, pressure sores, decubitus ulcers) are areas of localised damage to the skin and underlying tissue due to pressure, shear or friction. They are common in the elderly and immobile and costly in financial and human terms. Pressure-relieving beds, mattresses and seat cushions are widely used as aids to prevention in both institutional and non-institutional settings. OBJECTIVES: This systematic review seeks to answer the following questions: to what extent do pressure-relieving cushions, beds, mattress overlays and mattress replacements reduce the incidence of pressure ulcers compared with standard support surfaces? how effective are different pressure-relieving surfaces in preventing pressure ulcers, compared to one another? SEARCH STRATEGY: The Specialised Trials Register of the Cochrane Wounds Group (compiled from regular searches of many electronic databases including MEDLINE, CINAHL and EMBASE plus handsearching of specialist journals and conference proceedings) was searched up to January 2004, Issue 3, 2004 of the Cochrane Central Register of Controlled Trials was also searched. The reference sections of included studies were searched for further trials. SELECTION CRITERIA: Randomised controlled trials (RCTs), published or unpublished, which assessed the effectiveness of beds, mattresses, mattress overlays, and seating cushions for the prevention of pressure ulcers, in any patient group, in any setting. RCTs were eligible for inclusion if they reported an objective, clinical outcome measure such as incidence and severity of new of pressure ulcers developed. Studies which only reported proxy outcome measures such as interface pressure were excluded. DATA COLLECTION AND ANALYSIS: Trial data were extracted by one researcher and checked by a second. The results from each study are presented as relative risk for dichotomous variables. Where deemed appropriate, similar studies were pooled in a meta analysis. MAIN RESULTS: 41 RCTs were included in the review. Foam alternatives to the standard hospital foam mattress can reduce the incidence of pressure ulcers in people at risk. The relative merits of alternating and constant low pressure devices, and of the different alternating pressure devices for pressure ulcer prevention are unclear.Pressure-relieving overlays on the operating table have been shown to reduce postoperative pressure ulcer incidence, although one study indicated that an overlay resulted in adverse skin changes. One trial indicated that Australian standard medical sheepskins prevented pressure ulcers. There is insufficient evidence to draw conclusions on the value of seat cushions, limb protectors and various constant low pressure devices as pressure ulcer prevention strategies.A study of Accident & Emergency trolley overlays did not identify a reduction in pressure ulcer incidence. There are tentative indications that foot waffle heel elevators, a particular low air loss hydrotherapy mattress and an operating theatre overlay are harmful. REVIEWERS' CONCLUSIONS: In people at high risk of pressure ulcer development, consideration should be given to the use of higher specification foam mattresses rather than standard hospital foam mattresses. The relative merits of higher-tech constant low pressure and alternating pressure for prevention are unclear. Organisations might consider the use of pressure relief for high risk patients in the operating theatre, as this is associated with a reduction in post-operative incidence of pressure ulcers. Seat cushions and overlays designed for use in Accident & Emergency settings have not been adequately evaluated.

Beds↗