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PubMed1976

Noninvasive prevention of thrombosis of deep veins of the thigh using intermittent pneumatic compression.

Intermitten venous compression promotes cyclic emptying and refilling of the veins and sinuses of the legs. It prevents stasis and formation of thrombi while the patient is on the operating table and during recovery. Once the patient is ambulatory, the system is discontinued. While the system is in use, thromboelastography, venous impedance plethysmography and venography, when indicated, are used to monitor the system. The intermittent pneumatic compression system is safe, simple and practical to use for almost all patients. There was no evidence of deep vein thrombosis or pulmonary embolism in 123 patients, as determined by an absence of clinical signs, a negative impedance plethysmogram and a negative venogram.

Adult↗
PubMed1996

PatSim--simulator for practising anaesthesia and intensive care. Development and observations.

Simulators may be used in training personnel for the situations when consequences of inappropriate action could be dangerous or expensive. Mishaps and accidents in connection with the use of biomedical instrumentation are frequently a result of technical malfunction and improper use of the equipment. In the medical field, however, use of simulators is not very common. This paper reports our experiences of a development project to design the "PatSim' hands-on simulator for training anaesthesia and intensive care personnel. The simulator consists of a manikin positioned on an operation table or in a typical critical care bed. The manikin, which is controlled by a standard personal computer (PC), can be ventilated by an anaesthesia machine or a ventilator, intravenous pumps can also be connected. Any standard electrodes and transducers can be used to pick up parameters, like ECG, invasive and non-invasive blood pressure, airway pressure and CO2. Data can be displayed on any monitor or workstation. There is no need for modification or special adaptation of the medical equipment used in the simulation scenario. The manikin is capable of spontaneous breathing. Controlled from the PC, different clinical signs can be developed. In addition, typical clinical symptoms can be created during the simulated treatment period. They include laryngospasm, change of lung compliance or airway resistance, pneumothorax, leakage of the intubation tube cuff, blocking of the breathing sounds from one lung, secretion, gastric regurgitation and diuresis. During a simulation session, the trainee should be exposed to a lifelike situation. Hence, we place the manikin in a room that resembles either intensive care or operating room environment.

Algorithms↗
PubMed2001

Short-term impact of corticosteroids on hyaluronan and epithelial hyperplasia in the rabbit cornea after photorefractive keratectomy.

PURPOSE: To investigate the impact of corticosteroids on subepithelial hyaluronan deposition and corneal epithelium thickness in the first 10 days after photorefractive keratectomy (PRK) and to analyze a possible contralateral effect of corticosteroids. METHODS: Thirty-two New Zealand white rabbits were assigned into two groups and had a transepithelial 5.0-mm diameter, 8.00-diopter myopic PRK performed on one eye. The corticosteroid treatment group (16 animals) received 0.1 mL of methylprednisolone 4% subconjunctivally on the operation table, followed by 0.1% dexamethasone eye drops six times a day during the postoperative period. The sodium chloride (NaCl) treatment group received topical isotonic NaCl eye drops six times a day. In each treatment group, eight animals were killed after 3 and 9 days, respectively. The harvested specimens were stained for hyaluronan and the epithelial thickness was measured. RESULTS: In contrast to the epithelial thickness, the subepithelial hyaluronan did not show a significant increase during the observation period. The corticosteroid treated group showed at both time-points significantly less subepithelial hyaluronan formation as well as a significantly thinner epithelium, when compared with the NaCl-treated group. At 9 days, the corticosteroid-treated group showed a mild epithelial hyperplasia in only one of eight eyes, whereas this was a common finding in the NaCl-treated group. We detected no hyaluronan deposits in any contralateral-untreated eye, and the epithelial thickness did not differ significantly between any of the four contralateral-untreated eye groups. CONCLUSIONS: Corticosteroid medication during the first 10 days after operation reduces the amount of subepithelial hyaluronan production and inhibits the epithelial proliferation, and epithelial hyperplasia is prevented. Neither a contralateral hyaluronan deposition nor a contralateral corticosteroid effect could be detected.

Administration, Topical↗
PubMed1998

[Cranioplasty with polymethylmethacrylate. The clinico-statistical considerations].

BACKGROUND: The main purpose of the reconstruction of the cranium is the protection of the brain. Besides we have to consider important functional and aesthetic necessities in order to achieve satisfactory results. METHODS: Thirty-six clinical cases, operated from November 1991 to June 1996, in which the reconstruction of the cranial vault is carried out by a polymethylmethacrylate acrylic resin are analysed. The causes and locations of the most common bone defects and the main indications for reconstruction are examined. While the repair of the osseous gaps caused by neoplasms is immediate, in the traumatic occurrences, in order to reduce the probability of infectious complications, an average time of 11 months elapsed from the first operation. The surgical technique, with slightest alterations, is the same in all the presented cases, preparing the acrylic resin straight on the operating table. The resin, moulded and adapted to the defect until its complete hardening, presents, thanks to its properties, manifold advantages (and few real disadvantages). RESULTS: The results, in terms of complications, are very satisfactory, with an infectious rate of 2.7%. Besides, in one third of the patients, a considerable clinical improvement after the repair has been observed. CONCLUSIONS: According to personal experience, it is possible to affirm that polymethylmethacrylate, with its remarkable plasticity and stability in time, can always guarantee a satisfactory functional and aesthetic result.

Adolescent↗
PubMed1995

Lifting and handling of patients by anaesthetists.

The process of transferring patients from the operating table was assessed in a district general hospital. The survey was conducted in two parts; a confidential questionnaire was sent to all members of the department and a month long assessment of three anaesthetists' caseload was undertaken. All the anaesthetists questioned had scanty knowledge of the relevant manual handling regulations. Although 70% of anaesthetists questioned lift and transfer patients on a regular basis, none had received any relevant training. Ninety-six percent of patient transfers were performed by two staff alone, even though there were five or more staff available to assist at 95% of transfers. Difficulty in transferring patients occurred in 32% of cases. Improvement of training anaesthetists in safe manual handling procedures is recommended.

Anesthesiology↗
PubMed2003

Vessel-based non-rigid registration of MR/CT and 3D ultrasound for navigation in liver surgery.

OBJECTIVE: Computer assisted planning of liver surgery based on preoperative computed tomography (CT) or magnetic resonance imaging (MRI) data can be an important aid to operability decisions and visualization of individual patients' 3D anatomy. A navigation system based on intraoperative 3D ultrasound may help the surgeon to precisely localize vessels, vascular territories or tumors. The preoperative planning must be transferred to the intraoperative ultrasound data and thus to the patient on the operating table. Due to deformations of the liver between planning and surgery, a fast non-rigid registration method is needed. MATERIALS AND METHODS: A feature-based non-rigid registration approach based on the centerlines of the portal veins has been developed. The combination of an iterative closest point (ICP) approach and Multilevel B-Spline transformations offers a fast registration method. The vessels are segmented and their centerlines extracted from preoperative CT/MRI and intraoperative 3D Powerdoppler ultrasound data. Anatomical corresponding points on the centerlines of both modalities are determined in each iteration of the ICP algorithm. The search for corresponding points is restricted to a given search radius and the direction of the vessels is incorporated. RESULTS: The algorithm has been evaluated on two transcutaneous and one intraoperative clinical ultrasound data set from three different patients. Only a very few vessel segments were not assigned correctly compared to manual assignments. Using non-rigid transformations improved the root mean square target registration error of the vessels by approximately 3-5 mm. CONCLUSIONS: The proposed registration method is fast enough for clinical application in liver surgery. Initial accuracy results are promising and must be further evaluated, particularly in the operating room.

Algorithms↗
PubMed2005

Mini skin incision for carotid endarterectomy (CEA): a new and safe alternative to the standard approach.

PURPOSE: Patients requiring surgery are naturally attracted to shorter incisions because they tend to cause less pain and are esthetically more appeasing. To substantially shorten the length of standard skin incisions (4 to 7 inches) for carotid endarterectomy (CEA), we used preoperative duplex scanning to outline the carotid bifurcation as well as to determine the extent of disease in both the internal and common carotid arteries. METHODS: During the last 21 months, 265 consecutive primary CEAs were performed in 253 patients (mean age 72 +/- 10 years) at a single institution. Of these, 142 were men (56%). Hypertension, coronary artery disease, diabetes mellitus, smoking, and chronic renal failure were present in 81%, 44%, 43%, 28%, and 19% of the patients, respectively. Neurologically asymptomatic patients accounted for 71% of the cases. All patients received general anesthesia. Duplex-assisted skin markings of the diseased carotid artery were performed after proper patient positioning on the operating table. Synthetic patches were routinely used, and intraluminal shunts were deemed necessary by low stump pressures in 64 cases (24%). Completion duplex scanning was performed in all cases. RESULTS: The length of the longitudinal skin incision varied from 0.8 to 3.5 inches (average 1.4 +/- 0.5 inches). It was < or = 1 inch in 56 cases (21%), 1.1 to 1.5 inches in 110 (42%), 1.6 to 2 inches in 85 (32%), and 2.1 to 3.5 inches in the remaining 14 cases (5%). Intraluminal shunts were required in 9 (16%), 18 (16%), 29 (34%), and 8 (57%) of the cases, respectively. Incisions were longer in cases requiring an indwelling shunt (1.6 +/- 0.6 inches vs 1.4 +/- 0.4 inches) (P < .0001). The average patch length was 1.3 +/- 0.3 inches (range, 0.7 to 2.6 inches). The skin incision averaged 1.54 +/- 0.45 inches for the first 133 cases and 1.35 +/- 0.45 inches for the remaining 132 cases (P < .0001). Technical defects occurred in 10 cases (3.8%). The overall incidence of ipsilateral stroke and death was 1.9% and 0%. There were no technical defects or strokes in patients with the shortest incisions (< or = 1 inch). Overall, there were three transitory peripheral nerve injuries (1.1%). A comparative analysis with 265 consecutive CEAs performed immediately before this series without duplex-assisted skin markings revealed no significant differences in age (71 +/- 11 years), incidence of neurologically symptomatic patients (26%), sex (60% men), shunt use (24%), and major technical defects (3%). Also, postoperative transitory peripheral nerve injury (0.8%), stroke (0%), and death (0%) were not significantly different from the duplex-assisted group. It is of interest to note that none of the former cases was performed with a skin incision < or = 2 inches. CONCLUSION: Most CEAs (95%) can safely be performed with < or = 2-inch skin incisions. Pre-CEA duplex-assisted skin marking is a novel approach that confirms the side of the operation, localizes the disease, and minimizes the magnitude of the operation via shorter, more esthetically pleasing incisions.

Aged↗
PubMed2003

Shutting down operating theater ventilation when the theater is not in use: infection control and environmental aspects.

OBJECTIVE: In hospital operating rooms (ORs), specially conditioned air is supplied to protect patients from airborne agents that may cause infections. This study investigated whether it is hygienically safe to shut down the air supply at night if measures are taken to ensure a timely restart before surgery is performed. DESIGN: Experimental study. SETTING: Neurosurgical OR of a German university hospital. METHODS: The ventilation system was switched off and restarted after 10 hours. Particles suspended in the air near the operating table were counted, OR temperature was measured, and settle plates were exposed and incubated. RESULTS: In 13 investigations, a median of 1.3 x 10(4) particles 0.5 microm/m3 or greater (range, 5.8 x 10(3) to 1.1 x 10(5)) were documented immediately after restart in the morning. After 10 minutes and subsequently, no test showed a particle count exceeding the threshold limit of 1.0 x 10(4) particles 0.5 microm/m3 or greater recommended by the German Society of Hygiene and Microbiology. Only a few colony-forming units (CFU) were detected per settle plate (median, 0 CFU/60 cm2; range, 0 to 8) and OR temperatures quickly reached normal levels. CONCLUSIONS: Shutting down OR ventilation during off-duty periods does not appear to result in an unacceptably high particle count or microbial contamination of the OR air shortly after the system is restarted. Because substantial energy and cost savings are likely, this should be considered in hygienically safe heating, ventilation, and air conditioning systems. However, normal ventilation should be established at least 30 minutes before surgical activity.

Academic Medical Centers↗
PubMed2000

Injuries to the lateral femoral cutaneous nerve during spine surgery.

STUDY DESIGN: A prospective study to locate patients with injured lateral femoral cutaneous nerve after elective spine surgery. OBJECTIVES: To assess the prevalence of injury of the lateral femoral cutaneous nerve and to identify the cause of injury according to the position of the patients at surgery and the surgical approach. SUMMARY OF BACKGROUND DATA: Injuries to the lateral femoral cutaneous nerve, also known as meralgia paresthetica, may cause pain and therefore result in restriction of activity. Compression of the nerve by disc hernia, retroperitoneal tumors, and external pressure around the anterior superior iliac spine are among the more common causes. METHODS: One hundred five patients admitted for elective spine procedures were grouped according to position on the operating table and surgical approach. All patients were examined before and after surgery for signs of injury to the lateral femoral cutaneous nerve, and those found injured were followed up for 1 year after surgery. RESULTS: Injury to the lateral femoral cutaneous nerve was found in 21 (20%) patients. In 6 of them, all of whom underwent surgery on the Hall-Relton frame, the injury was bilateral. In 7 patients the injury was not associated with discomfort. In addition to injury by external pressure at the anterior superior iliac spine from the Hall-Relton frame, the nerve was also injured at the retroperitoneum by hematoma or traction and at the anterior iliac crest when bone was harvested. In 89% of the patients, the nerve completely recovered within 3 months of surgery. Two patients still had pain 1 year after surgery and hypoesthesia of the anterolateral thigh. CONCLUSION: Injuries to the lateral femoral cutaneous nerve during spine surgery are frequent, and patients should be informed of the possible risk. It usually has a benign course, but some preventive steps should be taken: keep posterior to the anterior superior iliac spine and minimize retraction when harvesting a bone graft, pad the posts of the Hall-Relton frame over the anterior superior iliac crest, and avoid traction on the psoas muscle during the retroperitoneal dissection.

Age Distribution↗
PubMed1976

Retinal tears 180 degrees and greater. Management with vitrectomy and intravitreal gas.

A new technique for the treatment of giant retinal dialysis of 180 degrees or more has been devised. After the lens and vitreous have been removed via the pars plana, the patient is rotated into a prone position on a special operating table. The retina is unfolded by filling the eye completely with gas and is held in place by gas. The patient is then brought back into the normal supine position, and a scleral encircling procedure is added. The initial success rate of reattachment is 12 out of 14 cases. Afterward, many eyes develop massive periretinal proliferation. After six months or more of follow-up, the retina remained attached in six of 14 cases.

Electrocoagulation↗
PubMed1980

Support and air supply tube for vitreous surgery.

A metallic tube is attached to the operating table or wrist rest, acts as a support for the assistant's hand, and provides free air flow during vitreous surgery while the patient is under local anesthesia.

Humans↗
PubMed1975

Competency test after fundoplication for treatment of reflux esophagitis.

A simple competency test has been devised that will establish the adequacy of a Nissen fundoplication at the operating table. Saline, 250 ml, is instilled into the stomach through a nasogastric tube and then the nasogastric tube is withdrawn to above the level of plication. The pylorus is occluded and the stomach compressed. If the cardia is competent, no saline can be aspirated from the esophagus. Ten patients studied immediately after the opening of the abdomen showed regurgitation by this test, whereas no regurgitation could be produced in 30 patients studied immediately after completion of the fundoplication.

Esophagogastric Junction↗
PubMed2006

Preventing pressure ulcers: a systematic review.

CONTEXT: Pressure ulcers are common in a variety of patient settings and are associated with adverse health outcomes and high treatment costs. OBJECTIVE: To systematically review the evidence examining interventions to prevent pressure ulcers. DATA SOURCES AND STUDY SELECTION: MEDLINE, EMBASE, and CINAHL (from inception through June 2006) and Cochrane databases (through issue 1, 2006) were searched to identify relevant randomized controlled trials (RCTs). UMI Proquest Digital Dissertations, ISI Web of Science, and Cambridge Scientific Abstracts were also searched. All searches used the terms pressure ulcer, pressure sore, decubitus, bedsore, prevention, prophylactic, reduction, randomized, and clinical trials. Bibliographies of identified articles were further reviewed. DATA SYNTHESIS: Fifty-nine RCTs were selected. Interventions assessed in these studies were grouped into 3 categories, ie, those addressing impairments in mobility, nutrition, or skin health. Methodological quality for the RCTs was variable and generally suboptimal. Effective strategies that addressed impaired mobility included the use of support surfaces, mattress overlays on operating tables, and specialized foam and specialized sheepskin overlays. While repositioning is a mainstay in most pressure ulcer prevention protocols, there is insufficient evidence to recommend specific turning regimens for patients with impaired mobility. In patients with nutritional impairments, dietary supplements may be beneficial. The incremental benefit of specific topical agents over simple moisturizers for patients with impaired skin health is unclear. CONCLUSIONS: Given current evidence, using support surfaces, repositioning the patient, optimizing nutritional status, and moisturizing sacral skin are appropriate strategies to prevent pressure ulcers. Although a number of RCTs have evaluated preventive strategies for pressure ulcers, many of them had important methodological limitations. There is a need for well-designed RCTs that follow standard criteria for reporting nonpharmacological interventions and that provide data on cost-effectiveness for these interventions.

Bedding and Linens↗
PubMed1976

Pelvic exenterative therapy for gynecologic malignancy: an analysis of 70 cases.

During the 10-year period from June 1, 1965 to June 1, 1975 70 patients with gynecologic malignancy were treated with some type of pelvic exenteration at the University of Michigan Medical Center. Total pelvic exenteration was performed in over 75% of the cases. The most recent figures suggest a 3-year and 5-year survival rate of over 60%. The surgical mortality is 1.4%: the hospital mortality is 1.4%. Those patients with squamous cell disease, such as recurrent carcinoma of the cervix, vagina or vulva, have a better prognosis than do those patients with gland cell disease. Regional lymph node involvement gives a bad prognosis. Advances in therapeutic techniques during this 10-year period, including: 1) use of prophylactic antibiotics: 2) transverse abdominal incision; 3) so-called "ski-position" on the operating table; 4) prophylactic compartmentalization of the inferior vena cava; 5) uretero-sigmoid conduit for urinary diversion; 6) peritoneal graft as a "lid" over the pelvic vault' and 7) split-thickness skin graft vaginoplasty as part of the rehabilitation program, are discussed.

Female↗
PubMed1994

Intraperitoneal thermochemotherapy for prevention of peritoneal recurrence of gastric cancer. Final results of a randomized controlled study.

BACKGROUND: Continuous hyperthermic peritoneal perfusion (CHPP) with a solution that contained 10 micrograms/ml mitomycin C was devised initially as a method for intraperitoneal thermochemotherapy. The authors conducted a randomized clinical trial to evaluate the efficacy of CHPP as a prophylactic treatment for prevention of peritoneal recurrence of gastric cancer with serosal invasion. METHODS: Between January 1983 and October 1986, 82 patients with gross serosal invasion but no gross peritoneal metastasis were divided by random sampling into two groups before undergoing potentially curative surgery for gastric cancer: 42 patients were scheduled to receive CHPP, whereas 40 were not scheduled to receive this treatment. CHPP was administered immediately after closing the abdomen after gastric resections while the patients were still on the operating table under general anesthesia. RESULTS: The 5-year survival rate (64.2%) of patients in the CHPP group was higher than that (52.5%) of patients in the control group although the difference was not significant. Of several patterns of cancer recurrence, peritoneal recurrence was more frequent in the control group than in the CHPP group. The mortality rate from peritoneal recurrence in the case of patients in the CHPP group was much lower than that of patients in the control group (P = 0.0854). CHPP did not induce anastomotic breakdown or chemical peritonitis after surgery. CONCLUSIONS: The results indicate that CHPP is effective in preventing peritoneal recurrence of gastric cancer with serosal invasion, which is highly likely to reappear in the peritoneum.

Aged↗
PubMed1975

Immediate operative fitting of upper limb prosthesis at the time of amputation.

Three patients are described--2 with an above-elbow amputation and 1 with a through-wrist amputation--in whom a temporary prosthesis was applied on the operating table and in all of whom function was rapidly established. The patients did not become one-handed, with the result that they have all continued to wear their prosthesis throughout their working hours and use their artificial hand for all everday functions. The value of this technique in making the patient accept the prosthesis and therefore to make full use of it suggests that this procedure should be more widely applied in patients who require upper limb amputation.

Adult↗
PubMed1988

Surgical approaches to vertebral artery injuries.

Twenty patients with penetrating injuries of the vertebral artery who were treated as emergencies were subjected to the following operative approaches: five cases, Henry's approach (posterior) and modified Henry's approach (anterior); five cases, limited exposure and application of metal clips; four cases, plugging of the arterial defect with Oxycell or crushed muscle; three cases, control with ligatures and non-conventional exposure of the artery; one case, inflation of a balloon catheter within the vertebral canal; one case, repair of the lacerated first extraosseous part of the vertebral artery. One patient died from exsanguination on the operating table, before any repair was possible. The overall mortality was 20 per cent and the mean hospital stay 6.1 days. Thirty-five per cent of the patients presented with neurological complications, and 55 per cent left the hospital well. No advantage of Henry's classical approach over limited exposure and control with metal clips was shown, when mortality, hospital stay and long-term problems were compared. Because of its relative simplicity we suggest that the metal clipping of the vertebral artery, above and below the site of injury, is an effective technique that can be used to stop the bleeding. One case presented as a false aneurysm of the vertebral artery, following a stab wound. This was successfully treated with excision of the aneurysm and vertebrovertebral artery bypass, using a saphenous vein graft.

Adult↗
PubMed1987

Double-chambered right ventricle with pulmonary valve endocarditis.

A rare case of isolated pulmonary valve endocarditis associated with a double-chambered right ventricle in a nonaddict, was diagnosed on two-dimensional echocardiography and cardiac catheterization and angiography. The patient was successfully operated and the above findings confirmed on the operation table.

Cardiac Catheterization↗