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At least 649 records · Page 36Linked to original sources
PubMed2003

A new, non-contact wide field viewing system for vitreous surgery.

PURPOSE: To report a new, noncontact wide field viewing system for vitreoretinal surgery. DESIGN: Device description: A noncontact wide field viewing system consisting of adjustable hinged arm and a combined condensing lens and reinverting prism has been developed. The arm clamps onto the operating table or wrist rest and holds the lens system in the air above the eye. METHODS: For vitreoretinal surgery, a new, relatively inexpensive noncontact wide field viewing system consisting of an adjustable hinged arm and a combined condensing lens and reinverting prism has been developed. The combination condensing lens and reinverting prism is used without a microscope-mounted inverter. The optical component may be sterilized with ethylene oxide, peracetic acid, or glutaraldehyde. Other components may be steam autoclaved. RESULTS: The new, noncontact wide field viewing system has been used satisfactorily in more than 200 vitrectomies at seven medical centers. It provides an excellent view of the vitreous and retina. CONCLUSION: A new, noncontact wide field viewing system for vitreoretinal surgery has been developed with satisfactory image quality and a field of view comparable to contemporary noncontact panoramic viewing systems.

Equipment Design↗
PubMed1978

A new headrest for ophthalmic microsurgery.

We designed and successfully used a new headrest for ophthalmic microsurgery. The symmetrical instrument has a U-shaped frame and is designed to be clamped to an operating table as a projecting extension. The headrest has been satisfactory for patients having either general or local anesthesia, and particularly useful for vitreous surgery with the Zeiss Mark VI microscope; this headrest gives excellent control over the visual field and eliminates all extraneous movement.

Humans↗
PubMed2001

Does patient position during liver surgery influence the risk of venous air embolism?

BACKGROUND: It is generally believed that positioning of the patient in a head-down tilt (Trendelenberg position) decreases the likelihood of a venous air embolism during liver resection. METHODS: The physiological effect of variation in horizontal attitude on central and hepatic venous pressure was measured in 10 patients during liver surgery. Hemodynamic indices were recorded with the operating table in the horizontal, 20 degrees head-up and 20 degrees head-down positions. RESULTS: There was no demonstrable pressure gradient between the hepatic and central venous levels in any of the positions. The absolute pressures did, however, vary in a predictable way, being highest in the head-down and lowest during head-up tilt. However, on no occasion was a negative intraluminal pressure recorded. CONCLUSION: The effect on venous pressures caused by the change in patient positioning alone during liver surgery does not affect the risk of venous air embolism.

Adult↗
PubMed2003

Additional right parasternal incision without thoracotomy provides alternative access for hepatic resection.

BACKGROUND: Although hepatic resections are performed with various access approaches according to the location of the tumor, the extent of resection and patient's physical constitution, the exposure of the root of the hepatic veins is not optimal in some patients by any conventional incision. METHODS: An additional 5 cm of right parasternal skin incision followed by division of two costal cartilages was performed in 8 patients, which demonstrated poor exposure of the upper part of the liver by abdominal incision. RESULTS: In all cases, satisfactory exposure of the operative area was obtained without thoracotomy, and hepatic resection procedure was carried out without significant events. CONCLUSIONS: This simple technique without necessitating rotation of the operating table may be useful as an alternative method of access to the liver especially when fine isolation around the root of the hepatic veins is required.

Blood Loss, Surgical↗
PubMed2002

[Bilateral compartment syndrome after colorectal surgery in the lithotomy position].

Lower limb compartment syndrome is an unusual but severe complication of prolonged surgery more than four hours in lithotomy position. It is usually a consequence of hypoperfusion of the lower extremities and muscle necrosis may occur. Several risk factors are pointed out: trendelenburg, the hardness of operating table, hypothermia, control hypotension, occlusion of arterial blood flow of the lower extremity, arteritis (and smoking), diabetes, obesity, arterial hypertension, myopathy and an important muscle mass. The symptoms are postoperative pain with neurological signs. A rapid diagnosis and aggressive management (i.e. resuscitation and aponevrotomy) is recommended. Neurological sequelae are sometimes invalidating. Reporting a case of bilateral syndrome, we reviewed the literature and describe the present diagnosis and therapeutic management as well as prevention modalities of this iatrogenic complication.

Adenocarcinoma↗
PubMed2003

Cerebral cortical oxygenation changes during OPCAB surgery.

BACKGROUND: We investigated the changes occurring in cerebral cortical oxygenation during off-pump coronary artery bypass (OPCAB) surgery using near infrared spectroscopy (NIRS). METHODS: Measurement of cerebral cortical oxygenation changes included concentration of deoxygenated hemoglobin [HHb], oxygenated hemoglobin [O(2)Hb], changes in the redox status of the cytochrome c oxidase [Cyt-Ox], cerebral saturation as expressed by the tissue oxygenation index (TOI), and cerebral blood volume (CBV) as expressed by tissue hemoglobin index (THI). Measurements were performed in 23 consecutive patients during grafting of: left anterior descending (LAD setup 1; n = 23), posterior descending (PDA setup 2; n = 17), and Circumflex (Cx setup 3; n = 19) coronary arteries. Measurements were performed before any surgical manipulation (baseline), following positioning of the pressure stabilizer during construction of the distal anastomosis and 2 minutes after the completion of each distal anastomosis with the heart returned to its natural position. RESULTS: There were no in-hospital deaths, neurologic deficits, or myocardial infarcts. Compared to baseline, during LAD grafting there was a marked reduction in [O(2)Hb] [-1.08 (-1.77 to -0.39), mean difference (95% CI) (p < 0.0008)], without a significant change in [HHb]. There was also a 4% reduction in cerebral saturation and a 3% fall in CBV (both p < 0.05). Setup 2 (PDA) was associated with a marked decrease of [O(2)Hb] [-1.92 (-2.95 to -0.88) mean difference (95% CI) (p < 0.0025)], which was accompanied by an increase in [HHb] [1.89 (1.00 to 2.77) mean difference (95% CI) (p < 0.0025)], and a 4% reduction in cerebral saturation (p < 0.0008). Grafting of the Cx was associated with a marked increase in [HHb] [2.85 (1.46 to 4.2) mean difference (95% CI) (p < 0.0025)], with no changes in [O(2)Hb], a 6% reduction in cerebral saturation, and a 12% increase in CBV (both p < 0.05). In all 3 settings, however, the changes were not associated with a modification in the redox state of [Cyt-Ox]. On returning to baseline condition, the changes in [O(2)Hb] and TOI observed in setup 1 persisted, and a significant reduction was observed in the redox state of the [Cyt-Ox] when compared with baseline [-0.08 (-0.14 to -0.02) mean difference (95% CI) (p < 0.002)]. For setups 2 and 3 there was recovery of the cerebral cortical oxygenation. CONCLUSIONS: Grafting of the LAD on the beating heart is responsible for changes in cerebral cortical oxygenation which persist early after returning the heart to its natural position. Grafting of the Cx and PDA result in transient reversible changes. Trendelenburg positioning and right lateral tilting of the operating table during grafting of lateral and posterior walls might have a protective role in preventing cerebral cortical ischemia. Further studies are needed to assess the clinical importance of these observations.

Aged↗
PubMed1980

Intraoperative fine needle aspiration biopsy of thoracic lesions.

Forty-one intraoperative fine needle aspiration biopsies were performed on 35 patients during exploratory thoracotomy (33 patients) or mediastinoscopy (2 patients). Each biopsy was done with a 22 gauge needle. Smears were prepared at the operating table, air-dried, sent directly to the laboratory, stained, and interpreted immediately by the pathologist. Preparation and reporting time averaged ten minutes. Surgical decisions were made on the basis of the pathologist's reports. Intraoperative fine needle aspiration biopsy was 100% accurate in differentiating inflammatory from neoplastic lesions. Ninety-five percent diagnostic accuracy for malignancy (39 out of 41 specimens) was obtained. It permitted quick biopsy of lesions deep within the lung parenchyma without the need to cut across uninvolved tissue, thus permitting appropriate resection in each patient. There were no deaths related to the procedure.

Adenocarcinoma↗
PubMed1981

The choice of operation for bronchial carcinoids.

In a review of the literature, 1,392 patients with bronchial carcinoids were found. Of these, there were 313 patients for whom individual data with regard to type of operation, follow-up period, and outcome were given. Actuarial curves for proportions of patients who had not died of the disease or who had not undergone reoperation for residual disease were constructed for each type of operation. The prognosis up to 20 years after surgical treatment for bronchial carcinoids is excellent. For 15 to 20 years postoperatively, the prognosis after a lobectomy is excellent and after a pneumonectomy, slightly worse. The prognosis after a lung parenchyma-saving operation (wedge or segmental resection and bronchoplastic procedures) is similar to that after a lobectomy up to 7 years postoperatively. After that, the proportion of disease-free patients declines precipitously. At 20 years the difference in comparison with a lobectomy is statistically significant for both wedge or segmental resections and bronchoplastic procedures. Parenchyma-saving operations cannot therefore be said to be radical. A policy for decision-making at the operating table is formulated.

Actuarial Analysis↗
PubMed1998

Off-pump coronary bypass grafting: how to use the Octopus Tissue Stabilizer.

Off-pump coronary artery bypass grafting requires immobilization of the coronary artery. A suction device (Octopus Tissue Stabilizer), attached to the epicardium and connected rigidly to the operating table rail, was used through limited and full surgical access for single-vessel and multivessel arterial revascularization, respectively. An outline for its application, as used by us to construct 122 anastomoses in 70 patients, including posterior wall grafting (in 9 patients) and sequential grafting on the anterior wall (in 17 patients), is presented.

Anastomosis, Surgical↗
PubMed2000

Intraoperative SSEP detection of ulnar nerve compression or ischemia in an obese patient: a unique complication associated with a specialized spinal retraction system.

OBJECTIVE: To report a case of peripheral nerve compression caused by a specialized spinal retraction system, the Thompson-Farley retractor system, that most likely would not have been detected without intraoperative monitoring of the ulnar nerve. DESIGN: Bilateral median and peroneal nerve somatosensory evoked potentials (SSEPs) were monitored continuously during a C5 corpectomy, as was core body temperature. RESULTS: Within minutes after cervical soft-tissue retraction, the left ulnar nerve SSEP began to decline in amplitude. Peroneal nerve SSEPs were normal throughout the surgery; core body temperature remained at 36 degrees +/- 0.2 degrees C. After much effort to reposition the patient, the SSEPs returned to baseline and the Thompson-Farley system was replaced by a self-retracting system. CONCLUSIONS: To our knowledge, this is the first report of peripheral nerve compression caused by the Thompson-Farley retractor system. Even with careful positioning on the operating table, obese patients may be particularly at risk for upper arm compression. Continuous monitoring of SSEPs is suggested to prevent postoperative morbidity.

Diskectomy↗
PubMed1997

Diaphragmatic injuries.

A 6-year series of 26 patients with diaphragmatic injury is presented, 15 with rupture from blunt injuries and 11 after penetrating injuries. All had associated injuries and seven died because of these. The diagnosis may be difficult and was consequently delayed in two patients. Eleven ruptured diaphragms were diagnosed before operation, 14 on the operating table and one at autopsy (dead on arrival). Herniation of abdominal organs was seen in nine of 15 patients after blunt injuries. In most patients repair was via laparotomy using absorbable sutures. It is still essential that the surgeon should be aware of the possibility of the diagnosis and the associated severe injuries.

Accidents, Traffic↗
PubMed1998

Management of displaced femoral neck fractures in young adults (a group at risk).

25 young adults (age 15-50 years) with femoral neck fractures were operated on an ordinary operating table, using a Watson-Jones approach. Open reduction of the fracture site through an anterior capsular incision was performed and fixation with three cancellous screws was done. Patients were regularly assessed for clinical and radiological evidence of non-union and avascular necrosis. Average follow-up was 32 months. Non-union was seen in one case (4 per cent) and evidence of avascular necrosis was seen in three cases (12 per cent). The results were compared with available published series of similar fractures, treated by closed and open reduction technique. The comparison showed that in young adults, primary open reduction and internal fixation of femoral neck fractures can be recommended as the treatment of choice.

Adolescent↗
PubMed1996

Safe ex vivo coronary angiography with isosmotic contrast agent.

Plain-film coronary angiography of the cardiac explant on the operating table should be considered when conventional cardiac catheterization is desired but unavailable. We compared the effects of three contrast solutions on cold-preserved, isolated guinea pig hearts. Hearts were excised, perfused for 30 minutes, and arrested with Plegisol solution at 7 degree C. Twenty minutes after arrest, experimental hearts were perfused with one of three solutions: hyperosmolar Hexabrix solution (n = 6), hyperosmolar Renografin-76 solution (n = 6), or diluted, isosmotic Omnipaque solution (n = 8). The hearts were flushed with cold Plegisol solution 5 minutes later. Control hearts received no contrast during arrest (n = 9). The hearts were reperfused after 1 hour of arrest, and coronary blood flow (in millimeters per minute), left ventricular developed pressure (in millimeters of mercury), and rate of developed pressure (in millimeters of mercury per second) were measured. Endothelium-dependent smooth muscle relaxation to bradykinin administration and endothelium-independent relaxation to sodium nitroprusside administration were also assessed. No significant difference in myocardial or endothelial function was noted between control hearts and hearts perfused with Omnipaque solution. Hearts perfused with Renografin solution or Hexabrix solution, however, were found to have significantly impaired endothelial and myocardial function. We conclude that an isosmotic contrast solution should be used for ex vivo coronary angiography in cold-preserved hearts to avoid impairment of endothelial and myocardial function.

Animals↗
PubMed2000

Migration of an intraspinal schwannoma documented by intraoperative ultrasound: case report.

BACKGROUND: Tumors of the cauda equina may shift with positioning on the operating table. Accurate localization at surgery is important to facilitate appropriate laminectomy and durotomy. CASE DESCRIPTION: We report a case of a 28-year-old man with a schwannoma of the cauda equina at L4 on preoperative MRI. Intraoperative ultrasound revealed that the tumor had migrated cephalad, and was now located at L3. CONCLUSION: Intraoperative ultrasound is a valuable technique in localization of tumors of the cauda equina.

Adult↗
PubMed2002

Arm-down Concorde position: a technical note.

BACKGROUND: When the surgeon's approach is from behind the patient's shoulder via the infratentorial supracerebellar approach in the prone position (Concorde position), the patient's shoulder nearest the surgeon occasionally interferes with the visual route and surgical manipulation. To avoid this difficulty the author developed a modified Concorde position. METHODS: In the prone position, the patient's arm at the surgeon's side hangs down over the head end of the operating table, with elbow flexion supported by an arm-holder. CONCLUSIONS: This arm-down Concorde position provides good access for the surgeon in muscular- or broad-shouldered, short-necked, or obese patients.

Arm↗
PubMed1998

The pathophysiology of UPJ obstruction. Current concepts.

It took more than half of a century for urologists to recognize that hydronephrosis is not necessarily equivalent to obstruction. Keeping this important truism in mind, particularly when dealing with antenatal hydronephrosis, one must also remember that hydronephrosis is not a normal condition. It is conceivable that although the initial intrinsic stenosis or ureterovascular obstruction may not be clinically significant in terms of renal functional damage, as compensatory renal pelvic dilatation develops, secondary obstructive elements may be recruited to create an insertional anomaly and peripelvic fibrosis. The individual types of UPJ obstruction that are seen in diagnostic studies or on the operating table may represent isolated "snapshots" of evolving pathophysiologic processes. If this is true, patients with asymptomatic congenital hydronephrosis, although lacking obvious renal function loss, require long-term follow-up.

Humans↗
PubMed2000

Reconstruction and navigation system for intraoperative brachytherapy using the flab technique for colorectal tumor bed irradiation.

PURPOSE: To present the development of a new navigation and reconstruction system based on an electromagnetic free-hand tracker and on CT imaging for treatment planning of intraoperative high-dose-rate brachytherapy (IORT-HDRB) in the sacral region. Our aim is to improve accuracy and to enable individualized treatment planning and dose documentation to be performed for IORT-HDRB using a flab technique. METHODS AND MATERIALS: The material consists of an electromagnetic 3D tracker system, a PC workstation with Microsoft Windows NT 4.0 operating system, and a recognition program for continuous speech. In addition, we designed an external reference system constructed of titanium and Perspex, which is positioned in the pelvis, and a special digitizer pen for reconstruction of the flab geometry. The flab design incorporates a series of silicon 10-mm-diameter spherical pellets. Measurements were made with a pelvic phantom in order to study the accuracy of the system. The reconstruction results are stored and can be exported via network or floppy to our different treatment planning systems. RESULTS: Our results for the reconstruction of a flab with six catheters and a total of 100 spherical pellets give mean errors in the range (2.5 +/- 0.6) mm to (3.5 +/- 0.8) mm depending on the positions of the pelvic phantom and transmitter relative to the operation table. These errors are calculated by comparing the reconstruction results of our system with those using a CT-based reconstruction of the flab geometry. For the accuracy of the navigation system for the pelvic phantom, we obtained mean errors in the range (2.2 +/- 0.7) mm to (3. 1 +/- 1.0) mm. CONCLUSIONS: The new system we have developed enables navigation and reconstruction within the surgical environment with a clinically acceptable level of accuracy. It offers the possibility of individualized treatment planning and effective documentation of the 3D dose distribution in IORT-HDRB using a flab technique.

Brachytherapy↗