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At least 685 records · Page 38Linked to original sources
PubMed2003

Bacterial adhesion on titanium nitride-coated and uncoated implants: an in vivo human study.

Titanium nitride (TiN) has been used in many fields as a surgical instrument coating that makes the surgical materials more resistant to wear and corrosion. The aim of the present study was an in vivo evaluation of the bacterial adhesion to TiN-coated (test) and uncoated (control) titanium implants. Six patients aged between 21 and 25 years and in excellent systemic health participated in the study. All of the participants gave their informed consent. The participants were selected on the basis of good periodontal health and no signs of mouth breathing. In each of the 6 participants, a removable acrylic device was adapted to the molar-premolar region of each quadrant of the jaws. One 4 x 13 mm titanium implant was glued to the buccal aspect of each device. The plasma spray covered 11.5 mm of the body of the implant, whereas the neck was machined titanium. Test implants were glued to the right devices and control implants were glued to the left devices. After 24 hours, the implants were removed from each device and processed for scanning electron microscopy for evaluation of the machined portion of the implant covered by bacteria. A total of 24 implants were used in this study, 12 test and 12 control. Surface characterization of the machined portion of the neck of the implant was performed on an additional 10 implants (5 test and 5 control). On test implants the implant surface covered by bacteria was significantly lower compared with that of control implants (P = .0001). The surface roughness was similar in both groups. TiN surfaces showed a significant reduction of the presence of bacteria, and this fact could probably be important in the decrease of the inflammation of the peri-implant soft tissues.

Adult↗
PubMed2000

Is it possible to resterilize disposable laparoscopy trocars in a hospital setting?

Nosocomial infections associated with interventional procedures have been attributed to improper decontamination of instruments. Disinfection of solid laparoscopic instruments, such as telescopes, by 2% glutaraldehyde and ethylene oxide was shown to be effective in preventing infection transmission. However, instrument design in more complex surgical instruments may hamper the quality of disinfection. The aim of this study is to investigate the safety of hospital disinfection of disposable laparoscopic instruments with a relatively more complex design. A total of 40 laparoscopic trocars were divided into two equal groups: group 1 was contaminated with bacteria and yeast, and group 2 was contaminated with the hepatitis B virus. Each group was then divided to two equal subgroups. After disinfecting subgroup A with 2% glutaraldehyde and B with ethylene oxide, samples were obtained for bacterial cultures and for virus detection using polymerase chain reaction (PCR). Bacterial and yeast cultures were positive in three instruments in group 1A and in two instruments in group 1B. Tests results for the hepatitis B virus were negative in group 2A, but positive in group 2B. Results of this study indicate that disinfection for multiple use of disposable laparoscopic instruments with a relatively complex structure is not effective and may result in nosocomial disease transmission by bacteria, fungi, and viruses.

Cross Infection↗
PubMedDate not supplied

Infected nonunion of the humerus.

Eight patients with infected nonunion of the humerus were treated surgically by removal of the instrumentation, surgical debridement or wide resection of the fracture site and stabilization in compression with an external fixator. A monoaxial external fixator was used in 5 patients, a circular external one in 3. The amount of time between trauma and treatment described was a mean of 13 months. Consolidation occurred in all of the patients after an average of 5.5 months. Long-term follow-up was obtained after a mean of 18 months (minimum 14, maximum 35). There was postoperative paralysis of the radial nerve in 2 of the cases, with complete recovery after 3 months. One case consolidated despite the persistence of a fistula.

Adult↗
PubMed2002

Intramedullary epidermoid cyst: preoperative diagnosis and surgical management after MRI introduction. Case report and updating of the literature.

Many patients with spinal tumours of developmental origin do not receive preoperative diagnosis and the surgical management, especially as for capsule resection, is often unplanned. Like other uncommon tumours, the intramedullary epidermoid cyst is often an operative or histological finding. Since magnetic resonance imaging (MRI) introduction, evidence has accumulated that they may be preoperatively suspected. In reporting the case of a young patient with a T3-T4 intramedullary epidermoid cyst, the authors present an overview of the clinical, radiological and surgical aspects of such tumors and review the latest literature in which MRI and microsurgical excision were performed. Despite the introduction of new diagnostic and surgical instrumentation, the preoperative diagnosis and surgical management of such tumours need further discussion.

Adult↗
PubMed1992

[Morphofunctional characteristics of wound inflicted by an ultrasonic destroyer].

A surgical model of EstoRex ultrasound destroyer operating at a frequency of 60 KHz, power of 6 W, and vibration amplitude at the tip of the tool of 15 microns was used to make incisions on rat liver. 5 to 7 s or 24 hr after surgery the specimens of the wound wall were fixed and further processed for electron microscopy and histochemical visualization of glucose-6-phosphatase at the ultrastructural level. In a separate series 2 mm-thick strips of the tissue were excised from the liver, processed by the destroyer for 45 s, and then exposed to a digestion treatment with mixture of trypsin and chymotrypsin for 24 hr at 37 degrees C or in solution of cathepsin L for 60 hr at 25 degrees C. The results showed that ultrasound caused not only thermal but also nonthermal ultrastructural and histochemical alterations, due probably to cavitation and viscous stresses. The ultrasound wound did not contain any proteolytically resistant material. Since ultrasound-processed tissue turned out to be highly susceptible to proteolytic digestion we suggest that the ultrasound destroyer, unlike Nd:YAG laser surgical instrument, would be a promising surgical tool with respect to wound cleaning and healing.

Animals↗
PubMedDate not supplied

Endoscopic management of failed frontal sinus obliteration.

BACKGROUND: Frontal sinus obliteration (FSO) traditionally has represented the final stage in the algorithm for difficult to manage frontal sinus disease. In addition, FSO has been used in selected cases of frontal sinus trauma. However, this procedure has been associated with failure in 5-10% of cases. Advances in surgical instrumentation and image-guided surgical navigation have permitted endoscopic management of these failures. METHODS: Eleven patients presenting with failure of a previously performed FSO were managed endoscopically with the assistance of image-guided surgical navigation. RESULTS: Initial frontal sinus pathology included chronic inflammatory disease in six patients and frontal sinus trauma in two patients. Two patients underwent obliteration after neurosurgical frontal craniotomy and one patient underwent obliteration after curettage of a frontal sinus ossifying fibroma. Frontal sinuses were obliterated with fat in eight cases, bone chips in two cases, and bone cement in one case. The mean time interval to FSO failure was 11.1 years (range, 4 months-35 years). The etiology of failure included mucocele in eight patients, chronic frontal sinusitis in two patients, and Pott's puffy tumor in one patient. All 11 patients were managed endoscopically, of which 3 patients underwent a trans-septal frontal sinusotomy. Two patients required revision endoscopic surgery, but all were patent at last follow-up (mean, 14.8 months). CONCLUSION: Endoscopic management of failed FSO may be performed safely. These approaches are viable alternatives to open revision procedures in the management of failed FSO.

Adult↗
PubMed1988

Iatrogenic instrumentation-induced plastic surgical referrals.

Iatrogenic instrument-induced injuries are presented. Most mistakes or accidents are preventable. Some are trivial and do not come to the patient's attention, while others can cause injury resulting in pain, disfigurement, prolonged hospitalization, and possibly even death. The major strides made in the field of surgery to today's level of sophistication are to a large extent the result of vast technological advancements that have been made. It behooves the user of this surgical equipment to follow the simplest precautionary rules of operation and to be completely au fait with the workings of the equipment. In this way, many injuries can be prevented. In many cases, the surgeon must bear the ultimate responsibility for injury.

Adult↗
PubMed1997

Ophthalmic instrumentation.

The instruments utilized in ophthalmic surgery are described along with their intended uses. The sterilization and storage of surgical instruments are also discussed. To guide the surgeon in the selection of instruments, examples of instrument packs are included.

Animals↗
PubMed1997

Management of flatback and related kyphotic decompensation syndromes.

STUDY DESIGN: The authors, in this retrospective study, examined a group of patients with flatback syndrome and a related kyphotic decompensation syndrome. Results of nonrealignment treatment as well as revision surgery with sagittal realignment were reviewed. OBJECTIVES: To determine effectiveness of physical therapy and limited surgical (instrumentation removal) as well as major realignment surgical treatment in the sagittally malaligned spine. SUMMARY OF BACKGROUND DATA: Flatback is a sagittal plane deformity associated with distraction instrumentation for scoliosis correction. Kyphotic decompensation syndrome involves malaligned fusions from the sacrum for disease other than scoliosis. Several studies describe surgical realignment for flatback involving instrumentation systems no longer commonly applied. Guidelines for a systematic approach to flatback and kyphotic decompensation syndromes are lacking. METHODS: Forty-eight patients with flatback and kyphotic decompensation syndromes were reviewed. Treatment groups were defined by treatment approach and level of previous fusion. Effectiveness of treatment was reviewed in terms of radiographic sagittal alignment and self-reported pain. RESULTS: Twenty patients were treated without realignment revision surgery. Twenty-eight patients were treated with anterior and posterior osteotomies and realignment with instrumentation. For patients originally fused to the sacrum, realignment averaged 12 cm. Pain was reduced from 7 to 3 (10-point scale). In patients fused to L4 or L5, realignment averaged 7 cm. Pain was reduced from 6 to 2. Magnetic resonance imaging revealed viable caudal discs in four patients who were consequently spared extension of fusion to the sacrum. CONCLUSIONS: Treatment without realignment surgery demonstrated long-term success in 27% of cases. The latter all had two intact discs below the previous fusion and sagittal malalignment less than 4 cm. Realignment surgery effectively reduced pain in patients failing a conservative approach.

Adolescent↗
PubMed2003

Joseph-Frédéric-Benoît Charrière: master cutler and instrument designer.

Modern surgery owes its development to the innovations and skill of those craftsmen in the early 19th Century. Joseph-Frédéric-Benoît Charrière was a Parisian Cutler of renowned fame. He pioneered many developments in ether administration, urologic and other general surgical instrumentation. He also made profound modifications to the syringe, haemostat and aneurysm clip. Charrière, most importantly, developed the French (Fr) or Charrière (Ch) gauge system used in sizing catheters and endoscopic equipment (1 Charr. = 0.333 mm). His contributions were widespread and are still evident today.

Anesthesia↗
PubMed1978

Instrumentation for placement of vitreous carbon endosseous implants.

The instruments required for placement, stabilization, and restoration of vitreous carbon endosseous implants are conventional in character and readily available. With the exception of extra-long burs for socket preparation, all instruments are normally available in dental offices. The surgery instruments should be rigorously sterilized prior to use, including the dental handpiece, burs, suction tip, etc. Gas sterilization techniques provide an effective means of sterilizing the surgical instruments without causing corrosion of burs and the handpiece.

Alveolar Process↗
PubMed2004

Total laparoscopic hysterectomy using multifunction grasping, coagulating, and cutting forceps.

We describe the use of multifunction grasping, coagulating, and cutting forceps in total laparoscopic hysterectomy (LH) and compare surgery time, estimated blood loss, and costs for a series of 123 LH performed by the principal author at one of two community hospitals in Seattle between January 2001 and July 2002. The first 73 were performed using bipolar Kleppinger forceps (Richard Wolf Instruments, Vernon Hills, Illinois), endoscopic scissors (Karl Storz Endovision, Charlton, Massachusetts), and a monopolar spatula electrode (Jarit Surgical Instruments, Hawthorne, New York); the last 50 cases were performed using the PlasmaKinetic (PK) (Gyrus Medical, Maple Grove, Minnesota) multifunction cutting forceps and the monopolar spatula electrode. We were able to compare patient data in two surgery categories: LH alone (43 patients, 26 using the Kleppinger forceps and endoscopic scissors, 17 using the PK system), and laparoscopic hysterectomy with bilateral salpingo-oopherectomy (30 patients, 20 using Kleppinger forceps and endoscopic scissors, 10 using the PK system). In the remaining 50 cases, the addition of other secondary procedures precluded effective statistical comparisons. We found significantly lower estimated blood loss in both surgery categories when using the PK cutting forceps, but no differences in mean surgery time. Costs for disposable instrumentation parts and handling were approximately 70 dollars greater per procedure with the PK system. Using the PK cutting forceps eliminated some instrument exchanges and the requirement for a third instrument cannula. We also noted significantly less plume, quicker coagulation, and less tissue char when coagulating with the PK forceps compared to the Kleppinger forceps.

Adult↗
PubMed2006

Methods to minimize the risks of Creutzfeldt-Jakob disease transmission by surgical procedures: where to set the standard?

New prion-related disorders have emerged over the past 20 years, of which the most notable in the human context is variant Creutzfeldt-Jakob disease (CJD). This disorder is a challenge to medical and public health professionals seeking early detection and diagnosis, provision of therapy, and support for persons affected and a better understanding of transmission risks. The risk of iatrogenic transmission of the disease remains a significant threat, given the well documented cases of CJD transmission via surgery, organ transplantation, and blood transfusion. This review discusses our current understanding of the prevalence of variant CJD, the distribution of tissue infectivity, and new methods for the decontamination of surgical instruments. A comparison of emerging technologies is provided on the basis of our current perception of surgical risk to identify methods that are likely to provide sufficient safety margins and to stimulate debate about the standards needed to protect against variant CJD and CJD transmission.

Blood Transfusion↗
PubMed1997

Video-assisted thoracoscopic operation for interruption of patent ductus arteriosus in adults.

BACKGROUND: Patent ductus arteriosus (PDA) is a frequent congenital heart disease encountered in premature neonates, infants, and children. Video-assisted endoscopic techniques have been used in PDA interruption since 1993. Almost all the experiences are in pediatric patients. Applications in adults with PDA have been limited. METHODS: We report our experience of video-assisted thoracoscopic surgical ligation of PDA in adults. From August 1995 to January 1996, 60 patients with PDA were operated on with a video-assisted thoracoscopic technique. Twelve adults were identified with mean age of 30 years (range, 20 to 57 years). With the patient under general anesthesia and double-lumen endotracheal intubation, two 5-mm holes were made in the left lateral chest wall. Another 4-cm incision was made in the left third intercostal space for manipulation, dissection, and ligation. Conventional surgical instruments were used except an endoscopic grasper and an endoscopic tube that connected to a video camera. The surgical procedure was viewed on a video screen. Transesophageal echocardiography was used for monitoring during PDA ligation. RESULTS: All patients had successful ligation of the PDA. There was no surgical mortality, but there was one morbidity; transient recurrent nerve injury, which recovered 3 months later. Ten patients were extubated in operative room and 2 patients were extubated 2 hours after the operation. Tube thoracostomy was performed in the first 2 cases; it was omitted thereafter. No patients needed narcotic to control chest pain. Postoperative follow-up by echocardiography showed faint ductal flow in 1 patient without any murmur. All patients were discharged within 3 days after the operation. CONCLUSIONS: Our experience suggests that with refinement of instruments and surgical technique, video-assisted thoracoscopic surgical ligation can be safely applied not only in pediatric patients, but also in adults with PDA.

Adult↗
PubMed1990

Rapid instrument sterilization.

A rapid dry heat sterilization system has been found to be an effective alternative to other popular methods for assuring instrument sterility. Unpackaged instruments can be sterilized in as little as 6 minutes. This system would be of particular value to the dermatologist who performs a minimal amount of surgery or maintains only a small inventory of surgical instruments.

Dermatology↗
PubMed2004

The chain saw--a Scottish invention.

The prototype of the chain saw familiar today in the timber industry was pioneered in the late 18th Century by two Scottish docors, John Aitken and James Jeffray, for symphysiotomy and excision of diseased bone respectively. The chain hand saw, a fine serrated link chain which cut on the concave side, was invented around 1783-1785. It was illustrated in Aitken's Principles of Midwifery or Puerperal Medicine (1785) and used by him in his dissecting room. Jeffray claimed to have conceived the idea of the chain saw independently about that time but it was 1790 before he was able to have it produced. In 1806, Jeffray published Cases of the Excision of Carious Joints by H. Park and P. F. Moreau with Observations by James Jeffray M.D.. In this communication he translated Moreau's paper of 1803. Park andMoreau described successful excision of diseased joints, particularly the knee and elbow. Jeffray explained that the chain saw would allow a smaller wound and protect the adjacent neurovascular bundle. While a heroic concept, symphysiotomy had too many complications for most obstetricians but Jeffray's ideas became accepted, especially after the development of anaesthetics. Mechanised versions of the chain saw were developed but in the later 19th Century, it was superseded in surgey by the Gigli twisted wire saw. For much of the 19th Century, however, the chain saw was a useful surgical instrument.

Amputation, Surgical↗
PubMed1984

Variation in disposable corneal trephine sharpness.

During a recent corneal transplantation procedure, it was discovered that the disposable corneal trephine being used was dull; it would not even penetrate Bowman's layer of the recipient cornea. In contrast, the replacement trephine was sharp. The appreciable variation of trephine sharpness was confirmed by scanning electron microscopy. The consequences of poor quality in an ophthalmic surgical instrument are discussed.

Corneal Transplantation↗
PubMed2005

A flexible endoscopic surgical system: first report on a conceptual design of the system validated by experiments.

BACKGROUND: Surgery is a standard diagnostic and therapeutic procedure. However, its technical difficulty and invasiveness pose problems that are yet to be solved even by current surgical robots. Flexible endoscopes can access regions deep inside the body with less invasiveness than surgical approaches. Conceptually, this ability can be a solution to some of the surgical problems. METHODS: A flexible (surgical) endoscopic surgical system was developed consisting of an outer and two inner endoscopes introduced through two larger working channels of the outer endoscope. The concept of the system as a surgical instrument was assessed by animal experiments. RESULTS: Gastric mucosa of the swine could be successfully resected using the flexible endoscopic surgical system, thereby showing us the prospect and directions for further development of the system. CONCLUSION: The concept of a flexible endoscopic surgical system is considered to offer some solutions for problems in surgery.

Animals↗