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At least 73 records · Page 4Linked to original sources
PubMed2006

Treatment of symptomatic spondyloptosis in an adult previously treated with in situ fusion and instrumentation by L5 vertebrectomy and L4-S1 instrumented reduction.

BACKGROUND CONTEXT: One traditional treatment for spondylolisthesis is fusion. However, for high-grade spondylolisthesis and spondyloptosis, posterior fusion has had high rates of nonunion, progression, and persistent physical deformity. Thus, some surgeons have recommended reduction and instrumentation. One such technique (Gaines procedure) entails a two-stage procedure: L5 vertebrectomy anteriorly, followed by resection of the L5 posterior elements and instrumented reduction of L4 onto S1. However, to our knowledge, there is no report of reversing the fusion and deformity reduction in a symptomatic patient with previous solid fusion of the spondyloptosis at L5-S1. PURPOSE: To present the first reported revision via the Gaines procedure for failed fusion secondary to spondyloptosis. STUDY DESIGN: Patient report. METHODS: A 24-year-old woman, who had undergone multiple procedures for L5-S1 spondylolisthesis and a final fusion and instrumentation attempt, presented with continued urinary retention, leg and back pain, and inability to stand. She subsequently underwent posterior hardware removal, followed by anterior L5 vertebral body resection. In the second stage, she had posterior osteotomy of the previous L5-S1 fusion, resection of the posterior elements of L5, and reduction and instrumentation of L4 to S1. RESULTS: At the 2-year follow-up, she had full resolution of symptoms, full return of motor strength, and resolution of urinary retention. CONCLUSIONS: The Gaines procedure has been performed successfully in patients without previous fusions at the level of spondylolisthesis or spondyloptosis. Patients for whom the traditional posterior fusion fails still may be candidates for this procedure, albeit at increased risk of neurologic injury.

Adult↗
PubMed1998

MAVIS: a non-invasive instrument to measure area and volume of wounds. Measurement of Area and Volume Instrument System.

Accurate measurement of the physical size of wounds is vital for assessment of the progress of healing. An instrument has been developed to measure area and volume of skin wounds, ulcers, and pressure sores. MAVIS--Measurement of Area and Volume Instrument System-is based on the principle of colour coded structured light. A set of parallel stripes of alternating colours is projected onto the wound area at an angle of approximately 45 degrees and is recorded by a CCD camera. From the known position of the focal points of projector and camera, and from the observed intersection points of the stripes of light with the wound surface, a computer calculates a three-dimensional map of the observed wound. The volume of the wound is defined as the volume of the region sandwiched between the observed surface and the original healthy skin surface which is simulated by cubic spline interpolation. This paper compares the performance of the instrument with three traditional wound measurement techniques using results obtained from a clinical trial involving 50 patients. Traditional area measurement techniques such as transparency tracings produce results with standard deviations between 4% (large wounds) and up to 20% (small wounds) of the measured mean value. MAVIS measurements reduce these standard deviations by 3-5%. Measuring the wound volume by alginate casts produces errors in volume figures between 5% and 40%. Standard deviations of MAVIS results are 5% smaller on average. The results demonstrate that MAVIS yields more reproducible results with a minimum of inter-observer error. The instrument does not make contact with the wound, provided visual records and measurements are made in less then 5 min. It is not suitable for undermined, very deep or very large wounds.

Humans↗
PubMedDate not supplied

Instrument monitoring, data sharing, and archiving using Common Instrument Middleware Architecture (CIMA).

The Common Instrument Middleware Architecture (CIMA) aims at Grid-enabling a wide range of scientific instruments and sensors to enable easy access to and sharing and storage of data produced by these instruments and sensors. This paper describes the implementation of CIMA applied to the field of single-crystal X-ray crystallography. To allow the researchers to easily view the current and past data streams from the instruments or sensors in a laboratory, a crystallography portal and associated portlets were developed for this application. The CIMA-based crystallography system provides an opportunity for anyone with Web access to observe and use crystallographic and other data from laboratories that previously had only limited access.

Journal Article↗
PubMed2003

On assessing responsiveness of health-related quality of life instruments: guidelines for instrument evaluation.

A lack of clarity exists about the definition and adequate approach for evaluating responsiveness. An overview is presented of different categories of definitions and methods used for calculating responsiveness identified through a literature search. Twenty-five definitions and 31 measures were found. When applied to a general and a disease-specific quality of life questionnaire large variation in results was observed, partly explained by different goals of existing methods. Four major issues are considered to claim the usefulness of an evaluative health-related quality of life (HRQL) instrument. Their relation with responsiveness is discussed. The confusion about responsiveness arises mostly from a lack of distinction between cross-sectional and longitudinal validity and from a lack of distinction between responsiveness defined as the effect of treatment and responsiveness defined as the correlation of changes in the instrument with changes in other measures. All measures of what is currently called responsiveness can be looked at as measures of longitudinal validity or as measures of treatment effect. The latter ones tell us little about how well the instrument serves its purpose and are only of use in interpreting score changes. We therefore argue that the concept of responsiveness can be rejected as a separate measurement property of an evaluative instrument.

Health Status Indicators↗
PubMed1999

Failed instrumental delivery: how safe is the use of a second instrument?

An audit of failed instrumental deliveries was undertaken to assess the incidence of complications and the adequacy of documentation. When one instrument has failed to effect delivery, the use of a second instrument could in most cases be used to complete the delivery without harm to the mother or baby. However in a small but significant number of cases there are severe maternal or perinatal complications, and these could be the subject of litigation. This could be avoided by adequate pre-application assessment, standard conduct of instrumental delivery and full documentation. Inadequate documentation could be overcome by the use of a pro forma. Selective use of plastic and metal cups could reduce the incidence of failed attempts.

Journal Article↗
PubMed1995

Transpedicular instrumentation and short-segment fusion of thoracolumbar fractures: a prospective study using a single instrumentation system.

Eleven patients were prospectively treated with bilateral short-segment transpedicular instrumentation using the Posterior Segment Fixator (Ace Medical Co., Los Angeles, CA, U.S.A.) construct combined with posterolateral fusion using autogenous iliac crest bone graft for the treatment of thoracolumbar vertebral fractures. All patients were evaluated clinically, radiographically, and functionally for a minimum of 2 years (mean 33 months). Four of the 11 patients (36.3%) had breakage or disengagement of the caudad screws during this interval. During the follow-up period, the angle of kyphosis increased an average of 12.9 degrees. The loss of correction was greater in those patients in whom the instrumentation failed (22 degrees) than in those patients in whom it did not (7.7 degrees). Five of the patients (45.5%) had a progressive increase in the angle of kyphosis of 10 degrees or more. At follow-up, the average loss of anterior vertebral body height for all 11 patients was 14% when compared with the body height that had been attained at surgery. Six of these patients (54.5%) had 10% or more loss of anterior body height. Despite the high incidence of failure of the instrumentation, progressive increase in the angle of kyphosis, and progressive loss of anterior vertebral body height, there was no worsening in the patients' Frankel grade postoperatively. The high rate of hardware failure and major postoperative loss of fracture reduction associated with this construct suggest that posterior short-segment pedicle-screw instrumentation with the Posterior Segment Fixator was not adequate to ensure stabilization of thoracolumbar fractures in this small group of patients. Maintenance of postoperative fracture reduction was the most consistent predictor of satisfactory functional outcome.

Adolescent↗
PubMed2004

Results of thoracoscopic instrumented fusion versus conventional posterior instrumented fusion in adolescent idiopathic scoliosis undergoing selective thoracic fusion.

STUDY DESIGN: Retrospective review of 31 consecutive female patients with adolescent idiopathic scoliosis undergoing selective thoracic fusion. OBJECTIVE: To compare safety and efficacy of two techniques in treating adolescent idiopathic scoliosis undergoing selective thoracic fusion. SUMMARY OF BACKGROUND DATA: There is paucity in the literature comparing posterior versus thoracoscopic instrumented fusion in scoliosis. METHODS: Nineteen patients (group 1) underwent posterior instrumented fusion. Twelve patients (group 2) had thoracoscopic anterior instrumented fusion. All patients had a minimum of 25 months of follow-up observation. RESULTS: Both groups were similar in terms of age at menarche and surgery. Preoperative Cobb angles in the coronal (erect and bending) and sagittal planes did not differ between the two groups. Group 1 patients had higher estimated blood loss (P = 0.006). Operative time (P < 0.001) and intensive care unit stay (P = 0.01) were longer in group 2 patients. There was no difference in parenteral analgesia requirement. There were no complications in group 1. Complications in group 2 included lobar collapse (1) and scapula winging (1). Improvement in scoliosis among group 1 patients averaged 77 (1 week), 72 (6 months), and 67% (most recent follow-up review). In group 2 patients, mean improvement in scoliosis was 66 (1 week), 62 (6 months), and 62% (most recent follow-up review). The differences between the two groups in terms of scoliosis improvement were not significant. Thoracic kyphosis (T2-T12) did not increase significantly with thoracoscopic versus posterior instrumentation. No significant change in lumbar lordosis (T12-S1) was noted with either procedure. CONCLUSIONS: The efficacy of thoracoscopic surgery was similar to standard posterior procedures. Advantages included lower intraoperative blood loss. The longer operative time and intensive care unit stay were attributed to the steep learning curve of this technique.

Adolescent↗
PubMedDate not supplied

ADCS Prevention Instrument Project: the Mail-In Cognitive Function Screening Instrument (MCFSI).

In future research on the prevention of Alzheimer Disease (AD), a large simple prevention trial might test a safe intervention (eg, vitamins) in a very large population (eg, 10,000 subjects), powered to detect a modest treatment effect size. In a large, simple design, regular assessments must be very low cost, for example, handled by mail. The Mail-In Cognitive Function Screening Instrument (MCFSI) was developed for the Alzheimer's Disease Cooperative Study Prevention Instrument Project to evaluate whether a brief mail-in screening tool can be used as a specific and sensitive trigger for a diagnostic evaluation in the course of a prevention trial. The MCFSI consists of 2 similar sets of 14 questions mailed separately to the subject and the study partner, who are asked to complete them independently. The questions are derived from a standard clinical assessment of dementia; they ask about decline in function over the last year. We are currently evaluating the utility of the instrument in 640 subjects over the course of the "simulated" AD prevention trial. Analysis of baseline data showed significant differences in mean MCFSI scores between sex and ethnic groups (for subjects), age groups (for partners), and Clinical Dementia Rating global score groups (both subject and partner). In this nondemented population, both subject's and partner's MCFSI responses were related to cognitive performance. There was no significant association between MCFSI score for either subjects or partners and apolipoprotein E genotype. The MCFSI captures information related to cognitive and functional status in nondemented elderly individuals; the Alzheimer's Disease Cooperative Study Prevention Instrument Project will determine whether this brief, mail-in questionnaire is useful as a trigger for diagnostic evaluation in an AD primary prevention trial.

Activities of Daily Living↗
PubMed2004

A novel instrument-independent no-scalpel vasectomy - a comparative study against the standard instrument-dependent no-scalpel vasectomy.

An instrument-independent no-scalpel vasectomy (IINSV) technique is reported. This technique does not use the standard specific instruments, but comparatively retains the advantages of minimally invasive instrument-dependent no-scalpel vasectomy (IDNSV). Between July 1999 and June 2002, 449 men were prospectively randomized to be vasectomized at two hospitals in Taipei. Of those who accepted, 215 underwent IDNSV at one hospital and the remaining 234 underwent IINSV at the other. The intra-operative conditions of each group were recorded. The postoperative pain and life conditions were self-reported through a questionnaire that had been carefully designed prior to the operations, in which the pain level was assessed using a 10-cm visual analogue scale under varying situations. Men vasectomized using the IINSV method experienced less operation time and postoperative complications (haematomas, infections and granulomas) (p < 0.05). There were no significant differences between the two groups with respect to incision length, postoperative pain, pain at coitus, time of return to work, time of resuming intercourse, self-reported satisfaction in sexual life, postoperative psychological status, postoperative body weight change and vasectomy failure as evidenced by sperm analysis (p > 0.05 for all items). Thus, the IINSV technique can offer an alternative option for vasectomists whenever the specific instruments of standard no-scalpel vasectomy are unavailable. The IINSV technique shortens the operation time and reduces the incidence of operative complications when compared with the IDNSV technique, while still retaining the advantages of minimally invasive vasectomy.

Adult↗
PubMed1991

Luque rod instrumentation in the treatment of adolescent idiopathic scoliosis. A comparative study with Harrington instrumentation.

Adolescent idiopathic scoliosis in 152 patients was treated by Luque L-rod instrumentation and early mobilisation without external support. This series was compared with a matched group of 156 patients treated by Harrington instrumentation and immobilised in an underarm jacket for nine months. All the operations in both groups were performed by one surgeon and the patients were followed prospectively for more than two years. Correction of the scoliosis in the frontal plane was similar in both groups. However, the normal sagittal contour was better maintained with Luque rods, especially in the thoracolumbar and lumbar regions, and provided less loss of correction than with Harrington rods. Neither method significantly derotated the scoliosis. All the patients with Luque instrumentation developed a solid fusion despite breakage of the sublaminar wires at one or two levels in 4.9%. There were no major neurological complications with either type of instrumentation.

Adolescent↗
PubMed2002

The Friedrich-Lively Instrument to Assess the Impact of Schizophrenia on Siblings (FLIISS): Part I--instrument construction.

Siblings of persons with schizophrenia may provide primary or secondary care for their sibling and support to parents who are primary care givers. These siblings experience stress and the accompanying sequelae of decreased quality of life, grief, chronic illness, and symptoms of depression and anxiety. Comprehensive measures of sibling stress have not been published. Before interventions to help siblings can be created, health professionals need such an assessment. The Friedrich-Lively Instrument to Assess the Impact of Schizophrenia on Siblings (FLIISS) has been developed to meet the needs of both health workers and siblings. The instrument has a strong conceptual basis adapted from Pearlin's model of stress in caregiving and was preceded by pilot work that evaluated both quantitative and qualitative data. In this article, (Part I), the development of the instrument and its relationships to the conceptual model are described. Health professionals can use the instrument for collecting information that will increase their ability to identify sources of stress faced by siblings of persons with schizophrenia, and from this assessment they may develop interventions for this underserved population.

Caregivers↗
PubMed1991

Hearing instruments for the elderly hearing impaired. A comparison of in-the-canal and behind-the-ear hearing instruments in first-time users.

The purpose of this investigation was to compare negative and positive experiences between two matched groups of elderly first-time users of hearing instruments (HI). One group had been supplied with behind-the-ear hearing instruments (BTE), the other with in-the-canal hearing instruments (ITC). There were 20 persons in each group. All were visited in their homes. Those who needed extra help were offered follow-up at the Hearing Centre. ITC were found to be superior to BTE as regards time-of-use, operational difficulties and undesirable sound experiences. ITC were also used in more difficult listening situations. Successful instruction and follow-up was more easily achieved with ITC users than with BTE users. ITC are recommended as the preferred instrument for elderly first-time HI users, at least for hearing losses not exceeding 60 dB PTA, provided the subject's dexterity and anatomical conditions permit fitting of ITC.

Acoustic Stimulation↗
PubMed2005

[Comparison of instrumented posterior fusion with instrumented circumferential lumbar fusion in the treatment of lumbar stenosis with low degree lumbar spondylolisthesis].

OBJECTIVE: To compare and evaluate instrumented posterior fusion with instrumented circumferential lumbar fusion in the treatment of lumbar stenosis with low degree lumbar spondylolisthesis. METHODS: From April 1998 to April 2003, 45 patients who suffered from lumbar stenosis with low degree lumbar spondylolisthesis were divided into 2 groups (A and B) at random. The patients in group A (n = 24, average age 54 years old) were performed decompressive laminectomy, intertransverse process arthrodesis with bone grafting and transpedicle instrumentation of solid connection (SOCON) system. The patients in group B (n = 21, average age 53 years old) were performed the same procedure as group A except adding posterior lumbar interbody fusion (PROSPACE). The main levels of lumbar spondylolisthesis in 2 groups was L(4 - 5) or L(5)-S(1). All cases were classified as degree 1 to degree 2. All patients in the two groups received preoperative myelography or CTM, and were diagnosed lateral recess stenosis and(or) central lumbar canal stenosis. RESULTS: All the patients were followed up from 12 to 72 months. In group A, the results showed that the preoperative clinical symptoms disappeared completely in 12 of 24 patients, pain relief was seen in 91.7% (22/24), anatomical reduction rate was 91.7%. No infection or neurologic complication occurred in this series. In group B, the results showed that the preoperative clinical symptoms disappeared completely in 13 of 21 patients, pain relief was seen in 90.5% (19/21), anatomical reduction rate was 95.2%. Four cases of infection or neurologic complication occurred in this series. Two groups had no significant difference in follow-up clinical outcome and anatomical reduction rate. But group A had better intraoperative circumstances and postoperative outcome than group B, group B had better postoperative parameters in X-ray of angle of slipping and disc index than group A. CONCLUSIONS: The best surgical treatment method of lumbar stenosis with low degree lumbar spondylolisthesis is complete intraoperative decompressive laminectomy, reduction with excellent transpedicle system instrumentation and solid fusion after bone grafting. The use of cage should be conformed to strict indications.

Adolescent↗
PubMed1977

[Virucidal efficacy of a chemical instrument surface disinfectant ("Gigasept") against coxsackie virus type B3. II. Investigation in the instrumental surface test (author's transl)].

The virucidal efficacy of the chemical disinfectant "Gigasept" on the basis of succine dialdehyde and formaldehyde was tested with an instrumental surface test which was elaborated for the control of instrument-surface disinfectants. These must be able to inactivate viruses on plastics, rubber and metal. Therefore, PVC tubes, PVC dental suction tubes, red rubber catheter and aluminium surfaces were included in this investigation. Coxsackie virus type B3 served as test virus. The surfaces were coated with liquid virus suspensions with the exemption of the aluminium surface which was contaminated with a gelatinous virus suspension. The instrumental surface test procedure enabled not only the analysis of the specific virucidal effect but also the evaluation of the unspecific virus adsorption onto the surface as well as the unspecific virus resuspension from the surface. Parameter for the disinfectant activity was the virus inactivation kinetic, i.e. the interdependence of the titer reduction vs. disinfectant contact time of a 5% solution of "Gigasept". An optimal disinfection must gain absence of virus, a titer reduction of larger than or equal to 103ID 50 and a significant titer decrease of p less than 0.0001. According to these criteria an optimal disinfection was achieved with a 5% Gigasept concentration after 4 hours. The different surfaces did not influence the virucidal activity of the disinfectant. The results of the instrumental surface tests confirmed those of the suspension test.

Disinfectants↗
PubMed2006

Shaping ability and safety of five different rotary nickel-titanium instruments compared with stainless steel hand instrumentation in simulated curved root canals.

OBJECTIVE: To compare the shaping ability and safety of engine-driven FlexMaster, GT Rotary, ProFile, ProTaper, and RaCe rotary instrumentation and Hedström hand instrumentation in simulated root canals. STUDY DESIGN: One hundred fifty simulated colored root canals with a curvature of 20 degrees and a radius of 10 mm were randomly distributed among 6 groups of 25 specimens each. After preparation to apical size 30 the area of remaining color on the canal wall indicating unprepared areas was measured in mm2 using image analyzer software. RESULTS: Specimens treated with RaCe left least areas of remaining color compared to all other groups (P < .001), followed by ProTaper. Preparation with ProFile left behind the highest amount of unprepared areas. The ProFile group revealed significantly more remaining color than ProTaper, GT Rotary, and FlexMaster (P < .05). Four FlexMaster files separated. CONCLUSION: RaCe rotary files were safe and more effective compared to the other instruments.

Dental Alloys↗
PubMed1997

Canal wall planning by engine-driven nickel-titanium instruments, compared with stainless-steel hand instrumentation.

Twenty-two mesial roots of extracted human mandibular molars were divided into two groups based on root curvature and length. The mesiolingual canals were instrumented using either Flexofiles in a step-back anticurvature filing method, or they were instrumented with engine-driven 0.02 taper nickel-titanium files. Ground sections were prepared at 1-, 2.5-, and 5-mm levels from the working length. The mesiobuccal canal was used as an uninstrumented control for predentin character. Digitizing software was used to calculate the instrumented portion as a percentage of the total canal perimeter. The results indicated no significant difference in overall canal wall planning between the two groups and no significant difference at each of the three levels.

Dental Instruments↗
PubMed2000

The history of thoracic surgical instruments and instrumentation.

Thoracic surgical practice has evolved from the innovations of its pioneers. Beginning with the stethoscope discovered by Laënnec with his system of auscultation, to the tools we use in the dissection and control of the hilum of the lung for resection, our practice of thoracic surgery has been entwined with the development of instruments and instrumentation. The development of strategies to prevent death from the open pneumothorax began with manual control of the mediastinum and progressed through differential pressure to, finally, the technique of intubation and the methods of positive-pressure and insufflation anesthesia. The instruments we place in our hands are not enough to define our art. Entry into the chest would not be possible without the use of rib retractors, rib shears, and even periosteal elevators. Finally, to the present day of minimally invasive techniques and the application of thoracoscopy for therapeutic purposes, we find the efforts of our predecessors well developed. For the progression from the fear of the open pneumothorax to the present-day state of the ease of thoracotomy for lung resection we are indebted to those who gave so much of their time and, for some, their lives to death from tuberculosis, to allow the advancement of our practice of surgery. These great people should be remembered not only for their acceptance of novel ideas but also, more importantly, for their lack of fear of testing them.

Endoscopes↗
PubMed2005

[Surgical instruments (II). An introduction to surgical instruments].

In clinical practice, there are many diverse ways to name each instrument. Some names consist of local terms related to the shape or the use of an instrument; others have their origin in confusing references; few of these names tend to be related to known nomenclature. This causes a serious inconvenience for someone who wishes to learn about the intra-surgical medium in an organized manner. Undoubtedly this is an inconvenience for the untrained person who discovers he/she is incapable of retaining an enormous volume of names, often presented without any logic whatsoever This also causes an inconvenience for the trained professional; it is difficult to understand terms since, depending on which surgical ward one refers to, the name for the same instrument changes.

Humans↗