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At least 721 records · Page 40Linked to original sources
PubMed1996

Is there a difference? A prospective study comparing lateral and standard SMAS face lifts with extended SMAS and composite rhytidectomies.

Presented is a prospective study comparing limited SMAS (lateral SMASectomy), conventional SMAS, extended SMAS, and composite rhytidectomies. Randomized patients received either a limited SMAS or conventional SMAS face lift on one side and an extended SMAS or composite rhytidectomy on the other. All procedures were performed at Manhattan Eye, Ear and Throat Hospital in accordance with their well-defined surgical descriptions. Postoperative courses were followed clinically for at least 1 year. Photographs were taken preoperatively and at 6 and 12 months postoperatively. Photographs were reviewed by three independent experienced face lift surgeons. The study comprises 21 patients, 20 women and 1 man, with a mean age of 59 years (range 47 to 70 years). Nineteen patients underwent primary rhytidectomies; two underwent secondary face lifts. For the first 12 patients, each had an extended SMAS procedure performed on one side; on the other, 7 had a conventional SMAS and 5 had a limited SMAS (lateral SMASectomy) face lift. In the last 9 patients, a conventional SMAS was carried out on one side in 8, a limited SMAS in 1, and on the opposite side, a composite rhytidectomy was performed. Complications were few. Temporary weakness of the buccal branch of the facial nerve occurred in 2 patients on the side of the more extensive surgery. On the operating table at completion of the surgery, there was more improvement in reversal of midfacial ptosis and flattening of the nasolabial folds with both extended SMAS and composite rhytidectomies. The composite flap had the most dramatic effect on the nasolabial folds and oral commissure. After 24 hours, once swelling developed and facial motion became reactivated, the noticeable differences in the midface and nasolabial folds were lost. No discernible differences in facial halves were noted again. Differences between facial sides on the 6- and 12-month postoperative photographs were not detectable. We conclude that for routine facial plasty, comparable clinical outcomes are obtained at 6 months and 1 year with limited (lateral SMASectomy) and conventional SMAS face lifts compared with extended SMAS and composite rhytidectomies. All procedures are lacking in their improvement of midface ptosis and the nasolabial folds. The increased surgical risks, morbidity, and convalescence associated with those more extensive procedures do not seem to be warranted in the average patient.

Aged↗
PubMed1997

Intraoperatively controlled small-incision forehead and brow lift.

Placement of screws at the posterior aspect of the incision sites and the gradual placement and removal of staples behind the screws allow for a controlled and titrated elevation of the forehead and brows. This technique does require the patient's acceptance of the temporary placement of screws and staples into the scalp, which in my experience has not been a problem. By seating the patient upright on the operating table, the surgeon can intraoperatively make a direct evaluation and adjustments (removal or addition of staples). This approach leads to a more controlled elevation of the forehead and brows and the potential of a more symmetrical and satisfactory result.

Anesthesia, Local↗
PubMed1998

Influence of muscle forces on loads in internal spinal fixation devices.

STUDY DESIGN: The loads acting on an internal spinal fixation device were measured in vivo. OBJECTIVES: To determine the influence of muscle forces on implant loads. SUMMARY OF BACKGROUND DATA: Only limited information exists regarding the loads acting on spinal implants in vivo. Though the muscles greatly influence spinal load, they have been neglected in most studies. METHODS: Telemeterized internal spinal fixation devices were used to study the influence of muscle forces on the implant loads in three patients before and after anterior interbody fusion. RESULTS: Contracting abdominal or back muscles in a lying position was found to significantly increase implant loads. Hanging by the hands from wall bars as well as balancing with the hands on parallel bars reduced the implant loads compared with standing; however, hanging by the feet with the head upside down did not reduce implant loads compared with lying in a supine position. When lying on an operating table with only the foot end lowered so that the hips were bent, the patient had different load measurements in the conscious and anesthetized state before anterior interbody fusion. The anesthetized patient evidenced predominately extension moments in both fixators, whereas flexion moments were observed in the right fixator of the conscious patient. After anterior interbody fusion had occurred, the differences in implant loads resulting from anesthesia were small. CONCLUSIONS: The muscles greatly influence implant loads. They prevent an axial tensile load on the spine when part of the body weight is pulling, e.g., when the patient is hanging by his hands or feet. The implant loads may be strongly altered when the patient is under anesthesia.

Abdominal Muscles↗
PubMed2000

Radiation exposure during fluoroscopically assisted pedicle screw insertion in the lumbar spine.

STUDY DESIGN: An experimental model to assess radiation exposure during lumbar pedicle screw insertion. OBJECTIVES: To measure skin (patient) and scatter (surgeon) doses of radiation during lumbar spine fluoroscopy to assess safety of the procedure for both the surgeon and patient and determine best practice. SUMMARY OF BACKGROUND DATA: Fluoroscopy assists with accuracy of pedicle screw placement, yet the optimal technique of C-arm use and risk to both patient and operating room staff from radiation exposure are unknown. METHODS: Entry- and scatter-dose recordings were made using a digital dosimeter while screening an anthropomorphic phantom prone on a radiolucent operating table. The source was positioned both superiorly and inferiorly with the height varied in the latter orientation to create a working space under the C-arm. The senior author's fluoroscopy records were reviewed in 140 consecutive cases. RESULTS: In a series of 140 patients who underwent pedicle screw fixation, the fluoroscopy time was 1.4 minutes per case or 0.33 minutes per screw. In the source-superior position, the effective dose received by the patient was approximately 2.3 mSv per case. In the source-inferior position with a working space of 300 mm, the effective dose was 6.8 mSv. Scatter dose to the surgeon was higher in the source-superior position but was still less than 10% of recommended limits for the hand, thyroid, and eyes. CONCLUSIONS: The source-superior position is the preferred position for pedicle screw screening if a working space is required. Patient exposure is minimized, and surgeon dose is well within current recommendations.

Bone Screws↗
PubMed1998

A case of shock subsequent to treatment of intracranial hypertension by mannitol injection combined with hyperventilation.

This report describes a sudden decrease in blood pressure after conservative treatment of acute intracranial hypertension. A 63-year-old woman with acute hydrocephalus after undergoing clipping of an aneurysm of the right supracerebellar artery developed increased intracranial pressure, necessitating surgical management. On the operating table, the patient developed Cushing's reflex. Mannitol injection combined with hyperventilation was begun immediately to reduce her intracranial pressure. Fifteen minutes later, a sudden and prolonged suppression of circulation was observed (blood pressure 65/35-85/40 mmHg, heart rate 90-100 beats/min). Postoperatively, computed tomography of the head showed compression of the brain stem. We believe that this patient's blood pressure decrease was related to a sudden reduction of intracranial pressure and that mannitol injection was principally responsible for this occurrence.

Diuretics, Osmotic↗
PubMed2007

Effect of head position on postoperative chemosis after prone spinal surgery.

Conjunctival swelling is a common finding in patients positioned prone. The purpose of this study was to evaluate the effect of head position on postoperative chemosis after prone spinal surgery. On the basis of the head position, 108 patients scheduled for prone lumbar surgery were randomly allocated to 1 of 2 groups: head neutral group (n=54) versus head down (HD) group (n=54). Head position was defined as neutral when the imaginary line from the occipital protuberance to the top of C7 spine process is parallel to the operating table. HD position was maintained by adjusting the height of the prone headrest 5 cm lower than neutral position. Chemosis was evaluated after surgery. The severity of chemosis, which was graded as none, mild, moderate, and severe, showed statistically significant difference between the head neutral group [24 (44%), 25 (46%), 3 (6%), 2 (4%), respectively] and HD group [10 (19%), 23 (43%), 17 (31%), 4 (7%), respectively, P<0.01]. Positive fluid balance and duration of surgery were risk factors for the development of postoperative chemosis. This result suggested that neutral head position, smaller fluid administration, and shorter duration of surgery were useful in decreasing the development of postoperative chemosis after prone spinal surgery.

Adult↗
PubMed2005

Balloon kyphoplasty is effective in deformity correction of osteoporotic vertebral compression fractures.

STUDY DESIGN: A prospective radiographic analysis of deformity correction during the balloon kyphoplasty procedure. OBJECTIVE: To determine the spontaneous reduction of the deformity in prone position, the subsequent deformity correction by the inflatable bone tamp, and the overall deformity correction after deposition of the cement. SUMMARY OF BACKGROUND DATA: Fracture mobility has been shown to contribute to fracture reduction in vertebroplasty. Spontaneous reduction has not been taken into account in recently published series of balloon kyphoplasty, but it must be considered when performing vertebral augmentation and when reporting and interpreting the significance of vertebral height restoration. METHODS: A consecutive series of 39 osteoporotic vertebral compression fractures were treated in 30 patients. Lateral radiographs were taken and analyzed at six different time points: 1) Preoperative standing. During the kyphoplasty procedure, four consecutive radiographs were obtained: 2) after placing the patient in prone position on the operation table, 3) after inflation of the bone tamp (IBT), 4) after deflation and removal of the IBT, and 5) after deposition of the cement. 6) Standing lateral radiographs were taken after the procedure. All fractures were analyzed for improvement in sagittal alignment (Cobb angle, kyphotic angle, sagittal index, vertebral height), complications, and reduction of pain (VAS). RESULTS: Placement of the patient in prone position displayed a significant spontaneous reduction in deformity of 6.5 degrees +/- 4.1 degrees Cobb angle. Inflation of the IBT demonstrated a further reduction of the fracture and a significant improvement of the Cobb angle of 3.4 degrees compared with baseline prone. After deflation and removal of the IBT and placement of the cement, no significant loss of fracture reduction was seen. Postoperative measurement of the Cobb angle by means of standing radiographs demonstrated a 3.1 degrees significant loss of reduction compared with the intraoperative measurement in prone position after cement application. Cement leaks occurred in 9 of 39 vertebral fractures. All patients subjectively reported immediate relief of their typical fracture pain. The VAS score significantly improved from 8.7 +/- 1.4 before surgery to 2.3 +/- 0.9. CONCLUSION: The restoration of height in kyphoplasty is attributed to dynamic fracture mobility as well as to the expansion of the inserted balloon tamp.

Aged↗
PubMedDate not supplied

Anterior chamber collapse following vitreoretinal surgery with gas tamponade in aphakic eyes: incidence and risk factors.

PURPOSE: To report the risk factors associated with occurrence of anterior chamber collapse in aphakic eyes that underwent vitrectomy with gas tamponade. METHODS: A total of 314 eyes of 314 patients who underwent vitrectomy with gas tamponade and who were aphakic or were made aphakic intraoperatively were studied prospectively. Factors such as iris and pupillary integrity, depth of anterior chamber, gonioscopic grading, behavior of the anterior chamber on the operation table during fluid-air exchange, removal of crystalline lens or intraocular lens during surgery, and type of internal tamponade were noted. The anterior chamber was assessed postoperatively in supine and sitting position and with head bent forward. Statistical methods were used to identify risk factors for development of postoperative anterior chamber collapse using SPSS soft ware. RESULTS: Anterior chamber collapse occurred in 13 eyes (3.14%). Presence of preoperative shallow anterior chamber, removal of intraocular lens as a part of the procedure, occurrence of intraoperative anterior chamber collapse, and use of sulfur hexafluoride (SF6) were associated with higher risk of anterior chamber collapse postoperatively. CONCLUSIONS: The identification of potential risk factors in a given eye can alert the surgeon to the possibility of development of anterior chamber collapse postoperatively.

Adolescent↗
PubMed2004

Laparoscopic management of extra-adrenal pheochromocytoma.

PURPOSE: Laparoscopic management of extra-adrenal pheochromocytoma presents a unique surgical challenge due to variable anatomical presentation and potential catecholamine surge during operative manipulation. We report our experience with laparoscopic removal of extra-adrenal pheochromocytomas. MATERIALS AND METHODS: Between 1999 and 2002, 5 patients presented with retroperitoneal extra-adrenal pheochromocytomas. Of the patients 2 had a history of von Hippel-Lindau disease, and the remaining 3 patients were diagnosed with sporadic extra-adrenal pheochromocytoma during hypertension evaluation. Although 4 patients had a history of hypertension, only 2 reported symptoms (episodic flushing, headaches, blurred vision) associated with excess catecholamine production. All patients had markedly increased preoperative urinary and plasma normetanephrine and/or norepinephrine levels, and 3 had positive I131 metaiodobenzylguanidine scan. In each case tumor was accurately identified on computerized tomography before surgery. RESULTS: Laparoscopic resection of extra-adrenal pheochromocytoma was successful in 4 patients. Open conversion was required in 1 patient, who also had von Hippel-Lindau related bilateral adrenal pheochromocytomas due to significant adhesion of the extra-adrenal tumor to the aorta and renal hilum, and a concern for possible local invasion. Mean laparoscopic operative time and blood loss were 273 minutes (range 240 to 350) and 119 cc (range 75 to 200), respectively. Three 10 mm ports in a standard triangular fashion were used for the left side tumors, in which the tumors were found lateral to the aorta. For the right side tumors located either in the inter-aortacaval or para-caval region, a fourth port (10 mm) was inserted for liver retraction as needed. Laparoscopic ultrasound was used to localize the tumor and to assess the retroperitoneum for possible metastasis (none detected) in 3 cases. None of the patients had a hypertensive crisis intraoperatively, and all had unremarkable postoperative recovery with an average hospital stay of 3.8 days (range 3 to 4). Plasma and/or urinary norepinephrine and normetanephrine levels returned to normal range postoperatively in all cases. One patient was noted to have left lower extremity lymphedema and gluteal hematoma due to a positional injury related to prolonged pressure from the operating table and was treated conservatively. There has been no tumor recurrence at a median followup of 14 months (range 9 to 36). CONCLUSIONS: With careful surgical planning and appropriate preoperative pharmacological blockade, laparoscopic surgery can be safely performed in patients with extra-adrenal pheochromocytomas with minimal morbidity. Laparoscopic ultrasound may be helpful in precise localization and evaluation of tumor extension.

Adult↗
PubMed2005

In vivo tension sustained by fascial sling in pubovaginal sling surgery for female stress urinary incontinence.

PURPOSE: In pubovaginal sling surgery arguments have focused on selecting stronger sling materials, better suturing methods and superior fixation techniques. However, the grounding information prerequisite for these arguments is still lacking, ie the in vivo tension sustained by the sling. We designed this study to obtain this information. MATERIALS AND METHODS: A total of 10 female patients (mean age 65.4 years) underwent pubovaginal sling surgery while under epidural anesthesia. A strip of rectus fascia (2 x 6 cm) was isolated. Each end of the fascia was anchored with a 1-zero Prolene suture (Ethicon, Somerville, New Jersey). The fascial sling was placed over the proximal urethra. Both ends of the prolene (polypropylene) sutures were transferred to the lower abdominal incision and tied on each other. The fascial sling was adjusted just to touch the proximal urethra without elevating it. We hooked the tied polypropylene suture on a digital force gauge to measure the tension sustained by the fascial sling. Patients were instructed to cough, and the tension was measured at different bladder volumes (100, 200, 300, 400 ml) and in 2 positions (horizontal and operative table tilted head-up 20 degrees). Intravesical pressure was monitored with a pressure transducer to ensure adequate cough strength. We also investigated the in vitro length-tension relationship and tensile strength of 3 rectus fascia strips (0.5 x 6 cm) obtained from 3 of these patients. RESULTS: Mean tension +/- SEM sustained by the fascial sling during cough in the horizontal position was 0.046 +/- 0.004, 0.043 +/- 0.006, 0.0475 +/- 0.006 and 0.0485 +/- 0.007 kg at 100, 200, 300 and 400 ml bladder volume, respectively. Bladder volume did not statistically affect the sustained tension. The 20-degree head-up position also did not statistically change the tension sustained. In vitro study showed that the fascia strip could be stretched for a mean of 0.4 cm before sling tension began to increase. A mean load of 2.4 kg broke 0.5 x 6 cm strips. CONCLUSIONS: In the horizontal and mild tilting positions during an increase in intra-abdominal pressure, the fascial sling only sustains minor tension, which is far less than the maximal load needed to break fascial strips. The excellent elasticity of the fascia may dissipate the straining force and partly explains the measured small sustained tension.

Aged↗
PubMed2002

A micromachine high frequency ultrasound scanner using photolithographic fabrication.

In this paper we describe two new types of transducer assemblies fabricated from polyimide films with photolithography that use a polyimide micromachine (MEMS) actuator to mechanically scan an ultrasound beam. Forward viewing transducers pivoting on cantilever hinges and side scanning transducers tilting on torsion hinges were fabricated on polyimide substrates with tables 1.125 mm and 2.25 mm wide. PZT transducers fabricated on these tables operating at 20 MHz and 30 MHz yielded insertion losses of 20-26 dB and fractional bandwidths of 34-49%. The transducer assemblies driven by MEMS actuators produced sector scans of 45-60 degrees in air at resonant frequencies of 32 to 90 Hz and sector scans in fluid of 6-8 degrees. Real time images of wire phantoms were obtained using a single channel imaging system based on a personal computer platform with LabVIEW (National Instruments Corp., Austin, TX) software.

Equipment Design↗
PubMed1979

Electrocution during anaesthesia.

Cardiac arrest due to electrocution occurred in a young obstetric patient undergoing laparotomy. The patient subsequently died despite initial resuscitation. The cause was traced to an inappropriate and faulty switch in the base of the operating table; the circuit was completed by the ECG monitor which was of the direct earth type.

Adult↗
PubMed1982

An inflatable obstetric anaesthetic 'wedge'.

An inflatable 'wedge' for use in obstetric or other operations is described. As well as being inexpensive, the apparatus is remarkedly robust and has the advantage that the degree of inflation or deflation can be easily adjusted from the head of the operating table.

Anesthesia, Obstetrical↗
PubMed2005

Radial nerve injury after general anaesthesia in the lateral decubitus position.

A 43-year-old female patient underwent pyelolithotomy in the left lateral decubitus position. Her upper right arm was placed on a padded armboard. Surgery lasted for 240 min. Postoperatively, she complained of numbness of the dorsal part of her right hand and wrist drop. Neurological examination revealed hypoaesthesia of the dermatome of the right forearm and hand innervated by the radial nerve. Electromyography revealed advanced axonal degeneration of the radial nerve below the level of the elbow. Treatment with diclofenac, vitamin B and physiotherapy was started. Her symptoms improved gradually and at the 60th postoperative day, motor weakness had completely resolved. In order to prevent peri-operative nerve injury, careful positioning of every patient on the operating table with proper padding is essential, with attention paid to time-dependent risks. If an injury occurs, diagnosis and treatment should be started as rapidly as possible.

Adult↗
PubMed2006

Assessing children's emotional responses to surgery: a multidimensional approach.

AIM: This paper reports a study to assess the interrelationships between physiological measures of children's heart rates and blood pressure, subjective measures of children's level of anxiety, and direct behavioural observations in children's emotional responses to surgery. BACKGROUND: Psychological upset has been described as a multidimensional phenomenon which includes behavioural, subjective, and physiological components. However, a majority of previous studies have employed only one or two measures of psychological upset. Most importantly, the interrelationships among these three components of psychological upset have seldom been explored. METHODS: A cross-sectional design was employed, and 106 Chinese children admitted for day surgery during the summer of 2004 were invited to participate in the study. They were asked to respond to the Chinese version of the State Anxiety Scale for Children. Their mean arterial blood pressure and heart rates were recorded in the operating theatre after being transferred to the operating table but before anaesthesia induction. A research nurse used the Children's Emotional Manifestation Scale to document the children's emotional behaviours during anaesthesia induction. The data were collected in 2004. RESULTS: Children with high preoperative anxiety levels manifested more negative emotional behaviour during anaesthesia induction. Those with more negative emotional behaviour or high levels of state anxiety also had faster heart rates and higher mean arterial blood pressure. CONCLUSION: A child's response to stressful medical procedures can be varied. The emotional responses of children to surgery need to be understood as a multidimensional phenomenon. To gain a more comprehensive understanding of the effects of surgery on children, it is recommended that assessment strategies used should reflect the multidimensional phenomenon of the emotional upset.

Ambulatory Surgical Procedures↗
PubMed1983

Anatomical shape of the airway.

The shape of the standard endotracheal tube does not conform to the anatomy of the airway and this nonconformity is probably the most injurious factor of tracheal intubation. In order to measure the tube recoil deformation pressure at different points of the airway, it is necessary to know the exact shape of the airway. The contours of the airway were studied from lateral radiographs in patients lying supine on the operating table, with the neck in the normal, extended and flexed position. A computer programme calculated the anterior and posterior contours of the airway as mean values of the original contours on the radiographs as well as of seven selected anatomical points. The mean configuration of the airway in non-intubated individuals was then presented in a standard coordinate system. The "ideal" shape of the airway was subsequently designed in accordance with our results, and this shape can be used clinically as a standard for comparison in cases with suspected pathological configurations.

Adult↗
PubMed1983

The conformity of an anatomically shaped endotracheal tube to the shape of the airway.

The conformity of a pre-shaped endotracheal tube to the shape of the airway during endotracheal intubation was studied from lateral radiographs in patients lying supine on the operating table, with the neck in the normal, extended and flexed positions. A computer programme calculated the anterior contour of the pre-shaped tube and the posterior contour of the airway as mean values of the original contours on the radiographs. The mean configuration of the airway in intubated individuals with a pre-shaped endotracheal tube was then presented in a standard coordinate system. The results were compared with the shape of the airway in non-intubated patients and in patients intubated with a standard endotracheal tube.

Adult↗
PubMed1985

A new method for measuring motor block in the lower extremities.

A method for determining muscle strength in the lower extremities was developed and its clinical application evaluated in ten elderly, healthy subjects, and also subsequently in one of them during spinal anaesthesia. With the subject lying in the lithotomy position on a modified operating table, muscle strength measurements were made during flexion of the hip, extension of the knee and plantar flexion of the big toe. The electromechanical performance of the apparatus was stable, and the maximum measurement errors observed at loads of 245 and 49 N were 4 and 11% of the deflections, respectively. The subjects underwent repeated muscle strength measurements during a 4-h period without any difficulty. No signs of muscular fatigue were observed. The variation of the measured isometric muscle strength was small and the average coefficient of variation roughly 10%. In the patient receiving spinal anaesthesia, the degree of motor block was determined, and the results are presented graphically. This new method for evaluation of motor block in the lower extremities is a reliable quantitative method for bilateral, three-joint muscle strength measurements, which is also applicable during regional anaesthesia.

Aged↗