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PubMed2001

The role of multimedia interactive programs in training for laparoscopic procedures.

BACKGROUND: The application of minimally invasive techniques to the performance of abdominal surgery by general surgeons has been perhaps the greatest advance in the history of general surgery. The safe adoption of many of these procedures, however, has been hampered by significant obstacles, mainly due to the problem of providing adequate training for surgeons. Outside of animal and cadaver labs, most training has been didactic in nature, and adoption rates after completion of these courses are discouraging. Multimedia interactive training has been used in a number of high-tech industries with great success. A >60% improvement in the learning curve after multimedia interactive training, as compared to traditional didactic training, has been reported. Multimedia interactive training programs for surgeons that use content and input from multiple experts in laparoscopic procedures have now been developed. METHODS: Residents from a general surgery residency program who used these programs were asked to rate their effectiveness in increasing their knowledge and comfort level prior to their participation in a real procedure as the primary surgeon or first assistant. A comparison to other traditional training techniques was also made. Eleven residents completed 41 programs designed to teach one of five different laparoscopic procedures-cholecystectomy, fundoplication, appendectomy, colon resection, or hernia repair. RESULTS: On a scale of 1 to 10, with 10 being the highest, the residents reported that the multimedia interactive training programs raised their knowledge level of the procedure from 6.0 to 8.7 (+2.7 point value increase after using the multimedia interactive program). The programs increased their comfort level when actually called on to perform or assist with the procedure from 5.3 to 8.1 (+2.8 point value increase after using the multimedia interactive program). In comparing the value of training methods for learning laparoscopic procedures, the residents rated text, lectures, videos, and animal labs at 4.7, 5.1, 6.0 and 7.3, respectively. By comparison, the residents rated the multimedia interactive training program at 8.8. CONCLUSION: The use of multimedia interactive training programs in addition to current laparoscopic training courses may help to increase the safe adoption of laparoscopic procedures. These programs may be a beneficial adjunct to residency training programs.

Adult↗
PubMed2004

Merit of the cuff-shaving procedure in children with chronic infection.

Catheter replacement and cuff-shaving are per-formed as a surgical treatment against tunnel infection(TI) in patients on chronic peritoneal dialysis. The efficacy of catheter replacement is well established, but that of cuff-shaving is not. For the purpose of evaluating the efficacy of cuff-shaving, we compared the time interval between each procedure and subsequent TI. In order to perform this comparison, we reviewed data from 32 cuff-shaving procedures and 29 catheter replacement procedures at Tokyo Metropolitan Kiyose Children's Hospital in the period from 1 March 1991 to 1 May 2001, retrospectively. There was no significant difference in the time interval between each procedure and subsequent TI(P=0.284). The incidence of recurrence was no more than 12.5% for the cuff-shaving procedures. The incidence of peritonitis due to post-surgery TI with the cuff-shaving procedures was 9.3% and 6.8% with the replacement procedure (P=0.725). There was no significant variation in time interval to post-cuff-shaving TI according to the reason for the cuff-shaving procedure. In conclusion,cuff-shaving may be worth considering for TI in adequately selected patients.

Adolescent↗
PubMed2003

Moyamoya disease and Moyamoya syndrome: experience in Europe; choice of revascularisation procedures.

OBJECTIVES: To present our clinical experience in terms of disease presentation and choice of revascularisation procedure in our first group of 23 European Moyamoya angiopathy (disease and syndrome) patients. METHOD AND PATIENT SELECTION: Twenty three patients were diagnosed and treated from 1997-2001 in our neurosurgical department. All patients underwent preoperative angiography, colour Doppler examination, cranial MRI and/or CT scans, HMPAO-SPECT or H(2)(15)O PET (baseline and Diamox challenge) scans. Nineteen patients presented with child-juvenile Moyamoya angiopathy with an average age at presentation of 8 years (range 1-17 years), in 4 patients adult Moyamoya was diagnosed with a mean age at presentation of 34 years (range 23-40 years). RESULTS: In all but one patient bilateral affection was present at the time of diagnosis. All patients underwent direct and/or additional indirect revascularisation procedures. Twenty-one patients underwent bilateral revascularisation procedures. In two patients a unilateral procedure was performed. A direct STA-MCA bypass (superficial temporal artery branch - middle cerebral artery branch anastomosis) was performed in all patients. Additional direct STA-ACA bypass (STA - anterior cerebral artery branch anastomosis) was performed in 10 patients. Indirect arteriosynangiosis using the occipital artery was performed in the posterior cerebral artery (PCA) territory in 3 patients. The frontal branch of the STA was used for arteriosynangiosis in the frontal region in another 2 patients. Indirect frontal durasynangiosis was performed in 14 patients. The number and location of multiple revascularisation procedures was determined according to the angiographic findings as well as the site of decreased perfusion reserves seen on H(2)(15)O PET. A one stage revascularisation procedure was performed in 7 patients. Fourteen patients underwent two stage procedures. Following operation no complications were encountered in all but one adult patient who died postoperatively due to a massive middle cerebral artery infarct on the nonoperated side. CONCLUSIONS: As territorial hemodynamic disorder seems to be a characteristic in Moyamoya disease and/or syndrome, judging from our experience with European patients in our series, and several reports hitherto, treatment with multiple revascularisation procedures is considered to be justified.

Adolescent↗
PubMed2005

Short-pouch and low-anastomosis Duhamel procedure results in better fecal control and normal defecation pattern.

PURPOSE: The purpose of this study was to analyze the long-term outcome of the short-pouch and low-anastomosis Duhamel procedure and to evaluate the quality of life after pull-through. We also tried to answer the questions: Does the modified Duhamel procedure produce fecal continence? Is the quality of life correlated to normal bowel function (1-3 per day) without the use of laxatives? MATERIALS AND METHODS: Between January 1993 and January 2002, 53 patients, 44 (83 percent) males and 9 (17 percent) females, who underwent a Duhamel procedure were assessed retrospectively. Of the 53 children, 36 (67.9 percent) underwent a primary Duhamel procedure at our institute (Group A). Seventeen (32.1 percent) patients had a primary Duhamel pull-through and subsequently a stoma before a redo modified Duhamel procedure (Group B). The technical modification was creation of a short rectal pouch of 35 mm, achieving a low colorectal anastomosis 0.5 cm from or on the dentate line. All 53 patients were assessed prospectively by a disease-specific questionnaire. The total score provided a single index of the quality of life associated with fecal continence. RESULTS: For Group A (n = 36), the mean period of follow-up was 71.4 +/- 29 months. Constipation was seen in four (11.1 percent) patients. In two (5.6 percent) patients there was a mild degree of soiling. Sensation and urge to defecate was intact in 34 (94.4 percent) children who could wait to go to the toilet until it was socially convenient. For Group B (n = 17), the mean period of follow-up was 73.9 +/- 31.2 months. Constipation occurred in 17 (100 percent), encopresis in 14 (82.4 percent), and enterocolitis in 15 (88.2 percent) after the primary Duhamel procedure. In comparison, there was complete absence of constipation (100 percent), encopresis (100 percent), and complete resolution of enterocolitis (100 percent) after the redo modified Duhamel (P = 0.001). Continence to solid stools after primary Duhamel was seen in 5 (29.4 percent) vs. 17 (100 percent) after redo modified Duhamel. After the redo modified Duhamel all 17 (100 percent) patients have retained the sensation and urge to defecate and 15 (88.2 percent) can wait to get to the toilet until it is socially convenient. In all 53 patients, the quality of life was good in 86.8 percent (46/53) and correlated directly with fecal continence (r = 0.977). There was no correlation between age of patient and fecal continence (r = 0.597) and rate of fecal incontinence did not decrease with age. Direct correlation was seen with the presence of constipation and the incidence of late onset enterocolitis (r = 0.942). CONCLUSIONS: Short-pouch, low-anastomosis Duhamel pull-through procedure results in fecal continence and complete emptying. The above procedure has a positive impact on the quality of life in these children.

Anastomosis, Surgical↗
PubMed2005

Lidocaine anal block limits autonomic dysreflexia during anorectal procedures in spinal cord injury: a randomized, double-blind, placebo-controlled trial.

PURPOSE: Autonomic dysreflexia is a common and potentially dangerous hypertensive response to stimulation below the level of injury that occurs in patients with spinal cord injury at T6 or above. Rectosigmoid distention and anal manipulation are among the stimuli that may precipitate autonomic dysreflexia. Instillation of topical local anesthetic into the rectum is the recommended prophylaxis against autonomic dysreflexia of anorectal origin. However, a previous randomized, double-blind, placebo-controlled trial showed that topical lidocaine in the rectum does not blunt the autonomic dysreflexia response to anorectal procedures. The purpose of this study was to determine whether lidocaine anal sphincter block would be effective in limiting anorectal procedure-associated autonomic dysreflexia. METHODS: We enrolled patients with chronic, complete spinal cord injury above T6, who were having anorectal procedures (flexible sigmoidoscopy and/or anoscopic hemorrhoid ligation). In a double-blind fashion, patients were randomized for intersphincteric anal block with 1 percent lidocaine or normal saline (placebo) before the procedure. Blood pressure was measured before, during, and after the block and procedure. RESULTS: Thirteen patients received lidocaine, and 13 received placebo. The groups were similar in age, level of injury, duration of spinal cord injury, type of procedure, and procedure duration. The mean maximal systolic blood pressure increase for the lidocaine group was 22 +/- 14 mmHg, significantly lower than the placebo group's 47 +/- 31 mmHg (P = 0.01). CONCLUSIONS: Lidocaine anal block significantly limits the autonomic dysreflexia response in susceptible patients undergoing anorectal procedures.

Anal Canal↗
PubMed1986

General surgical procedures in renal allograft recipients.

Since elective and emergent nontransplant-related surgical procedures are frequently necessary in renal allograft recipients, it becomes essential to determine the incidence and outcome of these operations in this population. For this reason, a retrospective analysis of 273 consecutive renal transplants performed in 254 patients between January 1978 and November 1985 was accomplished. During this interval, 139 patients underwent 162 nontransplant-related surgical procedures. In the 44 patients who underwent 55 emergent or semiemergent procedures, 8 patients (18 percent) died in the postoperative period. All deaths occurred in patients who underwent major abdominal or thoracic procedures for perforated viscera, gastrointestinal bleeding, or empyema and lung abscess, and all deaths were secondary to sepsis and multiple organ failure. In the survivors of emergent procedures, the mean preoperative and discharge serum creatinine levels were 2.87 mg/dl and 2.82 mg/dl, respectively. In the 95 patients who underwent 107 elective procedures, most of which were performed under general anesthesia, the operative mortality was 4.2 percent. In patients with stable renal allograft function at the time of operation, mean serum creatinine levels preoperatively and at the time of discharge were not significantly different (1.74 mg/dl versus 1.64 mg/dl). In conclusion, emergent operative procedures for intraabdominal or thoracic catastrophes are associated with a high mortality rate in renal allograft recipients. On the other hand, elective surgical procedures can be undertaken with an acceptable mortality rate and no adverse affects on graft function. Of utmost importance in these patients is the close monitoring of the immunosuppressive regimen and the early detection and treatment of potential septic complications.

Adolescent↗
PubMed1996

Comparison of Burch and lyodura sling procedures for repair of unsuccessful incontinence surgery.

OBJECTIVE: To assess the effectiveness and late postoperative morbidity of the Burch procedure and the sling procedure for the treatment of recurrent urinary stress incontinence after vaginal hysterectomy and anterior repair. METHODS: Clinical, urodynamic, and sonographic examinations were done on 77 women suffering with recurrent urinary stress incontinence. The women were randomized to two groups, modified Burch colposuspension and lyophilized dura mater sling surgery; 72 women were reexamined 32-48 months after these procedures. RESULTS: The cure rate at 32-48 months' follow-up was 86% for the Burch procedure and 92% for the sling. Women who had had the sling procedure demonstrated a clear decrease in maximal bladder capacity, from 330 to 240 mL (P < .05). In both groups, stress profiles demonstrated a shift of maximal pressure point toward the proximal urethra and a significant improvement in pressure transmission (P < .05). The post-operative patients who had persistent incontinence were found to have insufficient elevation of the bladder neck (less than 10 mm). The uroflow examination showed an increase of urination time in both groups. The incidence of bladder problems was 10% with the Burch procedure and 29% with the sling procedure; however, 13% of the Burch group developed rectoceles. CONCLUSION: Both procedures offer a high rate of success. We believe that the sling surgery should be used only in certain special cases because of its higher rate of complications, but that posterior vaginal repair should be considered after modified Burch colposuspension because of the possibility of rectocele and enterocele.

Aged↗
PubMed1986

Effects of anticonvulsant drugs under automaintenance and negative automaintenance procedures.

The behavioral effects of phenytoin, phenobarbital, clonazepam, valproic acid, and ethosuximide were evaluated in food-deprived pigeons performing under automaintenance and negative automaintenance procedures. Under the automaintenance procedure, brief periods of key illumination were followed by food delivery without regard to the subject's behavior. In most instances, when drugs were not given this procedure engendered high rates of keypecking during almost all key illuminations (trials). Acute administrations of phenytoin (10-20 mg/kg), valproic acid (40-120 mg/kg), and ethosuximide (40-120 mg/kg) produced generally dose-dependent decreases in percent trials with a response and rate of responding. Although phenobarbital (30-60 mg/kg) and clonazepam (2.5-7.5 mg/kg) produced little obvious effect on percent trials with a response, these drugs generally increased rate of responding. Under the negative automaintenance procedure, food delivery followed only key illuminations during which keypecking did not occur. Keypecking occurred at a low rate under this procedure, with no responses occurring during the majority of key illuminations. Thus, this procedure appeared to involve responding elicited by respondent conditioning but suppressed by the response-dependent omission of food. Across the same dose ranges evaluated under the automaintenance procedure, clonazepam and phenobarbital generally increased percent trials with a response and rate of responding in dose-dependent fashion. Phenytoin similarly increased percent trials with a response but had little consistent effect on rate of responding. Ethosuximide and valproic acid failed to affect responding under this procedure.

Animals↗
PubMed1987

The early detection of cancer in the primary-care setting: factors associated with the acceptance and completion of recommended procedures.

Effective cancer control efforts in the primary-care setting require that patients accept and are able to complete recommended early detection procedures. We thus assessed the extent to which procedure nonacceptance or noncompletion limited accomplishment of detection procedures offered as components of routine health care. We also examined the relationship of provider and patient factors to successful procedure accomplishment. Of 221 patients offered procedures by their primary-care provider, 58 (27%) initially declined at least one recommendation, with acceptance rates ranging from 98% for breast exam to 59% for sigmoidoscopy. Furthermore, only 50% of patients offered stool occult blood testing or sigmoidoscopy, 61% offered mammography, and 69% offered Pap smear were able to complete the procedures. Pap smear and mammography were more likely to be initially accepted by those patients with more years of formal education and were less likely to be completed by those with private insurance coverage. Among a subgroup of 76 patients completing a telephone interview, personal health beliefs were not consistently associated with procedure acceptance or completion. These results suggest that both the initial nonacceptance of procedures and the subsequent barriers to their completion limit the efficacy of cancer screening efforts in the primary-care setting. Future research will be required to develop an explanatory model or to propose a targeted intervention.

Female↗
PubMed1984

A sulphide-osmium procedure for detection of metal-containing synaptic boutons in the lizard cerebral cortex.

Two procedures of the Timm sulphide-silver method for the ultrastructural location of heavy metals and a sulphide-osmium procedure proposed here were applied to studying the Timm-reacting axonal boutons of the lizard cerebral cortex. It was shown that metal-containing boutons which would be labelled when using the Timm method, could be labelled by the sulphide-osmium procedure as well, i.e. perfusion and immersion in a glutaraldehyde fixative saturated with H2S vapour and then osmium postfixation. When the sulphide-osmium procedure was used, Timm-reacting boutons displayed an electron-dense loading in some of their synaptic vesicles. The histochemical significance of this labelling is suggested; metal contents (possibly zinc) in the synaptic vesicles are first transformed into metal sulphides that afterwards interact with OSO4 and render an electron-dense labelling. Moreover, chain-like electron-dense aggregates, which could not be detected in the Timm method, have been shown in endoplasmic reticulum cisternae using the sulphide-osmium procedure. The importance of both the Timm method and the sulphide-osmium procedure in ultrastructural studies in the lizard cerebral cortex could be paramount, as they define specifically one of the projection systems in the reptilian cortex. The sulphide-osmium procedure could be more useful than the Timm method since it is a simple procedure that avoids physical development, allows a better ultrastructural quality and a more precise location of the labelling.

Animals↗
PubMed1990

Neonatal facial and cry responses to invasive and non-invasive procedures.

Evaluation of pain in neonates is difficult due to their limited means of communication. The aim was to determine whether behavioural reactions of cry and facial activity provoked by an invasive procedure could be discriminated from responses to non-invasive tactile events. Thirty-six healthy full-term infants (mean age 2.2 h) received 3 procedures in counterbalanced order: intramuscular injection, application of triple dye to the umbilical stub, and rubbing thigh with alcohol. Significant effects of procedure were found for total face activity and latency to face movement. A cluster of facial actions comprised of brow bulging, eyes squeezed shut, deepening of the naso-labial furrow and open mouth was associated most frequently with the invasive procedure. Comparisons between the 2 non-invasive procedures showed more facial activity to thigh swabbing and least to application of triple dye to the umbilical cord. Acoustic analysis of cry showed statistically significant differences across procedures only for latency to cry and cry duration for the group as a whole. However, babies who cried to two procedures showed higher pitch and greater intensity to the injection. There were no significant differences in melody, dysphonation, or jitter. Methodological difficulties for investigators in this area were examined, including criteria for the selection of cries for analysis, and the logical and statistical challenges of contrasting cries induced by different conditions when some babies do not always cry. It was concluded that facial expression, in combination with short latency to onset of cry and long duration of first cry cycle typifies reaction to acute invasive procedures.

Analysis of Variance↗
PubMed1993

Coronary rotational ablation: initial experience in 302 procedures.

OBJECTIVES: The aim of this study was to assess the utility of percutaneous transluminal coronary rotational ablation in the treatment of coronary artery disease. BACKGROUND: Although numerous advances have been made in the treatment of coronary artery disease, there are lesions with complex morphology that are not amenable to current intravascular therapy. METHODS: A consecutive series of 242 patients having 302 coronary rotational ablation procedures was analyzed. One hundred nineteen (49%) of the patients had previously undergone attempted coronary angioplasty, which was unsuccessful in 31 patients (13%). The left ventricular ejection fraction was normal in 196 patients (81%). The ablation procedure was attempted in 308 vessels and 346 lesions. Of the 346 lesions treated, 26 (7.5%) were classified as American College of Cardiology/American Heart Association type A, and 320 (92.5%) as either type B or type C. RESULTS: Procedural success was achieved in 284 (94%) of the 302 procedures and 330 (95.4%) of the 346 lesions in which ablation was attempted. Five procedures (1.7%) were unsuccessful, but no cardiac event occurred during the hospital stay. A major cardiac event occurred in 13 cases (4.3%); 9 (3%) of these complications were due to the ablation procedure. Six patients sustained a Q wave myocardial infarction alone, two had a Q wave infarction and required emergency surgery and one needed emergency surgery but did not have a Q wave infarction. No procedural deaths were attributed to the ablation procedure. Follow-up has been obtained in 182 of the 242 patients at a mean interval of 9 +/- 5 months. Of the 182 patients, 174 (95.6%) were alive and free of myocardial infarction. Angiographic follow-up is available thus far in 87 patients. By combining angiographic and clinical outcome, an overall estimated restenosis rate of 37.4% (68 of 182) was calculated. CONCLUSIONS: These data suggest that coronary rotational ablation can be performed on lesions with a variety of morphologic features with high initial success rates. The overall rate of restenosis is similar to that of balloon angioplasty.

Angioplasty, Balloon, Coronary↗
PubMed1991

Regulating behavioral procedures for individuals with handicaps: review of state department standards.

We reviewed standards (i.e., mandatory policies or recommended guidelines) from 39 state departments of special education and 41 state departments of developmental disabilities/mental retardation (DD/MR) to determine how they addressed the use of behavioral procedures. Results indicated that many standards described procedures to change behaviors of individuals with handicaps and identified ways to regulate usage. Major findings were that (a) standards from state departments of DD/MR addressed behavioral procedures more frequently than standards from special education departments; (b) many standards addressed procedures to decrease, but not increase, behavior; (c) several standards identified safeguards to clients' rights, such as prior approval requirements and periodic review of behavioral procedures' effects; (d) some standards prohibited and/or restricted the use of specific procedures, such as those judged to be aversive; (e) about one-fifth of special education standards and two-thirds of DD/MR standards described staff training requirements for using some procedures; and (f) relatively few standards used decision models to select behavioral procedures. Implications of these findings for policy makers, service providers, and future research efforts are discussed.

Aversive Therapy↗
PubMedDate not supplied

A comparison of static and dynamic presentation procedures on discrimination learning of individuals with severe or moderate mental retardation.

A dynamic presentation of stimulus materials may be more effective than a static presentation. To test this hypothesis, we taught 16 individuals with moderate or severe mental retardation to identify two comparative discriminations (more, longer) by each of two different procedures. In the static, or traditional, presentation procedure the stimuli were positioned before a trial began and not manipulated by the experimenter during the trial. In the dynamic presentation procedure the individual watched the experimenter manipulate the relevant dimension of the stimuli during a series of trials. Both procedures were used in combination with a procedure that relied on fading and on many examples of both the correct and incorrect stimuli across trials. Data were presented in four phases: training, generalization, 1-week maintenance, and 1-month maintenance. No differences in percentage of unprompted correct responses were found between the two procedures in training, generalization, or any of the four maintenance tests. Discussion included possible reasons these results differed from those of prior studies as well as the need for further investigation of the dynamic presentation procedure used with more traditional teaching procedures that rely on extrastimulus prompts.

Adolescent↗
PubMed2006

Feasibility of forearm ultrasonography-guided nerve blocks of the radial, ulnar, and median nerves for hand procedures in the emergency department.

STUDY OBJECTIVE: We determine the feasibility of forearm ultrasonography-guided nerve blocks of the radial, ulnar, and median nerves, performed by emergency physicians, to provide procedural anesthesia of the hand in the emergency department (ED). METHODS: This was a prospective study involving a convenience sample of 11 patients presenting to an adult ED with hand pathology requiring a procedural intervention. Adults 18 years and older who presented to the ED during the 3-month study period were eligible. Physicians performing the nerve blocks were attending physicians, ultrasonography fellows, or residents who had participated in a 1-hour training session. The participants underwent ultrasonography-guided nerve blocks in the forearm to provide anesthesia. Any additional anesthesia or analgesia required to perform the procedure in the anesthetized region was recorded. Subjects rated their pain on a 100mm visual analog scale before the nerve block and 15 minutes after the nerve block. The primary outcomes for feasibility were the percentage of cases completed without rescue anesthesia or analgesia and the median reduction in pain on the visual analog scale after the nerve block. Secondary outcomes for feasibility included the median time to completion of the entire nerve block procedure for each subject (from initiation of ultrasonography to completion of the last injection) and the percentage of participants wishing to have the same procedure for similar injuries in the future. Other secondary outcomes included the percentage of participants with complications during the procedure and at 3 months. RESULTS: All procedures (100%) were completed without additional anesthesia or analgesia. The median reduction in visual analog scale score was 5.0 cm (interquartile range 3.0, 8.0; P=.003). The median time to completion of nerve blocks was 9 minutes per patient (interquartile range 6 minutes 30 seconds, 10 minutes 0 seconds), with a median of 2 blocks per patient. Ten of 11 patients (92%) stated they would wish to have the ultrasonography-guided nerve block in the future for similar injuries. There were no immediate complications and no complications reported at 3 months. CONCLUSION: Attending physicians, fellows, and residents can perform forearm ultrasonography-guided nerve blocks of the radial, ulnar, and median nerves quickly, without additional anesthesia and with high patient satisfaction, after minimal training. Although pilot data are suggestive, randomized controlled trials are needed to determine efficacy and safety. Ultrasonography-guided nerve blocks to provide anesthesia for hand procedures appear to be feasible in the ED.

Adult↗
PubMed2005

[Psychological adjustment of stereotactic breast biopsy instrumentation procedures: about 73 cases].

OBJECTIVE: The aim of the study was to investigate patients' perceptions after stereotactic breast biopsy instrumentation, after both procedure and results. PATIENTS AND METHOD: From 1 March 2002 to 31 March 2003, a questionnaire (Likert response type) on stress was given to 73 patients who had breast biopsies procedures, the first time at the end of the procedure (T1) and then after the histological diagnosis (T2). RESULTS: The questionnaire was validated through analysis of principal component with Varimax rotation. Three factors were identified: procedure, quality of life, information and perception after biopsy. Responses were analysed with Chi-square. Two groups of women were identified, the first group (G1) corresponding to patients with a benign diagnosis (N=32) and the second group (G2) to patients with malignant diagnosis (N=32). Only the "procedure" factor was different at T1 and T2 (P=0.022). Compression was found to be painful: 11% at T1 versus 21% at T2. Women were disturbed by local anesthesia: 26% at T1 versus 21% at T2. Biopsy was painful: 6% at T1 versus 13% at T2. Examination was too long: 24% at T1 versus 35% at T2. The procedure was discomfortable: 52% at T1 versus 54% at T2. Information satisfied patients in 90% cases. There was no statistically significant difference according to procedures and histological disease (P=0.357). DISCUSSION AND CONCLUSION: Information and medical empathy conditioned patients' perceptions. Patients tolerated the procedures well.

Adult↗
PubMed2004

Comparison of surgical procedures for vascular and airway anastomoses that utilize a modified non-suture external cuff technique for experimental lung transplantation in rats.

BACKGROUND: Lung transplantation in rats is technically difficult and results may vary. The non-suture cuff technique (non-suture [NS]), which involves using a cuff for anastomoses of vessels and airways, is commonly utilized to perform transplant procedures. However, the standard bronchial cuff may occlude the lumen, resulting in diminished graft survival. In contrast, the non-suture cuff technique for vascular anastomoses with bronchial suturing (bronchial suture [BS]), although more technically difficult, is known to have prolonged bronchial patency. We developed a "modified" NS technique that uses a larger and longer cuff for anastomoses and compared the efficacy of this procedure to the BS technique for lung transplantation. METHODS: The BS procedure was performed in 146 transplant procedures. The modified NS procedure, which uses a larger cuff than the standard NS procedure, was performed in 113 procedures. RESULTS: Although total ischemic times were comparable, the total operation time in the NS group was significantly shorter than in the BS group (p < 0.0001). Bronchial leakage occurred in 9.6% of BS group patients and 0% of NS group patients. Survival rates were comparable between groups. Although the BS technique is widely acknowledged to provide prolonged patency of bronchial anastomosis, graft survival in the NS group was observed up 17 months post-transplant. CONCLUSIONS: These data show that the NS technique, which is less technically difficult, results in shorter operative times compared with the BS procedure, and results in durable anastomoses of lung grafts.

Anastomosis, Surgical↗
PubMed2004

Radial versus femoral approach for percutaneous coronary diagnostic and interventional procedures; Systematic overview and meta-analysis of randomized trials.

OBJECTIVES: We sought to compare, through a meta-analytic process, the transradial and transfemoral approaches for coronary procedures in terms of clinical and procedural outcomes. BACKGROUND: The radial approach has been increasingly used as an alternative to femoral access. Several trials have compared these two approaches, with inconclusive results. METHODS: The MEDLINE, CENTRAL, and conference proceedings from major cardiologic associations were searched. Random-effect odds ratios (ORs) for failure of the procedure (crossover to different entry site or impossibility to perform the planned procedure), entry site complications (major hematoma, vascular surgery, or arteriovenous fistula), and major adverse cardiovascular events (MACE), defined as death, myocardial infarction, emergency revascularization, or stroke, were computed. RESULTS: Twelve randomized trials (n = 3,224) were included in the analysis. The risk of MACE was similar for the radial versus femoral approach (OR 0.92, 95% confidence interval [CI] 0.57 to 1.48; p = 0.7). Instead, radial access was associated with a significantly lower rate of entry site complications (OR 0.20, 95% CI 0.09 to 0.42; p < 0.0001), even if at the price of a higher rate of procedural failure (OR 3.30, 95% CI 1.63 to 6.71; p < 0.001). CONCLUSIONS: The radial approach for coronary procedures appears as a safe alternative to femoral access. Moreover, radial access virtually eliminates local vascular complications, thanks to a time-sparing hemostasis technique. However, gaining radial access requires higher technical skills, thus yielding an overall lower success rate. Nonetheless, a clear ongoing trend toward equalization of the two procedures, in terms of procedural success, is evident through the years, probably due to technologic progress of materials and increased operator experience.

Angioplasty, Balloon, Coronary↗