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At least 793 records · Page 44Linked to original sources
PubMed2004

Differential mortality risk of postprocedural creatine kinase-MB elevation following successful versus unsuccessful stent procedures.

OBJECTIVES: This study was designed to evaluate the effect of periprocedural myocardial infarction (MI) on mortality according to success of the stent procedure. BACKGROUND: The mortality effect of periprocedural MI relative to successful versus unsuccessful procedures has not been examined. METHODS: All-cause mortality during the first year was evaluated prospectively among 5,850 patients from coronary stent clinical trials. Myocardial infarction was classified according to creatine kinase-MB level as type 1 (>1 but <3 times normal), type 2 (>or=3 but 8 times normal or Q-wave MI). Procedures were classified as successful unless there was a final diameter stenosis >50%; final Thrombolysis In Myocardial Infarction flow grade <3; final National Heart, Lung, and Blood Institute dissection grade >or=D; repeat revascularization within 24 h; or stent thrombosis within 24 h. RESULTS: Myocardial infarction was more frequent after unsuccessful procedures (69.6% vs. 20.4%, p < 0.001). Mortality during the first year was higher in patients with MI (2.8% vs. 1.7%, p = 0.01), but the effect was significant only for type 3 MI (4.7% vs. 1.7%, p = 0.008). Moreover, the mortality difference for any MI was confined to patients with unsuccessful procedures (13.1% vs. 0%, p = 0.03), with no significant effect among patients with otherwise successful procedures (2.1% vs. 1.7%, p > 0.20). The independent predictors of mortality were unsuccessful procedure (p < 0.001), diabetes mellitus (p = 0.001), history of prior MI (p = 0.003), multivessel disease (p = 0.006), and advancing age (p < 0.001), but not periprocedural MI. CONCLUSIONS: The association of periprocedural MI with increased mortality during the first year following stent placement was confined to patients with unsuccessful procedures.

Aged↗
PubMed2006

Complications of right heart catheterization procedures in patients with pulmonary hypertension in experienced centers.

OBJECTIVES: This study sought to assess the risks associated with right heart catheter procedures in patients with pulmonary hypertension. BACKGROUND: Right heart catheterization, pulmonary vasoreactivity testing, and pulmonary angiography are established diagnostic tools in patients with pulmonary hypertension, but the risks associated with these procedures have not been systematically evaluated in a multicenter study. METHODS: We performed a multicenter 5-year retrospective and 6-month prospective evaluation of serious adverse events related to right heart catheter procedures in patients with pulmonary hypertension, as defined by a mean pulmonary artery pressure >25 mm Hg at rest, undergoing right heart catheterization with or without pulmonary vasoreactivity testing or pulmonary angiography. RESULTS: During the retrospective period, 5,727 right heart catheter procedures were reported, and 1,491 were reported from the prospective period, for a total of 7,218 right heart catheter procedures performed. The results from the retrospective and the prospective analyses were almost identical. The overall number of serious adverse events was 76 (1.1%, 95% confidence interval 0.8% to 1.3%). The most frequent complications were related to venous access (e.g., hematoma, pneumothorax), followed by arrhythmias and hypotensive episodes related to vagal reactions or pulmonary vasoreactivity testing. The vast majority of these complications were mild to moderate in intensity and resolved either spontaneously or after appropriate intervention. Four fatal events were recorded in association with any of the catheter procedures, resulting in an overall procedure-related mortality of 0.055% (95% confidence interval 0.01% to 0.099%). CONCLUSIONS: When performed in experienced centers, right heart catheter procedures in patients with pulmonary hypertension are associated with low morbidity and mortality rates.

Aged↗
PubMedDate not supplied

Use of cloze and contrast word procedures in repeated storybook reading: targeting multiple domains.

UNLABELLED: The purposes of this study were: (1) to implement an intervention approach for children with language and phonological impairments, targeting multiple linguistic domains within a unitary activity, and (2) to investigate whether any observed changes in selected outcome measures were associated with particular scaffolding procedures. The intervention approach employed a variety of scaffolding procedures (cloze procedures; cloze procedures with expansions; contrast words) within an interactive repeated storybook reading activity. It was delivered across 12 sessions to three kindergarten children with language and phonological impairments. Pre-treatment and post-treatment probes, together with treatment data, provided indices of the semantic and phonological complexity of the participants' utterances. Changes in complexity levels were observed in all participants. Associations between increases in outcome measures and use of particular scaffolding techniques were identified. LEARNING OUTCOMES: (1) The reader will learn a rationale for use of cloze procedures, cloze procedures with expansions, and contrast words during repeated storybook reading as an intervention for some children with both language and phonological disorders. (2) The reader will learn how to implement cloze procedures, cloze procedures with expansions, and contrast words during repeated storybook reading. (3) The reader will learn how various outcome measures (e.g., level of semantic complexity) may be used to track change in performance over time.

Articulation Disorders↗
PubMed2006

Costochondral autograft as a salvage procedure after failed trapeziectomy in trapeziometacarpal osteoarthritis.

PURPOSE: Osteoarthritis at the base of the thumb is a common problem, especially in women. Among the many surgical procedures aimed at restoring the function of the trapeziometacarpal joint, total trapeziectomy has been shown to provide good long-term results in most patients. But in some patients continued pain may lead the surgeon to consider a revision procedure. We report the use of costochondral autograft as an interposition material in revision of trapeziectomy in trapeziometacarpal osteoarthritis and to study its usefulness. METHODS: The study design was retrospective. All of the patients had a costochondral autograft as a revision procedure after a failed trapeziectomy with ligament reconstruction. Patients were clinically assessed before and after surgery. The follow-up period was 24 months. Results were assessed as follows: good, complete relief of pain; fair, persistent mild pain and stiffness; poor, no relief of pain or any improvement with revision surgery. RESULTS: Four patients were included; there were 2 good results, 2 fair results, and no poor result. Pain relief was obtained in all patients. Thumb opposition showed a slight improvement in 1 patient and no change in the other 3 patients. Pinch strength showed no change. One case of iatrogenic injury of the sensory branch of the radial nerve was noted. CONCLUSIONS: Costochondral autograft as a revision procedure after failed trapeziectomy is a reliable procedure. These preliminary outcomes showed that the result did not compare favorably with soft-tissue interposition. Nevertheless, in case of an iterative procedure, the lack of available soft-tissue material to interpose may lead the surgeon to consider a costochondral autograft. This procedure should be considered a salvage procedure.

Carpal Joints↗
PubMed2004

The ex utero intrapartum treatment procedure: Looking back at the EXIT.

PURPOSE: The ex utero intrapartum treatment (EXIT) procedure was developed originally for management of airway obstruction after fetal surgery, and indications have continued to expand for a variety of fetal anomalies. The authors review their single-institution experience with EXIT. METHODS: Retrospective review of all patients who underwent an EXIT procedure from 1993 to 2003 (n = 52) was performed. Variables evaluated include indication for EXIT, gender, gestational age at EXIT, birth weight, maternal blood loss, operative complications, operative time, and survival rate. Technique, personnel, and anesthesic management were reviewed. RESULTS: Long-term follow-up was available for all patients. Fifty-one of 52 patients were born alive; currently, 27 of 52 patients (52%) are alive. All deaths have been in patients with congenital diaphragmatic hernia. Forty-five patients underwent EXIT for reversal of tracheal occlusion for congenital diaphragmatic hernia. Of these patients, 30 underwent tracheal clip removal. Two patients had repair of tracheal injury from clipping at EXIT. Fifteen patients underwent bronchoscopy and tracheal balloon removal. Five patients underwent EXIT procedure for neck masses. Tracheostomy was performed in 3 of these patients. One patient was intubated successfully, and 1 patient underwent resection of the neck mass while on placental support. Two patients underwent EXIT procedure and tracheostomy for congenital high-airway obstruction syndrome. Average gestational age at delivery was 31.95 +/- 2.55 weeks. Average birth weight was 1,895 +/- 653 g. Average maternal blood loss was 970 +/- 510 mL. Average operating time on placental support was 45 +/- 25 minutes with a maximum of 150 minutes. CONCLUSIONS: EXIT procedures can be performed with minimal maternal morbidity and with good outcomes. It is an excellent strategy for establishing an airway in a controlled manner, avoiding "crash" intubation or tracheostomy. Longer procedures on placental support allowing for definitive management of neck masses and airway obstruction have been realized. EXIT procedures have evolved from an adjunct to fetal surgery to a potentially life-saving procedure in fetuses with airway compromise at birth.

Airway Obstruction↗
PubMed2004

Sequences assessed by declarative and procedural tests of memory in amnesic patients with hippocampal damage.

Previous research indicates that amnesic subjects tested on sequential learning or serial reaction time tasks can learn a repeated procedural sequence but are unable to explicitly recall the correct sequence when asked to generate the sequence. Rats with hippocampal lesions are also able to learn and remember procedural or implicit sequences but were impaired for declarative sequences. We used analogous procedures used in rats to assess the role of the hippocampus in the acquisition of declarative and procedural sequences in amnesic and control participants. Amnesic participants with damage restricted to the hippocampus and control participants were administered analogous tasks of declarative and procedural sequential learning using a computer version of the radial arm maze. The amnesic participants had slower response times during the acquisition of procedural sequences, but were not impaired compared to controls when switched to a random sequence, suggesting that both groups learned the sequence. Alternatively, the amnesic but not control participants were significantly impaired in the declarative sequence task. Our findings provide support for evolutionary continuity in cognitive function of the hippocampus in rats and humans and the dissociation between the declarative and procedural sequential learning. The performance differences on the two sequence learning tasks are likely due to the use of different strategies associated with learning sequences based on procedural versus declarative knowledge.

Adult↗
PubMed2000

Safety and efficacy of percutaneous coronary interventions performed immediately after diagnostic catheterization in northern new england and comparison with similar procedures performed later.

"Ad hoc" percutaneous coronary interventions (PCIs)-those performed immediately after diagnostic catheterization-have been reported in earlier studies to be safe with a suggestion of higher risk in certain subgroups. Despite increasing use of this strategy, no data are available in recent years with new device technology. We studied use of an ad hoc strategy in a large regional population to determine its use and outcomes compared with staged procedures. A database from the 6 centers performing PCIs in northern New England and 1 center in Massachusetts was analyzed. During 1997, excluding only patients requiring emergency procedures or those with a prior PCI, 4,136 PCIs were performed, 1,748 (42.3%) of these being ad hoc procedures. Patients having ad hoc procedures were less likely to have peripheral vascular disease, renal failure, prior myocardial infarction, or coronary artery bypass surgery, congestive heart failure, or poor left ventricular function, and more likely to have received preprocedural intravenous heparin or nitroglycerin or to have required an urgent procedure. Narrowings treated during ad hoc procedures were less frequently types B and C or in saphenous vein grafts. Adjusted rates of clinical success were not different between ad hoc and non-ad hoc procedures (93.7% vs 93.6%); there was no difference in the incidence of death (0.6% vs 0.5%), emergency (0. 9% vs 0.8%) or any (1.4% vs 0.8%) coronary artery bypass surgery, or myocardial infarction (2.6% vs 2.0%). As currently practiced in our region, ad hoc intervention is used selectively with outcomes similar for ad hoc and non-ad hoc procedures.

Angina Pectoris↗
PubMed2000

Repeated procedure after radical surgery for tetralogy of Fallot.

BACKGROUND: Although the immediate results of radical operation for tetralogy of Fallot are excellent, long-term follow-up has shown that the number of repeated procedures has increased in many institutions. We describe patients who underwent a second or third procedure after radical operation for tetralogy of Fallot. METHODS: Between April 1981 and August 1996, we operated on 44 patients for the second time and on 4 for the third time after radical operation for tetralogy of Fallot. Indications for a second and third procedure included right ventricular outflow tract obstruction in 38 patients, infective endocarditis in 4, and isolated residual ventricular septal defect in 3. RESULTS: One patient died after concomitant replacement of the pulmonary and tricuspid valves. Three patients who underwent sternotomy more than twice (before the second or third operation) underwent accidental cardiovascular trauma during this procedure (30%). Moreover, when patients underwent more than two sternotomy procedures before the repeated operation for tetralogy of Fallot, the total bypass time, interval between cessation of the cardiopulmonary pump to completion of the operation, amount of blood transfusion, and length of intensive care unit stay were significantly higher compared with those who underwent less than two sternotomy procedures (p < 0.05). Right ventricular outflow tract obstruction was the main indication for a second operation. After the second operation for right ventricular outflow tract obstruction in 35 patients, the preoperative right ventricle to left ventricle pressure ratio decreased significantly (from 0.75 +/- 0.13 to 0.51 +/- 0.12; p < 0.0001). However, the right ventricle to left ventricle pressure ratio did not significantly decrease in patients who underwent a third procedure to treat right ventricular outflow tract obstruction. CONCLUSIONS: The surgical results of a second procedure after radical operation for tetralogy of Fallot were acceptable. However, the risk of accidental cardiovascular trauma during dissection was high among patients who underwent sternotomy more than twice before repeat operation.

Adolescent↗
PubMed1998

The Ross procedure: shorter hospital stay, decreased morbidity, and cost effective.

BACKGROUND: The Ross procedure has become an accepted and sometimes preferred alternative to mechanical aortic valve replacement. One criticism of the Ross procedure is that it may have a higher operative mortality, morbidity, and cost. Several groups have shown that this operation can be performed safely with less than 3% mortality. The issue of higher cost has not been resolved. In this retrospective study we compared a consecutive group of patients undergoing the Ross procedure with an age- and disease-matched group of patients who underwent mechanical aortic valve replacement. METHODS: From 1993 to 1996, 22 consecutive adult patients (age range, 20 to 57 years; mean, 38 +/- 14 years) underwent the Ross procedure. Twenty-seven patients (age range, 17 to 57 years; mean, 41 +/- 10 years) underwent mechanical aortic valve replacement between 1991 and 1996. The hospital cost (in 1996 dollars) and postoperative length of stay were calculated for each patient using Transition I, a hospital-wide cost accounting system. RESULTS: There was no hospital mortality in either group. The incidence of significant valve-related complication was 5% (1/22 patients) in the Ross procedure group and 22% (6/27 patients) in the mechanical valve group. There were two late deaths in the group with mechanical aortic valve replacement. The length of stay for the Ross procedure group was 5.9 +/- 2.1 days, versus 8 +/- 1.85 days for the mechanical valve group (p < 0.01). The mean hospital costs were not significantly different, $23,140 +/- $7,825 for the mechanical valve group and $23,226 +/- $6,960 for the group having the Ross procedure. CONCLUSIONS: The data from this review demonstrate that the Ross procedure can be done safely, with short hospital stays, decreased morbidity, and costs comparable with those of standard mechanical aortic valve replacement in patients with isolated aortic valve disease.

Adolescent↗
PubMed1998

Comparison of immunoaffinity chromatography enrichment and nuclease P1 procedures for 32P-postlabelling analysis of PAH-DNA adducts.

32P-postlabelling analysis for detecting DNA adducts formed by polycyclic aromatic compounds is one of the most widely used techniques for assessing genotoxicity associated with these compounds. In cases where the formation of adducts is extremely low, a crucial step in the analysis is an enrichment procedure for adducts prior to the radiolabelling step. The nuclease P1 enhancement procedure is the most established and frequently used of these methods. An immunoaffinity procedure developed for class specific recognition for polycyclic aromatic hydrocarbon (PAH)-DNA adducts has therefore been compared with the nuclease P1 method for a range of DNA adducts formed by PAHs. The evaluation was carried out with skin DNA from mice treated topically with benzo[a]pyrene, 7,12-dimethylbenz[a]anthracene, 5-methylchrysene or chrysene. The immobilised antibody had the highest affinity for adducts structurally similar to the BPDE-I-deoxyguanosine adduct ([+/-]-N2-(7r,8t,9r-trihydroxy-7,8,9,10-tetrahydrobenzo[a]pyrene-1 0t-yl)-2'-deoxyguanosine) against which the antibody had been raised. Of the PAH-modified DNAs evaluated, the maximum adduct recovery was obtained for DNA containing the BPDE I-deoxyguanosine adduct. With DMBA-modified DNA, the profiles of adducts recovered from the column were similar when the column material was treated either with a digest of DMBA-modified DNA or with 32P-labelled DMBA adducts. I-compounds (endogenous adducts in tissue DNA of unexposed animals), which had similar chromatographic properties to PAH-DNA adducts, were not enriched by the immunoaffinity procedure. Compared to the simple nuclease P1 enhancement procedure, the immunoaffinity methods were lengthier and more labour intensive. Advantages of the immunoaffinity procedure include: specificity, allowing the selective detection of a certain class of adducts: efficient adduct enrichment, providing a viable alternative to other enrichment procedures; adequate sensitivity for model studies and the potential to purify adducts for further characterisation. However, as a general screen for detecting the formation of DNA adducts, the nuclease P1 procedure was viewed as the initial method of choice since it was capable of detecting a wider range of PAH-DNA adducts.

9,10-Dimethyl-1,2-benzanthracene↗
PubMed2005

[The Hartmann procedure: current situation in Spain].

INTRODUCTION: The therapeutic alternatives in emergency surgery of the colon are a constant subject of debate and the Hartmann procedure is one of the most controversial techniques. The aim of the present study was to analyze when, why and in whom this procedure is performed, as well as its results. PATIENTS AND METHOD: We performed a descriptive analysis of 105 emergency Hartmann procedures. Clinical variables (age, sex, antecedents, symptoms, risk factors, preoperative diagnosis) were analyzed and correlated with surgical variables (surgical findings, surgeon) indicating the Hartmann procedure depending on general and local factors. RESULTS: The mean age was 69.3 years and 56% of the patients were men. Seventy-three percent had personal antecedents. Presenting symptoms were occlusion in 48%, acute abdomen in 30% and septic shock in 12%. Seventy-eight percent were ASA III-IV. The most frequent surgical findings were intestinal occlusion (39%), purulent peritonitis (22%) and fecal peritonitis (18%). Perforation of the colon was found in 14%. Morbidity was 51% and mortality was 11%. Sixty-three percent of the procedures were performed by general surgeons and 37% by specialists in colorectal surgery. In 20 patients intestinal continuity was restored after a mean wait of 9 months. Retrospective evaluation of the indications for the Hartmann procedure revealed that 50.5% of the patients could have undergone anastomosis and the reasons for not performing this procedure were analyzed. CONCLUSION: In our experience the Hartmann procedure is performed primarily for factors related to the patient (risk factors, general status and local status of the abdomen) and secondly due to factors related to the duty surgeon.

Adult↗
PubMedDate not supplied

Artifact removal procedure distorts multifocal electroretinogram.

PURPOSE: To study whether the Artifact Removal procedure available for eliminating artifacts in multifocal electroretinograms (mERG) works correctly or not. METHODS: A test response was made using a photo-diode circuit. mERGs were recorded from 3 well-trained normal subjects using the Veris III system, and were then analyzed by the procedure that is included in the Veris Science (Artifact Removal) software program. The stimuli consisted of densely arranged arrays of 103 or 37 hexagonal elements. It took a total of 8 minutes to obtain one mERG record, and 16 sessions were required to complete this record. The first-order as well as the second-order kernel response components were extracted by Veris Science software, and the Artifact Removal procedure was used for both components. RESULTS: The Artifact Removal procedure influenced both the test response on the center element as well as the neighboring traces just around the test response. After the repetitions of the Artifact Removal procedure, the shape of the test response changed considerably. Some of the traces of the second-order kernel response components elicited from a normal subject changed irregularly when the Artifact Removal procedure was repeatedly used. The noise increased at the first iteration of the Artifact Removal procedure. CONCLUSION: This procedure has been considered useful for eliminating artifact distortion in mERG, but should be carefully checked by well-established testing methods before clinical use.

Adult↗
PubMed2003

Effect of laboratory procedures and thermocycling on the shear bond strength of resin-metal bonding systems.

STATEMENT OF PROBLEM: During fabrication or repair of removable partial dentures, resin-to-metal or resin-to-denture tooth bonds may be stressed by laboratory procedures. PURPOSE: The purpose of this in vitro study was to evaluate the effect of steam cleaning, boiling, ultrasonic cleaning (laboratory procedures), and thermocycling on shear bond strength of resin bonds to metal and denture teeth. MATERIAL AND METHODS: Resin-metal bonding systems and their specific veneer resins (Rocatec, Sinfony; Rocatec, Visio-Gem, HLC-BOND, Zeta LC and Ducera experimental veneer resin) were tested on a Co-Cr alloy (Wirobond C). The veneer resins were bonded to resin denture teeth. The experimental groups (n=7) were subjected to the following conditions: 24-hour storage of the specimens in air (group I, control group), storage in air and treated with simulated laboratory procedures (2 minutes steam cleaning, 15 minutes ultrasonic cleaning at room temperature, 1 hour boiling in water, group II), storage in air with thermocycling (5000 cycles, 5 degrees to 55 degrees C, group III), storage in air with laboratory procedures followed by thermocycling (group IV), and storage in air with thermocycling followed by laboratory procedures (group V). Shear strength tests (MPa) were performed with a universal testing machine until fracture. After shear bond testing, the failure mode of the resin-metal and resin-denture tooth bonds was assessed. Statistical analysis of the results was carried out with one-way analysis of variance and Bonferroni-Dunn's multiple comparisons post hoc analysis for test groups (alpha=0.05). RESULTS: Except for Ducera/denture tooth specimens (groups III to V: 8.7 +/- 3.4-9.1 +/- 1.7; 10.8 +/- 1.9 MPa control group), the Wirobond C and denture tooth specimens (groups III, IV and V: 1.4 +/- 0.9-11.9 +/- 2.3 MPa), showed significantly lower shear bond strengths than the corresponding control groups (7.5 +/- 2.9-21.0 +/- 3.4 MPa, P<.05). The shear bond strengths of group II of Sinfony/Wirobond C (11.6 +/- 3.3 MPa, P<.0001), Visio-Gem/Wirobond C (7.4 +/- 1.9 MPa, P<0.0001), Ducera/Wirobond C (11.8 +/- 2.9 MPa, P<.0001) and of Zeta/denture tooth (3.9 +/- 1.6 MPa, P=.0005) were significantly decreased by steam, boiling, and ultrasonic procedures compared with the corresponding control groups (21.0 +/- 3.4 MPa; 14.7 +/- 4.0 MPa; 19.1 +/- 2.3 MPa; 7.5 +/- 2.9 MPa, respectively). No significant differences were noted among groups III, IV, and V. Co-Cr specimens subjected to the Rocatec system and bonded with Sinfony and HLC BOND/Zeta specimens showed cohesive failure. Adhesive failure was observed for the experimental veneer resin on the Co-Cr specimens and for all veneer resins on the denture teeth. CONCLUSION: Simulation of laboratory procedures and thermocycling caused a significant drop in shear bond strength of metal-resin and denture tooth-resin bonds for most of the tested veneer resins. Thermocycling before shear testing had the same effect on veneer resin bond strength as the simulated laboratory procedures.

Acrylic Resins↗
PubMed2002

Comparison of four reverse transcription-polymerase chain reaction procedures for the detection of dengue virus in clinical specimens.

The sensitivity of dengue virus identification by mosquito inoculation and four reverse transcription-polymerase chain reaction (RT-PCR) procedures (Am. J. Trop. Med. Hyg. 45 (1991) 418 (H); J. Clin. Microbiol. 29 (1991) 2107 (M); J. Clin. Microbiol. 30 (1992) 545 (L); and Southeast Asian J. Trop. Med. Public Health 27 (1996) 228 (Y)) were compared using coded clinical specimens derived from areas in Thailand where all four dengue serotypes circulate. The sensitivity of virus detection in serologically confirmed dengue cases was 54, 52, 60, 79, and 80% for mosquito inoculation, procedures H, M, L and Y, respectively. In comparison to clinical specimens which yielded virus isolates by mosquito inoculation, there was relatively low sensitivity in detecting each of the four dengue serotypes by PCR: procedure H-dengue 4 (25%), procedure M-dengue 3 (73%), procedure L-dengue 1 (70%), and procedure Y-dengue 1 (79%). Dengue virus was detectable by RT-PCR for more days of illness and in the presence of dengue-specific antibody when compared to virus isolated in mosquitoes. Procedures L and Y were more sensitive than mosquito inoculation or procedures H and M in detecting all four dengue serotypes in clinical specimens and may be the RT-PCR methods of choice for virus surveillance or research use.

Aedes↗
PubMed1996

Diffusion of six surgical endoscopic procedures in the Netherlands. Stimulating and restraining factors.

The diffusion of six surgical endoscopic procedures in the Netherlands was investigated. Questionnaires were sent to 138 laparoscopic surgeons. They were asked which of the following laparoscopic procedures they had adopted in their hospital: cholecystectomy, appendicectomy, Nissen fundoplication, inguinal hernia repair, large bowel resection and thoracoscopic procedures. Furthermore, they were asked to indicate the influence of 13 pre-defined factors: "budget', "competition', "conference', "extra benefit', "media', "nature of the technology', "patient demand', "planning/logistics', "reimbursement', "service industry', "support industry', "surgical technique' and "training/course' on the adoption of those procedures. The adoption rates for the procedures were: 100%, 69%, 19%, 43%, 19% and 52%, respectively. In general, factors were assessed more positively by adopters than by non-adopters. Significant differences were mainly found for "extra benefit', "nature of the technology', "surgical technique' and "conference'. The surgeon's perception of the additional benefits of an endoscopic technique and, to a lesser degree, of its technical aspects were the most important factors in deciding whether or not to adopt a procedure. In an ideal diffusion model, a description is given of when and how the 13 factors can influence the diffusion of an endoscopic procedure in the desired direction. In this model, the extra benefit of a new procedure must be proven before other factors are allowed to influence the diffusion.

Budgets↗
PubMed1995

Modified transnasal endoscopic Lothrop procedure as an alternative to frontal sinus obliteration.

Persistent frontal sinusitis traditionally has been treated with external procedures such as osteoplastic frontal sinus obliteration or the Lynch procedure. Currently, functional endoscopic sinus surgery can be used in most cases to remove disease from the frontal recess, the most frequent site of frontal sinus obstruction, thereby relieving the sinusitis. In some cases, however, frontal recess exploration has failed to relieve the obstruction of the frontal sinus, necessitating an osteoplastic frontal sinus obliteration. We present our experience with a transnasal modification of the Lothrop procedure. The Lothrop procedure, first described in 1914, uses a combined external and transnasal approach to resect the median frontal sinus floor, superior nasal septum, and intersinus septum to drain the frontal sinus. This procedure was largely abandoned and forgotten by modern otolaryngologists. However, with the advent of the computed tomography scan and endoscopic techniques, we sought to reassess the basic tenant of the Lothrop procedure (i.e., wide median frontal sinus drainage). An anatomic study of cadaver heads was performed to quantify the surprisingly large potential opening and to better understand the pertinent anatomy. This procedure was performed on 10 patients, with no resulting complications and no failure to maintain patency of the frontal sinus drainage throughout the follow-up period (mean, 7 months). We are encouraged by our initial favorable results and intend to use the procedure in the future as needs arise.

Adult↗
PubMed1992

Sertl shelf arthroplasty (BOP procedure) in the treatment of canine hip dysplasia.

The BOP/Sertl shelf arthroplasty procedure is not difficult or lengthy. It uses minimal metallic fixation. It is quite physiological with minimal morbidity because there is no change in the bony anatomic pelvis except to create an extension of the lateral rim of the acetabulum. The animal is able to walk the day after surgery. The procedure can be performed bilaterally the same day, thus creating good bony stability and decreasing stretching of the joint capsule, which in turn prevents further subluxation and pain in the hip joint. The aim of this procedure is to return the animal to a satisfactory lifestyle through an effective but less complicated surgical procedure as compared to other available options. This procedure is straightforward and can be done by a surgeon who is familiar with orthopedic surgical techniques and has been trained in this procedure. To date, more than 150 veterinarians have had hands-on training to perform this operation. We are not claiming that this procedure is a cure for CHD; rather, it is a procedure that dramatically slows down the progress of this malady and allows the dog to lead a more normal lifestyle and avoids euthanasia. After 51 months, our study of 200 hips has had a success rate of 99% on the animals available for follow-up as evidenced by returning those animals to a satisfactory lifestyle with stable hips.

Animals↗
PubMed1998

Loss of glove integrity during emergency department procedures.

STUDY OBJECTIVE: We sought to assess the loss of integrity of the latex-glove barrier during use in the ED setting. METHODS: We conducted a prospective observational study in an urban ED and Level I trauma center. Procedures performed by ED health care workers (HCWs) were directly observed, timed, and categorized. The gloves used by the HCWs were collected and subjected to the standard US Food and Drug Administration leak test. RESULTS: Ninety-nine (7.9%) of 1,254 pairs of gloves used for observed procedures leaked, compared with 2 of 200 unworn control pairs (1.0%) and 12 of 300 pairs that were worn but not used (4.0%). Leak rates varied by manufacturer and were higher for gloves worn 20 minutes or longer (13.7%, P = .015), used for four or more procedures (50%, P < .01), or used for critical care procedures (23.5%, P < .01). Sixty-six of an additional 325 pairs of gloves collected from unobserved critical care procedures (20.3%) leaked. CONCLUSION: Loss of glove integrity occurs during the performance of ED procedures, subjecting the HCW to possible infectious-fluid exposure. Risk of glove perforation increases with duration of wear, number of procedures performed, and the performance of critical care procedures.

Critical Care↗