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Urological complications of Okabayashi's operation for cervical cancer.
It has been suggested that the Okabayashi technique for radical hysterectomy in cervical cancer results in fewer urological complications as compared with the Wertheim-Meigs technique. Of 479 women with cervical cancer operated on consecutively during the period 1963 to 1978 by the Okabayashi operation, 52 (10.8 per cent) had urological complications (17 bladder and ureter injuries, 35 fistulae and strictures). Thirty-five elective urological operations were required (Table IV). Operative mortality related to urological complications was 1/479. Compared with an earlier series of 397 women operated on in our department, mainly by the Wertheim-Meigs operation, the Okabayashi operation did not result in significantly fewer urological complications. However, because of technical advantages and possible better radicality the Okabayashi operation for cervical cancer is still preferred.
[Safe use of the Orthographique II table in the operating room].
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Radiographic table for hip operations.
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[Operating stand-table for large animals].
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[Round table conference. Surgical operations by general practitioners].
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Current operating statistics. Monthly tables.
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Social Security: current operating statistics - monthly tables.
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CFD investigation of room ventilation for improved operation of a downdraft table: novel concepts.
We report a computational fluid dynamics (CFD) study of containment of airborne hazardous materials in a ventilated room containing a downdraft table. Specifically, we investigated the containment of hazardous airborne material obtainable under a range of ventilation configurations. The desirable ventilation configuration should ensure excellent containment of the hazardous material released from the workspace above the downdraft table. However, increased airflow raises operation costs, so the airflow should be as low as feasible without compromising containment. The airflow is modeled using Reynolds Averaged Navier Stokes equations with a high Reynolds number k-epsilon turbulence model. CFD predictions are examined for several ventilation configurations. Based on this study, we find that substantial improvements in containment are possible concurrent with reduction in airflow, compared with the existing design of ventilation configuration.
A new operating room stretcher-table.
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Rhabdomyolysis of gluteal muscles leading to renal failure: a potentially fatal complication of surgery in the morbidly obese.
BACKGROUND: Rhabdomyolysis is a well-known cause of renal failure and is most commonly caused by ischemia/reperfusion or crush injury. We describe a new cause of this syndrome in a series of 6 patients who underwent necrosis of the gluteal muscles after bariatric surgery, 3 of whom eventually died of renal failure. METHODS: Potential etiologic factors were studied by comparing these patients with a consecutive series of 100 patients undergoing primary uncomplicated bariatric surgery during a 1-year period. Demographics, preoperative BMI, co-morbidities, duration of operation, and postoperative creatinine phosphokinase (CPK) levels. RESULTS: All patients presented with an area of buttock skin breakdown initially diagnosed as a simple decubitus ulcer. All had extensive myonecrosis of the medial gluteal muscles requiring extensive debridement. 5 of the 6 patients were male, with median BMI 67 compared with a median BMI 55 in the control group (P=0.0022). The patients were on the operating-room table for a median of 5.7 hours compared with 4.0 in the control group (P=0.01). 3 of the 6 developed renal failure requiring dialysis, which was fatal in all. One other patient developed a transient elevation of BUN and creatinine which did not require dialysis. Since recognition of this pattern, we now routinely perform serial CPK measurements. Median CPK rise in uncomplicated patients was to 1,200 mg/dl (SD 450-9,000), while CPK in affected patients ranged from 26,000 to 29,000 IU/l. We now routinely add additional buttock padding in very obese patients and institute aggressive hydration and mannitol diuresis if CPK rises above 5,000. No cases have occurred in the past 18 months in 220 patients. CONCLUSIONS: This is an important and potentially fatal complication of bariatric surgery. Very obese male patients with prolonged surgery are at risk of gluteal muscle necrosis with consequent renal failure, which we hypothesize is due to pressure by the operating-table leading to rhabdomyolysis and the creation of a compartment syndrome. Prevention may be aided by attention to intraoperative padding and positioning, and by limiting the duration of the operation.
Robotic assistance in microsurgery.
The purpose of this study was to introduce a new robotic system for microsurgical procedures of the eye, ear, brain, face, and hand. The design and main features of the Robot Assisted MicroSurgery (RAMS) work station are described. In addition, compatibility with the operating-room table is assessed. The engineering components of the RAMS work station consist of a laptop computer, a joystick, a mouse, slave robot, VME and amplifier chassis, and safety control box. The mechanical part of the RAMS, the slave robot, is designed to simulate movements of the human upper extremity, which has five joints and six degrees of motion. The robot has a zero backlash in five joints, and can sustain full extension of loads over three pounds. The arm measures 2.5 cm in diameter, and it is 34.6 cm long from its base to its tip. The arm and its base weigh 2.5 kg. Motors and encoders on the robot are easily removable, allowing for the arm to be sterilized in an autoclave. Assessment of robotic positioning, time for setup, relative precision, and possible problems in the operating field are compared with human-assisted microsurgical procedures. Robotic arm positioning on the operating-room table differs for each type of procedure. For those involving the hand and upper extremity, the robotic arm base occupies 35 percent of the operating table; this is only 10 to 15 percent for human-assisted procedures. The setup time for robot-assisted procedures is longer than for human-assisted surgery. However, microsurgical manipulations with the RAMS are more rapid than the surgeon's motions. Therefore, depending on the type of procedure, the total operating time is comparable to human-assisted procedures. The movement of the RAMS was found to be more precise, in attempting to perform vascular and neural anastomoses. The authors conclude that concurrent use of the remote-controlled RAMS as a microsurgical assistant is applicable in microsurgery, with the advantages of greater precision and more rapid microsurgical manipulation. However, the long-term cost effectiveness of using this system as an assistant in microsurgery warrants further investigation.
Endotracheal tube obstruction during stereotactic craniotomy.
The authors present a case of endotracheal tube (ETT) obstruction during stereotactic computer-assisted volumetric resection of an enlarging left thalamic mass in a prone patient. The head was fixed in a stereotactic COMPASS head frame and the patient positioned on transverse hip and shoulder rolls. The prone position was achieved with attention given to ensure an adequate distance between the sternum and mentum. At the time of dural incision, the patient's peak airway pressure and end-tidal CO2 tension increased markedly whereas the O2 saturation remained stable at 99%. It immediately became clear that the patient's torso had moved cephalad resulting in ETT obstruction, despite the continued integrity of head fixation. We emphasize the need for proper and safe patient positioning, the placement of a bite block between the molar teeth, and particularly in obese patients, the need to tape the patient's torso securely to the operating room table. In addition, it may be necessary to place the operating room table in reverse Trendelenberg position to prevent cephalad movement of the torso. This case represents an unusual mechanism of ETT obstruction, as normally the latter is caused by flexion of the head rather than by cephalad movement of the torso.
On-table pancreatography: importance in planning operative strategy.
We describe our experience with 124 on-table pancreatograms performed during 117 operative procedures on 112 patients in a wide variety of clinical settings. Endoscopic retrograde cholangiopancreatography (ERCP) was performed on 84 occasions with a 73 per cent success rate for visualization of the main pancreatic duct. On-table pancreatography (OTP) was performed by one of five different techniques: retrograde, prograde or ambigrade ductography, cystography and ascending loopography after pancreaticojejunostomy. OTP provided important information about the main pancreatic duct when endoscopic visualization was unsuccessful (n = 23), incomplete (n = 17) or not performed (n = 33); there was a failure rate of 4 per cent. In 35 patients either the additional information or discrepancies between ERCP and OTP findings resulted in a change of operative plan (19 extra procedures, 16 altered procedures). Complete ductography was especially helpful in the 63 patients with chronic pancreatitis. OTP is technically simple, free from complications and invaluable for planning operative strategy.
Formal representation of summary tables for health care statistical database management.
There is an ever-increasing demand for statistical information in health-care societies, and voluminous statistics are collected every year. When one needs information on survey results, it is generally not allowed to access the original data, and the summary tables are the most important source of information which can be shared. In order to store summary tables as a well-organized database and to perform flexible retrieval, a formal study has been made on the structure of summary tables. We introduce the notion of summary table scheme and define the operations called table transformation. A statistical database management system has been implemented based on the study. In our study, a statistical database is a collection of summary tables obtained from a survey. If a survey is conducted periodically, a database consists of all the tables obtained in the past. System utilities have been implemented for handling time-oriented information.
Septic complications in colo-rectal surgery after 24 hours versus 60 hours of preoperative antibiotic bowel preparation. I. Prospective, randomized, double-blind clinical study.
A prospective, randomized, double-blind study was performed to compare 24 hours and 60 hours of preoperative antibiotic bowel preparation by means of gentamicin + vancomycin + mycostatin. 83 patients undergoing elective colo-rectal operations completed the study (Tablet I), and the two groups proved similar in terms of age, sex, diagnosis, surgical procedures and operation time (Table II). No significant difference in septic complications was found between patients receiving 24 hours and 60 hours of preoperative treatment (Table III). Wound infection occurred significantly more frequently in operations of long duration (Table IV). Cultures made from infected wounds revealed a mixture of aerobic and anaerobic bacteria in half of the cases, whereas pure aerobic or anaerobic infections were equally frequent (Table V).
Cost-savings case study: clinical engineering management maintenance of sterilizers and operating room and procedure tables.
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Complexities in ETS-domain transcription factor function and regulation: lessons from the TCF (ternary complex factor) subfamily. The Colworth Medal Lecture.
The ETS-domain transcription factor family can be divided into a series of subfamilies. Elk-1 represents the founding member of the ternary complex factor (TCF) subfamily. By focusing on the TCF subfamily, we can demonstrate the complexities that exist in the function and regulation of ETS-domain transcription factors. This article focuses on Elk-1 in detail and summarizes the functions of other TCFs. The key themes covered include the domain structure of the TCFs, the mechanisms of complex formation with serum response factor, regulation of TCFs by mitogen-activated protein kinase cascades, and transcriptional regulatory properties of the TCFs. Finally, the emerging role of the TCFs in vivo is discussed. A picture is developing indicating that, while these proteins exhibit significant sequence and functional conservation, key differences in their structure and regulation are being identified which may relate to unique functions of these proteins in vivo.