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At least 955 records · Page 53Linked to original sources
PubMedDate not supplied

Comparison of radiolucent and fracture tables in the treatment of slipped capital femoral epiphysis.

A retrospective study was undertaken to see whether there was any difference in the time required and the accuracy of pin placement between slips pinned on a fracture table and those pinned on a radiolucent table. All patients were treated by single screw fixation of stable slipped capital femoral epiphysis (SCFE), 36 on a fracture table and 29 on a radiolucent table. Mean operating room time on the fracture table (63 minutes) was greater than that on the radiolucent table (51.2 minutes) (P <0.05). Mean surgery time for the fracture table (38.55 minutes) was greater than that on the radiolucent table (24.8 minutes) (P <0.05). The deviation of screw placement from the ideal for the two tables was not significantly different in the anteroposterior or lateral planes. The use of the radiolucent table, with manipulation of the limb to obtain lateral images of the hip, is a useful alternative to use of the fracture table for pinning of SCFE.

Adolescent↗
PubMedDate not supplied

Evaluation of operative imaging techniques in surgical education.

BACKGROUND: Certain open surgical procedures are difficult to observe, and poor visualization of the surgical field results in a compromised teaching environment for residents and medical students. In an attempt to improve the visualization of the open surgical field, we performed an open surgical procedure while viewing it via a laparoscope mounted to the side of the operating room table with an alpha port. These images were then compared in a blinded fashion with images from a boom-mounted camera positioned above the surgical field and a head-mounted camera positioned on the operating surgeon. METHODS: Participants viewed all 3 images from a remote location in a blinded, random fashion. All participants then completed a Likert questionnaire evaluating each image. RESULTS: Fourteen participants were in the study. The alpha port/laparoscope image was superior to the head-cam image in all 8 categories. The alpha port/laparoscope image was superior to the sky-cam image in 4 of 8 categories. All 14 participants felt the alpha port/laparoscope image would benefit surgical education CONCLUSIONS: Use of a laparoscope mounted via an alpha port to an operating room table provides superior images during open surgery. This provides a unique and affordable way to teach residents and medical students operative procedures that are otherwise difficult to view.

Adult↗
PubMedDate not supplied

Pressure ulcer risk factors in cardiac surgery: a review of the research literature.

BACKGROUND: Pressure ulcer incidence in patients undergoing cardiac surgery is reported to be up to 29.5%. Common known risk factors for pressure ulcer development include compressive and shearing forces. However, knowledge about the specific risk factors in a defined population is helpful in the development of an effective prevention management. This literature review is part of a quality improvement project to reduce pressure ulcer incidence in the cardiac surgery population. OBJECTIVES: The objective is to determine "which specific risk factors for pressure ulcer development in the cardiac surgery population are identified in the literature." RESULTS: The results of this literature review indicate a high-risk potential in the tissue tolerance for oxygen as temperature manipulation, vasoactive drugs, hypotensive periods, and reduced hemoglobin and hematocrit levels. Time on the operating room table, frequency of repositioning, immobility time, older age, low albumin level, and corticosteroid are also found as significant risk factors in this population. CONCLUSION: Diseases that influence oxygen supply in older patients in combination with the special demands of temperature and circulation regulation during the cardiac surgical procedure place the patient at risk for pressure ulcer development. Prevention measures should be aimed at supporting tissue tolerance for pressure and tissue tolerance for oxygen. These measures should be additional to pressure-relieving devices on the operating room table and, postoperatively in bed, a defined minimum frequency of postoperative turning and early mobilization after the surgical procedure should be considered.

Cardiac Surgical Procedures↗
PubMed2000

Advances in mobile intraoperative magnetic resonance imaging.

OBJECTIVE: The goal was to enhance a mobile magnetic resonance imaging system developed for neurosurgery. Components of the system included an actively shielded, 1.5-T superconducting magnet, a titanium operating room table, a radiofrequency (RF) head coil that could be disassembled, and local RF shielding. METHODS: The system was designed and implemented by the Division of Neurosurgery, University of Calgary (Calgary, Alberta, Canada), in collaboration with the National Research Council of Canada Institute for Biodiagnostics (Winnipeg, Manitoba, Canada). The ceiling-mounted, 1.5-T magnet was moved into and out of the surgical field as required. After initial success in monitoring the resection of various intracranial and cranial base lesions, significant modifications to the system were made by Innovative Magnetic Resonance Imaging Systems, Inc. (Winnipeg, Manitoba, Canada), and BrainLAB (Heimstetten, Germany). These modifications included the design and construction of a shorter magnet with a larger bore and stronger gradients, widening of the titanium operating room table, modification of the RF coil housing to allow vertical movement and incorporation of a three-pin head-clamp, construction of a transparent, copper-impregnated RF shield, and integration with a surgical navigation system. RESULTS: The movable intraoperative imaging system has now been used for 101 neurosurgical procedures, including the previously reported cases. CONCLUSION: The modifications to the system have enhanced its integration with established neurosurgical techniques and have improved patient safety. The larger magnet bore size, together with the ability to move the RF coil vertically, allows placement of patients in prone or lateral positions. Surgical navigation has been successfully integrated with the intraoperatively acquired high-resolution images. The ability to identify and resect residual lesions before wound closure remains a tremendous immediate advantage of this technology.

Adolescent↗
PubMed1992

Nonorthopedic use of the fracture table.

Use of the fracture table for patient positioning instead of the standard operating room table is advantageous in many nonorthopedic surgical situations. Benefits include circumferential accessibility of bilateral lower extremities, permitting two or more surgical teams to work simultaneously on different anatomical sites. Burns and multiple acute and chronic leg wounds are particularly suitable for this technique.

Adult↗
PubMed1988

[The noise factor in the manufacture of chocolate and pastry products].

Studies are performed on the noise and vibration condition and hearing in women workers in enterprises for confectionery. It is established that the noise is leading occupational hazard in the working environment and in half of the working places significantly surpasses the sanitary norms and the peak values reach sometimes to 102-105 db/A. Especially intensive sources of noise are some machines and industrial operations-vibratory tables, mixers, cocoa-rollers, grinder for sugar and cocoa, the operation "hammering of forms". The vibrations (general) are rarely met hazard in industry. A considerable decrease of hearing in the examined women workers is established.

Audiometry↗
PubMed1996

The micro-laserbot: an alternative method for frameless stereotactic localization.

An alternative method for frameless stereotactic localization which combines an articulating arm for spatial positioning with a three-dimensional laser beam localization technique will be presented. The moveable segments of the arm are counterbalanced, and allow it to smoothly glide to a given position. Micro-brakes in the arm joints permit rigid spatial fixation. The proximal end of the micro-laserbot attaches to the operating room table and the distal end, with the laser localizer apparatus, can be either free or attached to the operating microscope around the objective lens assembly. When attached to the surgical microscope, the laser light beams projected on the brain surface are seen while viewing the surgical field through the operating microscope. When used in this mode, the standard surgical microscope is converted into a stereotactic positional device, and the lasers guide the surgeon during the surgical dissection. Intersection of the laser beams indicate the spatial position of targets and volumes which are referenced and seen on the multi-modality computer imaging system. When not attached to the microscope, various other instruments can be affixed to the distal end of the micro-laserbot for stereotactic referencing.

Equipment Design↗
PubMed1984

[Indications for early operation in acute gastric hemorrhage].

Under study were 1392 patients with acute gastric hemorrhage in order to analyze indications for early operations. A table of indications is made with the help of Wald's consecutive analysis. It was found that when the operation was indicated and fulfilled the mortality rate was significantly lower than when the patient was not operated upon.

Acute Disease↗
PubMed2005

Risk factors regarding the need for a second operation in patients with Crohn's disease.

BACKGROUND/AIMS: The majority of Crohn's disease patients undergo surgery. However, the factors that predict post-operative recurrence remain controversial. The aim of the present study was to shed light on the potential predictors of such recurrence. METHODS: 86 patients who underwent operative procedures for Crohn's disease were retrospectively studied. Recurrence was defined as the need for a second operation. Life table and multivariate analysis were performed to find the predictors of recurrence. RESULTS: In 26/86 (30%) of the patients, post-operative recurrence was diagnosed within a mean of 42 months of the follow-up. Logistic regression analysis revealed that smoking (OR 3.69, 95% CI 2.06-11.52) and perforating disease (OR 4.09, 95% CI 1.31-12.65) were associated with a risk of recurrence. However, survival analysis showed that only perforating disease was associated with an early post-operative recurrence (log-rank test, p < 0.001). Neither resected surgical specimen characteristics, nor the duration and the location of the disease were found to predict the need for a second operation. CONCLUSION: The risk for Crohn's disease patients who undergo surgery is related to the presence of perforating disease and smoking, which predict the need for a second operation. The former is associated with an even earlier recurrence.

Adult↗
PubMed2001

Neurosurgical suite of the future. I.

Although the past 10 years have seen a huge influx of technology into the operating room, the environment within which this technology is used has not been greatly modified. The result is a poorly integrated collection of machines and an overcrowded situation in the floor space around the operating room table. Clearly, many areas are open for improvement in the process of surgery, from booking a case to carrying out the operation. Newer operating room designs need to incorporate the flexibility to handle the ever-increasing digital information load that is being generated and that is necessary for the surgical environment to be efficient in time and cost. Room for expansion without major reconstruction should also be incorporated in these designs. In addition, because one operating room design cannot be all things to all specialties, specialized room designs for surgical services would be practical and necessary. The next 10 years will offer the opportunity to make some of these changes, and many groups are working toward making them a reality.

Humans↗
PubMed1995

Intramedullary nailing of aseptic tibial nonunions without the use of the fracture table.

Twenty-seven patients with 28 aseptic nonunions were treated with reamed intramedullary (IM) nailing of the tibia and were followed for at least 1 year postoperatively. The management protocol called for a radiolucent operating room table with the limb draped free and manual manipulation of the nonunion with a preference for closed nailing. Nail interlocking was used when residual axial or rotational instability was observed after nail insertion. Iliac crest bone grafting was performed on all patients requiring open nailing. Closed nailing, using the described technique, was accomplished in 20 cases; open nailing was necessary in eight. Although operative time and total blood loss were significantly increased with open nailing, time to union was similar in the two groups. Twenty-seven nonunions healed. The lone persistent nonunion responded to bone grafting, leaving the nail in situ. One infection occurred, which responded to debridement, drainage, and long-term antibiotic therapy without requiring nail removal. Acceptable bony alignment was attained in all patients. Functional results were excellent. This method is recommended for all tibial nonunions amenable to IM nail stabilization. A history of prior acute infection and/or excessive shortening due to bone loss constitute the relative contraindications.

Adolescent↗
PubMedDate not supplied

Spontaneous right ventricular disruption following treatment of sternal infection.

BACKGROUND: Spontaneous right ventricular disruption is a rare and frequently catastrophic event that occurs during the treatment of mediastinitis complicating median sternotomy wound. OBJECTIVE: The purpose of this study is to understand the pathogenesis of the spontaneous right ventricular disruption and to suggest strategies for the prevention and treatment of this rare but potentially fatal complication of cardiac surgery. METHODS: We report three cases as an introduction to the review of 39 cases found in the English-language literature. RESULTS: The majority of patients (71%) underwent coronary artery bypass grafting as the primary procedure prior to the development of a sternal infection. Staphylococcus Aureus and Staphylococcus Epidermidis were cultured most frequently from the sternal wound (31% and 24%, respectively). The mean interval between sternal debridement and the right ventricular disruption was 2.9 days. Most patients (24 of 42) required cardiopulmonary bypass for the repair of the right ventricular disruption. Biologic patches and adjuncts were used in 15 patients (36%). Eight patients (19%) died either preoperatively or on the operating-room table. CONCLUSIONS: Spontaneous right ventricular disruption is a potentially preventable complication. To prevent this complication we recommend: (1) avoidance of delay between diagnosis and operative treatment of mediastinitis; (2) complete lysis of adhesions between the posterior sternal edge and anterior surface of the right ventricle under general anesthesia with heart-lung machine stand-by; (3) repair of the right ventricular tear using biologic patches with heart-lung machine stand-by; (4) early (if possible immediate) closure of the chest with a myocutaneous flap.

Aged↗