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At least 1,045 records · Page 58Linked to original sources
PubMed2000

Intraoperative computed tomography for complex craniocervical operations and spinal tumor resections.

OBJECTIVE: To improve intraoperative observation of unexposed anatomic features and to verify surgical correction, a mobile computed tomographic (CT) scanner has been introduced into the operating room. To date, intraoperative CT scanning has been used predominantly for intracranial procedures. We report on the expanded use of intraoperative CT scanning for spinal surgery, because CT scanning provides excellent observation of osseous pathological features. We report on our first 17 cases, which involved complex craniocervical operations and spinal tumor resections. METHODS: The Tomoscan M CT scanner (Philips Medical Systems, Eindhoven, The Netherlands) is mobile and consists of a translatable gantry, a translatable table, and an operator's workstation. In the operating room, the patient is placed on the CT table and prepared in the usual manner. The aperture of the gantry is covered with sterile plastic drapes. The gantry is docked to the table for intraoperative CT scanning as needed for navigation and verification during surgery. Each series of scans requires approximately 15 to 20 minutes. RESULTS: Our initial experience with neurosurgical spinal cases demonstrated that the use of intraoperative CT scanning changed the course of surgery in 6 of 17 cases. CT scanning was beneficial in facilitating adequate ventral clival and craniocervical decompressions, promoting more complete tumor resections, and verifying correct graft and instrument placement before surgical closing. Other settings in which we have found the mobile CT scanner useful include the neurointerventional suite and the intensive care unit; it is also useful for radiotherapy planning. CONCLUSION: On the basis of findings for our first 17 spinal surgery cases, we conclude that intraoperative CT scanning of the spine is both feasible and beneficial for select complex spinal procedures from the craniocervical junction to the sacrum.

Adult↗
PubMed1994

[Combined lung and liver transplantation. Anesthesiologic management].

A 53-year-old man with alpha-1-antitrypsin deficiency had an 8-year history of progressive dyspnoea and two episodes of bleeding oesophageal varices with liver decompensation. After the diagnosis of terminal pulmonary emphysema (Fig. 1) and liver cirrhosis with progressive liver failure was made, he was accepted for combined lung and liver transplantation. METHODS. Anaesthesia was induced with thiopentone and fentanyl and maintained with fentanyl, midazolam, and isoflurane. After relaxation with succinylcholine, the patient's trachea was intubated with a left endobronchial double-lumen tube. Haemodynamic monitoring included arterial, central-venous, pulmonary-artery, and capillary-wedge pressures and cardiac output measurement. Ventilatory monitoring consisted of pulse oximetry, side-stream spirometry, and continuous measurement of arterial and mixed-venous blood oxygen saturation with fibreoptic catheters. A left single-lung transplantation was performed under one-lung ventilation without cardiopulmonary bypass. Prostacyclin was infused to reduce pulmonary vascular resistance. The transplant was ventilated separately with 50% oxygen and positive end-expiratory pressure of 8-10 cm H2O, and then liver transplantation was carried out. The institution of veno-venous bypass during the anhepatic phase failed because of portal-vein and axillary-vein thrombi. RESULTS. Total operation time was 6 h 30 min. Clamping of the left pulmonary artery lasted 45 min and the duration of the anhepatic phase was 92 min. Ventilation and oxygenation during lung transplantation caused no problems (Table 1). Clamping of the left pulmonary artery caused a slight increase in pulmonary vascular resistance (104 to 124 dyn.s.cm-5) and mean pulmonary artery pressure (25 to 27 mm Hg) without a decrease in cardiac index (Table 2). During the anhepatic phase with exclusion of the portal vein and inferior vena cava, a marked decrease in cardiac index (-27.2%) was seen (Table 4). The operation required substitution with 10 units packed red blood cells, 12 units fresh frozen plasma, and 5 platelet concentrates. The post-operative course showed normal liver graft function (Table 5). Acute pulmonary rejection on the 7th day was treated successfully with methylprednisolone. The patient's trachea has extubated 10 days after transplantation and he was discharged from the intensive care unit 2 weeks later. CONCLUSION. The management of this combined lung and liver transplantation was performed according to the experience with isolated lung and liver transplants in our hospital. Aggressive haemodynamic and ventilatory monitoring, including systemic and pulmonary arterial fibreoptic catheters, seems of particular importance in such high-risk procedures.

Anesthesia↗
PubMed2006

Multiple twinning in cubic crystals: geometric/algebraic study and its application for the identification of the Sigma3(n) grain boundaries.

Multiple twinning in cubic crystals is represented geometrically by a three-dimensional fractal and algebraically by a groupoid. In this groupoid, the variant crystals are the objects, the misorientations between the variants are the operations, and the Sigma3(n) operators are the different types of operations (expressed by sets of equivalent operations). A general formula gives the number of variants and the number of Sigma3(n) operators for any twinning order. Different substructures of this groupoid (free group, semigroup) can be equivalently introduced to encode the operations with strings. For any coding substructure, the operators are expressed by sets of equivalent strings. The composition of two operators is determined without any matrix calculation by string concatenations. It is multivalued due to the groupoid structure. The composition table of the operators is used to identify the Sigma3(n) grain boundaries and to reconstruct the twin related domains in the electron back-scattered diffraction maps.

Copper↗
PubMed1990

[Diagnostic approach in coronary disease in vascular surgery. Role of myocardial scintigraphy].

Dipyridamole thallium scintigraphy (tomo SMTD) (fig. 2) and a bicycle stress-testing ECG were performed in a prospective study of 102 patients (Tabl. VIII) referred for aortic reconstruction surgery with aortic cross-clamping (fig. 1), carried out without knowledge of tomo SMTD results. A clinical coronary artery disease (CAD) was suspected in 45 patients (44%). The exercise test (tabl. IV) was inadequate in 78%, normal in 11% and abnormal in 11% of patients. Tomo SMTD (tabl. VI et X) was normal in 60 patients (59%), abnormal with persistent defect in 21 (20.5%) and abnormal with transient defect in 21 (20.5%). Post-operative cardiac events (tabl. I) occurred in 4 patients (3.9%): 2 deaths, 1 non-fatal myocardial infarction and 1 rest angina; but only 2 of these had documented CAD. All 4 had abnormal tomo SMTD (3 with transient, 1 with persistent defect). It is concludes that abnormal tomo SMTD had a significant pronostic value (p less than 0.03) in predicting post-perative cardiac events (tabl. XI, fig. 3) after abdominal aortic surgery with cross-clamping. This test facilitates selection of patients for coronary angiography.

Aged↗
PubMed1979

[Primary small-intestinal neoplasms. Discussion of own experiences and of the literature].

There is a relatively long delay in diagnosis of malignant tumors of the small bowel and operation is often carried out too late. These tumors cause symptoms in about 90% of the cases (according to our own experiences in 20 of 21 cases). In the discussion of the symptoms there is a description given that might be a help for "earlier thinking of it". Anamnesis and exploratory laparotomy are of paramount importance for the diagnosis in time. Operation carried out in time leeds to a relatively favourable prognosis. Out of 5 patients who did not have metastases at the time of operation there are 3 alive for longer than 8 years post operationem. From the German literature of the past 10 years (288 cases) the following data were subsumized in a table: radical resection, operation mortality, 5-year-survival, delay of diagnosis, ileus/perforation, diagnosis by barium studies of the small bowel.

Aged↗
PubMed2005

A portable, universal patient positioning and holding system for use in the burn patient 'The Burnwalter'.

A technique is described for the intra-operative positioning of the burn patient, which allows circumferential access without the need for specialized equipment or extra personnel. The equipment is available in any standard operating room and table without the need for redesign or new construction. In addition, it allows full 360 degrees access and eliminates the need for extra personnel to hold proper positioning. This allows for more efficient operating and should minimize the unwanted sequelae of hypothermia and blood loss. Operating time may be decreased and the patient may require less operative procedures. The same or more work can be done by less personnel, in less time, with no added cost.

Burns↗
PubMed1994

Superficial femoral vein: a useful autogenous harvest site.

PURPOSE: The purpose of this study was to present the use of superficial femoral vein (SFV) as an arterial bypass graft when ipsilateral saphenous vein is inadequate. METHODS: Data collected prospectively were reviewed on 24 patients (25 limbs) who had an arterial bypass with SFV performed by the authors between January 1, 1988, and December 31, 1991. Many anatomic sites are represented. The indication for operation was gangrene in six patients, severe rest pain or ulceration in 11, mild to moderate rest pain in six, and graft infection in two. There had been 42 previous reconstructions in these 25 limbs. RESULTS: There has been surprisingly little long-term disability from removal of the SFV. Immediately after surgery four limbs developed acute venous congestion that resolved quickly. Twenty percent of the patients with patent grafts have continued to wear a pressure gradient stocking for swelling 1 year after surgery, one patient requires additional pressure to control induration. All grafts were patent at 30 days. During a mean follow-up of 2 years, three grafts have required revision, and three have occluded. Stenosis did not develop at valve sites or in the body of the SFV portion of any of these grafts. There were two deaths from heart-related causes in the first 30 days after operation. Life-table analysis for the whole group shows a primary patency rate of 66% (SE 10.3%) and an assisted patency rate of 80% (SE 8.7%) at 2 years. CONCLUSIONS: SFV harvest is well tolerated, even in the absence of ipsilateral saphenous vein. The magnitude of the operation is greater than saphenous vein harvest but yields a thick-walled vein of excellent diameter with many applications as an autogenous conduit, particularly where a large-diameter graft is indicated.

Aged↗
PubMed2006

Predictors for mortality after lower-extremity amputations in geriatric patients.

BACKGROUND: The identification of independent predictors for operative and long-term mortality after lower-extremity amputations in the geriatric population would allow targeted management for high-risk patients and appropriate allocation of resources. METHODS: Univariate and multivariate logistic regression analyses were used to identify independent predictors for operative mortality. Life tables and Kaplan-Meier survival curves were generated. Independent predictors for long-term mortality were tested by log-rank test followed by Cox regression analysis. RESULTS: Female gender, congestive heart failure, and high-level amputation were identified as independent predictors for operative mortality (odds ratios 4.14, 4.59, and 4.77, respectively). The logistic regression model showed good calibration and discriminative power. Female gender, high-level amputation, cerebrovascular accident, congestive heart failure, noncommunity ambulation, and institutionalization before amputation were associated with an increased risk for long-term mortality. However, only high-level amputation, congestive heart failure, and noncommunity ambulation remained as independent risk factors after Cox regression analysis (relative risks 1.68, 2.08, and 2.10, respectively). CONCLUSIONS: Extra care should be given to patients identified with independent predictors for operative and long-term mortality.

Aged↗
PubMed1995

Progesterone concentration as a predictor of pregnancy normalcy is the most useful when hCG levels are less than 2000 mIU/mL.

OBJECTIVE: Measurements of serum progesterone to predict early gestational normalcy have been found to be as predictive as serial hCG titers. Since ultrasound would be the diagnostic tool of choice if hCG was > 2000 mIU/ml, the purpose of the present study was to determine the best predictive value of a single progesterone measurement when hCG levels were < 2000 mIU/ml. DESIGN: Relative operating characteristic analysis of progesterone level as a predictor of early gestational normalcy when hCG is < 2000 mIU/ml. MATERIALS AND METHODS: Ninety-three pregnant patients that conceived spontaneously were evaluated with progesterone measurements when the patient's hCG was < 2000 mIU/ml. Two-by-two contingency tables were constructed that compared pregnancy outcome with multiple discriminatory serum progesterone concentrations between 0 and 38 ng/mL. From these tables, a relative operating characteristic (ROC) curve was generated to compare the sensitivity and false-positive rates. RESULTS: Of a total of 93 pregnancies, 27 had a normal outcome and 66 had an abnormal outcome. The ROC curve indicated that a serum progesterone concentration of 12 ng/ml had the highest sensitivity associated with the lowest false-positive rate. The area under the curve was equal to 0.941 +/- 0.024. This observation was compared to our previously reported data of progesterone levels that included hCG levels > 2000 mIU/ml, yielding an area under the curve of 0.772 +/- 0.053. Calculation of the critical ratio z revealed that there is a significant improvement in the predictive value of progesterone when hCG is < 2000 mIU/ml (P < 0.005). CONCLUSION: A single serum progesterone level has a better predictive value of pregnancy normalcy when hCG measurements are < 2000 mIU/ml.

Chorionic Gonadotropin↗
PubMed2001

A rapid look-up table method for reconstructing MR images from arbitrary K-space trajectories.

Look-up tables (LUTs) are a common method for increasing the speed of many algorithms. Their use can be extended to the reconstruction of nonuniformly sampled k-space data using either a discrete Fourier transform (DFT) algorithm or a convolution-based gridding algorithm. A table for the DFT would be precalculated arrays of weights describing how each data point affects all of image space. A table for a convolution-based gridding operation would be a precalculated table of weights describing how each data point affects a small k-space neighborhood. These LUT methods were implemented in C++ on a modest personal computer system; they allowed a radial k-space acquisition sequence, consisting of 180 views of 256 points each, to be gridded in 36.2 ms, or, in approximately 800 ns/point. By comparison, a similar implementation of the gridding operation, without LUTs, required 45 times longer (1639.2 ms) to grid the same data. This was possible even while using a 4 x 4 Kaiser-Bessel convolution kernel, which is larger than typically used. These table-based computations will allow real time reconstruction in the future and can currently be run concurrently with the acquisition allowing for completely real-time gridding.

Algorithms↗
PubMed1997

[Perioperative plasma amino acid spectrum analysis in portal hypertensive cirrhotic patients undergoing portacaval H-graft shunt].

Perioperative plasma amino acid spectrum (PAAS) was analysed in 10 portal hypertensive patients (PH) receiving portacaval H-graft shunt (D = 8 mm) and 10 gastroenteropathic patients (GE) without hepatic disease. In both groups, arterial, peripheral and hepatic venous blood was drawn for analysis immediately pre- and post-operation on the table, postoperative day 1 and 3, respectively. It was found that amino acid concentration decreased in both groups but in PH group it was changed significantly. The preoperative branched chain amino acid (BCAA)/aromatic amino acid (AAA) ratio was less than 2 in the PH group and larger than 3 in the GE group after operation. The ratio did not change significantly in both groups after operation. In the PH group, the pre- and post-operative BCAA and AAA level in hepatic vein was higher than in other sites. The immediately BCAA and AAA levels were lower than preoperative levels. Among the changes the postoperative decrease of VAL and LEU was significant. Both BCAA and AAA reached preoperative level at postoperative day3. The results reveal that small diameter portacaval shunt has no significant influence on PAAS. The temporary decrease of amino acid levels postoperatively may be related to the stress of operation and liver impairement.

Adult↗
PubMed1998

Factors affecting postoperative pregnancy rate after endoscopic management of large endometriomata.

OBJECTIVE: To identify factors influencing postoperative pregnancy rate in women with extensive endometriosis and large endometriomata as the only identified cause of infertility that were treated by laparoscopy. METHOD: Sixty-four infertile patients with endometriomata (> or = 3 cm) and no other apparent cause of infertility. The latter were removed by operative laparoscopy. Life table calculations, the Student's t-test and the chi2 test were used where appropriate. RESULT: Thirty-four patients (53%) became pregnant during the 2-year follow-up period. A significantly increased pregnancy rate was found for the first year compared to the second (76 vs. 24%). The existence of adhesions affected adversely the outcome of the operation only as far as early achievement of pregnancy is considered. The number and size of endometriomata and the existence of peritoneal implants have not been found to affect pregnancy rates. The severity of the disease did not affect pregnancy rate, but in the cases with moderate disease most of the pregnancies were achieved during the first postoperative year. The duration of infertility was significantly associated only at the 10% level with decreased pregnancy rates. CONCLUSION: Extensive endometriosis with large endometriomata can be safely and effectively treated with laparoscopy using the traditional laparoscopic tools providing the infertile patient with a high chance to conceive in a relatively short period of time postoperatively.

Adult↗
PubMed2004

Routine insertion of permanent peritoneal dialysis catheters in the nephrology ward. The sliding percutaneous technique.

AIM: A prerequisite to the technical success of peritoneal dialysis in its different modifications is a safe, reliable, correctly positioned, and functioning peritoneal catheter. The ideal method for insertion of permanent catheters (PC) remains debatable. The most commonly used technique is an open surgical approach, by minilaparatomy. Others have proposed a blind approach, using either a trocar method or a modified Seldinger technique or an insertion by means of peritoneoscopy. METHODS: We describe our 5-year experience (May 1997 - June 2002) with 68 percutaneous PC insertions in 63 consecutive patients. A modified technique of percutaneous PC insertion was used that here we call sliding percutaneous technique (SPT): 1) a midline incision is made 4 cm below the umbilicus; the peritoneum is punctured using a straight plastic catheter with a stylet. The catheter is pushed caudally towards the left iliac fossa; 2) a straight stiff 90 cm stylet is inserted through the temporary catheter, which is subsequently removed. The stylet has 2 tips, a blunt proximal one, which is pushed through the catheter into the iliac fossa, and the distal one; 3) having the stylet in situ, a double-cuffed curled-end PC is mounted at the distal tip of the stylet starting from the curl; then, the PC is gently slid down along the stylet as a train does along the rail-way. PC failure was defined as mechanical dysfunction, persistent dialysate leak and persistent peritonitis, or exit site/tunnel infection requiring PC removal. Furthermore, PC failure was defined as early, if occurring in the first 30 days after PC placement, or late, if occurring more than 30 days post-operation. Life-table estimates of PC survival were determined by Kaplan-Meier analysis. RESULTS: Early complications: in the 1st month on dialysis, obstruction to dialysate flow was the commonest cause leading to PC failure. The early actuarial survival (AS) was 90%. Late complications: peritonitis was the commonest cause of PC failure. The late AS, i.e. excluding the catheter failures occurring in the 1st month post-operation, was 82% at 3 years. Global AS, i.e. including both early and late PC failures, was excellent (74% at 3 years). CONCLUSIONS: Even though this study is retrospective and does not compare percutaneous with surgical PC placement techniques, it allows us to state that percutaneous PC insertion is a well-tolerated, rapidly performed, side-room procedure that gives excellent results, above all when using SPT.

Aged↗
PubMed1978

[Chronic venous insufficiency of the lower extremities and a halt to absenteeism].

In this work authors experiences about the influence of operation on absentism decrease in 2450 surgically treated patients with chronic venous insufficiency signs and clinical manifestations of various intensity have been presented. In the introduction higher frequency of this disturbance and great financial loss which appear as consequence of this disease, as well as complications which affect the patients with syndrome of chronic venous insufficiency have been described. The authors particularly emphasize still intensive conservative attitude in the therapy of this illness, what leads to its deterioration. Further the authors describe the method of their investigation and the results obtained have been presented in tables. That the operative treatment protects the respective patient with such disturbances from more serious clinical manifestations as well as adequate complications of these disturbances has been emphasized in the conclusion. Further it has been pointed out that immediately applied operative treatment obviously decreases absentism.

Absenteeism↗
PubMed1958

The two-wavelength method of microspectrophotometry. II. A set of tables to facilitate the calculations.

The calculations required for two-wavelength measurements are time consuming and laborious. In order to circumvent this limitation of the method, a set of tables which combined four operations into one has been designed and is reproduced within. The tables are based on Patau's formulae. The two transmission readings obtained according to the photometric method provide the coordinates which lead directly to a value for the relative absorbance. The product of this absorbance and the area of the photometric field gives the relative amount of chromophore in the field. The range of transmission values covered in the table corresponds to the effective range of the two-wavelength method.

Microspectrophotometry↗