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PubMed1995

Quantification of operative benefit for unruptured cerebral aneurysms: a theoretical approach.

The indications for surgery on unruptured asymptomatic cerebral aneurysms are still unclear. In this report, the authors use mathematical methods to attempt to quantify the benefit of surgery for unruptured aneurysms. Theoretical survival curves for either operative or conservative treatment were obtained by solving differential equations on the survival rate of a patient harboring an unruptured aneurysm. Patients' life expectancies were calculated as areas under these curves, and operative benefit was quantified as a gain in average life expectancy. To analyze morbidity, two concepts were introduced: premorbid survival rate and average premorbid survival period, and the operative gain of average premorbid survival period was calculated under certain assumptions. Larger operative benefit was observed in younger patients, with increasingly less benefit in the elderly. The operative gain of average life expectancy was 3.9 years for a 40-year-old patient, 2.4 years for 50, 1.3 years for 60, and 0.6 years for a 70-year-old. Quantified operative benefit is presented in a table for various patient ages, yearly rupture rates, and expected operative morbidity and mortality. This mathematical method would be useful to both surgeons and patients in making their decisions on surgery.

Actuarial Analysis↗

PubMed2005

Radiation exposure to operators during vertebroplasty.

PURPOSE: To measure the radiation received by physicians during percutaneous vertebroplasty with use of two types of injection devices with the interventional equipment guided by computed tomography (CT) and an angiographic/CT system. MATERIALS AND METHODS: Twenty consecutive patients who underwent percutaneous vertebroplasty were included in this study. The patients were divided into two groups, the 1-mL syringe group and the bone cement injector group. Percutaneous vertebroplasties were performed with the IVR-CT system, which combines angiographic and CT equipment with a single fluoroscopy table. Radiation dose to operators was measured as equivalent dose penetrating at a 10-mm tissue depth with use of electronic personal dosimeters attached outside and inside lead aprons. Effective radiation dose (HE) was estimated based on the radiation dose outside the lead apron (Ha) and the radiation dose inside the lead apron (Hb). Differences between the groups in doses and fluoroscopic duration were analyzed. RESULTS: In the 1-mL syringe group and bone cement injector group, mean Ha measurements were 320.8 microSv and 116.2 microSv, respectively. Mean Hb measurements were 14.5 microSv versus 7.8 microSv and mean HE measurements were 48.2 microSv versus 19.7 microSv. Significant differences were found in Ha, Hb, and HE. However, duration of fluoroscopy did not differ significantly between groups. CONCLUSIONS: Radiation dose was relatively high for operators performing percutaneous vertebroplasty. The bone cement injector was useful in reducing the level of radiation exposure to operators during vertebroplasty.

Fluoroscopy↗

PubMed2005

Closed femoral nailing in lateral decubitus position without a fracture table: a preliminary report of fifteen patients.

BACKGROUND: The use of a fracture table is standard for closed intramedullary nailing of femoral fractures. Instead of a fracture table, some clinicians have successfully performed this operation in the supine position via manual traction. Here, we present our experience performing this operation in the lateral decubitus position without a fracture table. METHODS: From December 2001 to November 2002, we consecutively performed closed intramedullary femoral nailing in 15 patients with low comminuted femoral shaft fractures in the lateral decubitus position without a fracture table. We used manual or joystick traction to approximate the fracture fragments and introduced a guide pin. A reaming procedure was done with serial reamers of increasing diameters to reduce the fracture fragments. Then, the nail was inserted along the guide pin. RESULTS: Six femora underwent Küntscher nailing and nine femora underwent interlocking nailing. Nine procedures were completed via joystick traction and six were completed via manual traction only. All fifteen procedures were completed without any changes in the other operative methods. The mean operation time was 55 minutes for Küntscher nailing and 118.3 minutes for interlocking nailing. The average union time was 5.8 months with 100% union. CONCLUSIONS: For low comminuted femoral shaft fractures, using manual or joystick traction in the lateral decubitus position without a fracture table is an alternative in closed femoral intramedullary nailing.

Adolescent↗

PubMed2002

[Urological consequences of pudendal nerve trauma during orthopedic surgery: review and practical advice].

Pudendal nerve trauma is a rare complication of orthopaedic and traumatological surgery, which occurs after traction of the pelvis on an orthopaedic table fitted with a pelvic support. This trauma is generally due to crushing of the nerve against the central part of the table or stretching of the pudendal nerve due to excessive traction during fractures of the femur. the urological consequences of this neurological trauma present in the form of disorders of perineal sensitivity, which usually rapidly resolve spontaneously, or vesicosphincteric and/or erectile disorders, which have a more pejorative course and which can sometimes persist. The prognosis depends on the severity of the symptoms and the results of electrophysiological studies, which are reserved for serious lesions. This investigation identifies the level of the neurological lesion. Surgical decompression, rarely indicated, can be necessary in the case of serious and persistent sensory or motor lesions. Patients must be clearly informed about this possible neurological complication before an operation on the orthopaedic table as part of good surgical practice.

Erectile Dysfunction↗

PubMedDate not supplied

The surgeon's garb.

A comprehensive evaluation of all factors associated with the surgeon's garb worn with and without laminar air flow revealed that in a conventional operating room, all personnel should wear an impermeable one-piece suit with foot attachments, any type of head cover, and, if they are going to be near the operative site or instrument table, a disposable mask. Scrub personnel should wear some type of a disposable gown to reduce the amount of surface contamination. The best way to reduce the environmental and surface contamination would be for all personnel to wear some type of a hooded exhaust equipment, but this is impractical both for circulating nurses and for anesthesiologists. Despite the reduction obtained from all the above controls, the reduction in the amount of bacterial contamination would not be as great as that obtained with laminar air flow, 93% (p < 0.005). Laminar air flow produced the greatest single reduction in environmental and surface contamination and variables such as time, people and attire did not influence the overall counts. The attire recommended for the conventional operating room can be used in laminar air flow with an expectation of overall reduction in contamination.

Antisepsis↗

PubMed1994

Axillofemoral grafting with externally supported polytetrafluoroethylene.

OBJECTIVE: To evaluate the results of axillofemoral bypass grafting using externally supported polytetrafluoroethylene. DESIGN: Consecutive patients who were operated on by us from 1983 to the present were prospectively followed up in a vascular registry. The results of surgery with respect to morbidity and mortality, patency, limb salvage, and patient survival were determined by life-table methods. PATIENTS: A standardized operative technique was used to perform 184 axillofemoral bypass procedures in 164 consecutive patients (age range, 14 to 90 years; mean age, 67 years; female, 33%). Follow-up ranged from 0 to 95 months (mean, 23 months). RESULTS: Ischemia was the indication for 83% of the procedures, and aortic sepsis was the indication for 16%. There were nine operative deaths (5%) and 17 major complications. Life-table primary patency, limb salvage, and survival rates at 5 years were 71%, 92%, and 52%, respectively. Indication for surgery, patency of the superficial femoral artery, and the performance of multilevel procedures did not significantly influence patency. CONCLUSIONS: The results of axillofemoral grafting using polytetrafluoroethylene are equivalent to those achieved with other accepted methods of treatment for lower extremity ischemia, including balloon angioplasty, aortofemoral bypass, and infrainguinal bypass. Axillofemoral bypass is an appropriate technique that is deserving of more widespread use.

Adolescent↗

PubMed1990

[The choice of the method of anesthesia as a risk factor in the femoral fracture near the hip joint in elderly patients].

Between January 1983 and December 1988, 317 patients with fractures near the hip joint were operated upon. In a retrospective study we compared 180 patients with general anesthesia (AN) and 137 patients with spinal anesthesia (RA). The average age of patients with RA was 80.5 and with AN 79.8 years. The preoperative management was done by an internist. The operation followed at an average of 2.8 days (Tables 1, 2). All patients were placed into 3 risk groups, based on after preoperative cardiac and pulmonary risk scores, as modified by Goldman (Table 3). Spinal anesthesia was performed with 2 ml 4% hyperbaric mepivacaine (80 mg mepivacaine hydrochloride, 190 mg glucose monohydrate). The AN was induced with thiopental (3-5 mg/kg) and maintained with N2O and enflurane. Fentanyl (0.05-0.15 mg) was given for analgesia. The statistical examination was done using the chi-square test (Fisher-exact or Pearson). The groups were compared for age, time of operation, and risk score (Table 4). The mortality in operations with protection of the femoral head (FP) (Ender pinnings, Böhler pinnings and dynamic hip screws) was significantly higher after RA (13.8%), than with AN (6.5%). In operations with hip prostheses (HP), the mortality for RA (19.0%) was also significantly higher then for AN (4.2%) (Fig. 1). The mortality in group I (4-20 points) was 1.7% in patients with AN (FP 1.4%, HP 2.1%) and 3.7% for RA (FP 4.1%, HP 0%).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed2006

Comparison of transvaginal sonography in recumbent and standing maternal positions to predict spontaneous preterm birth in singleton and twin pregnancies.

OBJECTIVE: To evaluate whether serial transvaginal sonographic examination of the cervix with the woman in a standing position improves the prediction of spontaneous preterm birth (SPB) compared with the conventional posture. METHODS: For both a recumbent and upright maternal position, the inter- and intraobserver agreement of cervical length (CL) measurement was calculated. In 363 pregnancies at risk for SPB, we determined prospectively CL and funnel width (FW) including differences between the positions and between longitudinal measurements from 15 weeks onwards. Multivariate logistic regression analysis, contingency tables and receiver-operating characteristics (ROC) curves were used. Data were stratified according to singleton or twin pregnancy, maternal position, gestational age at examination and different cut-off values to predict SPB < 36 weeks. RESULTS: The interobserver variability in each position was similar, with an interclass correlation coefficient (95% CI) of 0.952 (0.811-0.984) in the recumbent and 0.942 (0.837-0.978) in the upright maternal position. After exclusion of pregnancies with iatrogenic preterm birth, 15/138 (11%) singletons and 29/153 (19%) twin pairs were born at <36 weeks. The incidence of funneling was greater in an upright compared with a recumbent maternal position by 12.3% in singleton and 13.1% in twin pregnancies before 25 weeks, and by 13.0% and 21.6% between 25 and 30 weeks, respectively. This resulted in an earlier and more accurate prediction of SPB by transvaginal ultrasound in an upright compared with a recumbent maternal position, which could be shown by all applied statistical methods. The influence of posture on the prognostic value of the CL varied depending on the cut-off value. Differences in CL or FW between 15-20 and 25-30 weeks predicted SPB better than did differences between shorter intervals. CONCLUSIONS: Evaluation of the cervix with the woman in the upright position permits earlier detection of funneling. This may enable earlier and more appropriate intervention to avoid SPB.

Adult↗

PubMed1991

A laser densitometer for selective spot analysis on dot blots and two-dimensional gel autoradiograms.

We describe an inexpensive densitometer, employing a small HeNe laser and an IBM-compatible personal computer that performs accurate measurements of selected spots on two-dimensional gel autoradiograms or chromatograms with an accuracy and a sensitivity equal or superior to those of many commercial instruments. Our open-table design allows the operator to visually monitor the scanning process in room lighting, and provides great flexibility in both the size and the nature of items to be scanned. The instrument has two moving parts (a prism and a small motor). A commercially available software package (ASYST) acquires digital data, graphs the data on the TV monitor, converts the data to optical density or to radioactive incorporation (cpm), subtracts background, integrates peak areas, and stores data on disk. The total time for these operations is 20-30 s per spot. The instrument has a dynamic range of 0.25 to 3.0 OD units and can measure a 10,000-fold range of 14C or 35S isotope concentrations on autoradiograms. The complete device can be assembled with a hobbyist's knowledge of electronics, moderate programming abilities (no machine language required), and a cost of less than $3000, not including the IBM PC.

Costs and Cost Analysis↗

PubMed1984

A communication aid for the physically handicapped.

A communications aid for the severely handicapped is described. The aid is primarily intended to be mounted on an electric wheelchair and to be powered from the chair's battery. It may be operated by any two-switch input system or by more elaborate controls such as joy-sticks. The central unit of the aid is a purpose-built 8085 microcomputer, the operating program and data tables being sorted in a 2 kbyte EPROM. The input control is used to drive a cursor around an 8 X 8 letter board array, the selected alphanumeric character being output to a liquid crystal display. Up to 64 messages, each of no more than 15 characters, can be composed and stored by the user and recalled as required. The messages are stored in a 2 kbyte CMOS memory and are retained when the aid is switched off. It is a simple matter to increase the number of stored messages. The aid was designed with the needs of a particular 15 year old, athetoid child in mind and the results of his tests of the aid will be briefly discussed.

Biomedical Engineering↗

PubMedDate not supplied

IMAGO: a complete system for acquisition, processing, two/three-dimensional and temporal display of microscopic bio-images.

This work describes IMAGO, an integrated bio-imaging system developed in our laboratory. The whole system consists of a personal computer, a commercially available frame grabber directly plugged into a personal computer, video input/output modules, specific hardware for z-axis movement and light shuttering, and a software package. IMAGO is user-friendly, menu driven and enables one to perform image acquisition with different methods: optical sectioning, flashing epifluorescence, transmitted and phase contrast microscopy. It makes various functions possible, including: image transfer, gray scale processing, conventional and advanced filtering, logical operations, look-up table management, three-dimensional (3D) editing, 3D representation and auto-correlation techniques. More than 100 image processing functions have been implemented and can be easily managed through IMAGO. Examples are given in the area of biophysical research, like 3D representation of nuclei and of electron microscopic images, in situ microscopy of living cells. IMAGO processes information in an x, y, z, t space.

Image Processing, Computer-Assisted↗

PubMed2006

Relation of electrocardiographic criteria for left atrial enlargement to two-dimensional echocardiographic left atrial volume measurements.

Left atrial (LA) enlargement by 2-dimensional (2-D) echocardiography predicts adverse cardiovascular outcomes. Electrocardiographic (ECG) criteria for LA enlargement are based on M-mode echocardiographic LA diameter, which is inferior to 2-D-derived LA volumes. This study compared established ECG criteria for LA enlargement with atrial volume obtained by 2-D echocardiography to determine if traditional ECG criteria accurately represent LA chamber enlargement, therefore offering a low-cost screening tool. A total of 261 randomly selected patients who underwent electrocardiography and 2-D echocardiography were enrolled. ECG parameters and electronically derived P-wave medians were analyzed with electronic calipers for maximal accuracy. LA volumes by 2-D echocardiography were measured with Simpson's method of discs, with enlargement defined as 32 ml/m(2). Sensitivity and specificity tables and receiver-operating characteristic curves were constructed for each criterion. Univariate and multivariate analyses were performed for predictors of 2-D echocardiographic LA enlargement. LA enlargement was present in 43% of patients. ECG P-wave duration was the most sensitive for the detection of LA enlargement (69%) but had low specificity (49%). Conversely, a biphasic P wave was the most specific (92%) but had low sensitivity (12%). The maximum area under the receiver-operating characteristic curve for any criterion was 0.64, too low to be of clinical utility. In conclusion, established ECG criteria for LA enlargement do not reliably reflect LA enlargement and lack sufficient predictive value to be useful clinically. These results suggest that P-wave abnormalities should be noted as nonspecific LA abnormalities, with the term "LA enlargement" no longer used.

Aged↗

PubMed2005

Improved outcomes in the recent management of secondary aortoenteric fistula.

OBJECTIVE: We reviewed the presentation, management, and late events in a recent experience with aortic graft-enteric communications (secondary aortoenteric fistula) to identify variables associated with poor outcomes. METHODS: Since 1991, 29 patients (19 men, 10 women; mean age, 70) presented with a secondary aortoenteric fistula. The duration from aortic graft implantation to aortoenteric fistula development ranged from 8 months to 180 months (mean, 47 months). Presenting symptoms included gastrointestinal bleeding (n = 25), sepsis and retroperitoneal abscess (n = 3), and ruptured para-anastomotic aneurysm (n = 1). One third (10/29) of patients were hypotensive at presentation. Repair was accomplished by graft excision with axillobifemoral bypass (17 simultaneous, 8 staged), graft excision with in situ deep vein replacement (n = 2), or graft excision with rifampin-treated prosthetic replacement (n = 2). Mean follow-up was 51 months, and the incidence of late events was reported by life table methods. RESULTS: The operative (< or = 30-day) mortality rate was 21%, with shock at presentation (P < .01), the need for preoperative transfusion (P < .01), and use of suprarenal aortic clamping during aortoenteric fistula repair (P = .03) associated with lethal outcome. Cumulative mortality related to aortoenteric fistula management was only 24% within an overall 5-year survival rate of 61%. Freedom from recurrent infection or amputation was 86% and 88% at 5 years, respectively, and assisted graft patency was 79%. Presence of staphylococcal species in 22% of patients and occasional operative findings of adjacent perigraft "biofilm" suggests that underlying indolent graft infection may contribute to the development of aortoenteric fistula in some cases. CONCLUSION: Outcomes associated with aortoenteric fistula repair were surprisingly favorable in the absence of preoperative hemodynamic instability.

Aged↗

PubMed2003

Assessment of neonatal tetanus elimination in an African setting by lot quality assurance cluster sampling (LQA-CS).

Neonatal tetanus (NT) elimination, < 1 case per 1,000 live births (LB), was assessed at district level in Zimbabwe using a combined lot quality assurance-cluster sampling survey (LQA-CS). Three of the highest risk districts were selected. NT was considered eliminated if fewer than a specified number of NT deaths (proxy for NT cases) were found in the sample determined using operating characteristic curves and tables. TT2 + vaccine coverage was measured in mothers who gave birth 1-13 months before the survey and women aged 15-49 years. NT was considered as eliminated, TT2+ coverage was 78% (95% CI 71-82%) in women aged 15-49 and 83% (95% CI 76-89%) in mothers. The survey cost 30,000 US dollars excluding costs of consultants. NT incidence was below the elimination threshold (< 1/1,000 LB) in the surveyed districts and probably in all districts. LQA-CS is a practical, relatively cost effective field method which can be applied in an African setting to assess NT elimination status.

Adult↗

PubMed1988

Vitrectomy for diabetic eye disease.

Thirty four eyes which underwent vitrectomy because of diabetic proliferative retinopathy were reviewed. The overall success rate of the operation was 62%. Excluding table top retinal detachments, which all did badly, the success rate was 72%. Grading by ultrasound was found to be helpful in; (a) planning surgical approach, (b) assessing visual outcome. The most common late complication was cataract. Extracapsular cataract extraction with implantation was found to be successful in these cases.

Adult↗

PubMed2003

Standardization of occupational dose to patient DAP enables reliable assessment of radiation-protection devices in invasive cardiology.

PURPOSE: With the aim of assessing the effectiveness of radiation-protection devices in invasive cardiology, the goal of this study was to validate relative parameters for operator occupational exposure, standardized to the patient's primary dose. MATERIAL AND METHODS: One of these parameters was the local dose, measured in air at the operator's position per dose area product (DAP), applied to a male anthropomorphic Alderson-Rando phantom for simulation of coronary angiography. The second parameter was personal occupational dose to the operator per DAP, measured by thermoluminescence dosimeter stripes during 121 procedures in routine clinical work. RESULTS: The local and personal doses per unit DAP - using typical 0.5-mm lead overcouch and undercouch protection - were comparable (left eye 180 vs. 360, thyroid 260 vs. 260, left shoulder 280 vs. 150, chest 400 vs. 500, hands 400 vs. 550, waist 900 vs. 400 nSv/Gy x cm (2)). The results, however, were far lower than typically reported values. Our findings therefore disclose a typically inadequate use or acceptance by individual operators of available table-attached lead protection devices, and of ceiling-attached lead-glass screens. The additional use of individual 1.0-mm lead-equivalent garments reduced local doses to levels between 1. 10 %. CONCLUSIONS: DAP-standardized dose parameters - determined experimentally (phantom measurements), or in routine clinical work - are not appreciably influenced by the equipment age and type, or by the image-intensifier entrance dose rate of the respective catheterization system. They are consequently best suited for obtaining eloquent comparisons of various radiation-protection devices, and for reliable estimation of local scatter radiation exposure by simple documentation of intervention DAP.

Computer Simulation↗

PubMed1993

Classification of frontal fossa fractures associated with cerebrospinal fluid rhinorrhea, pneumocephalus or meningitis. Indications and time for surgical treatment.

The classification of anterior fossa fractures with their sequelae: cerebrospinal fluid (CSF) rhinorrhea, pneumocephalus, or meningitis is presented. This classification is based on five selection criteria which are discussed in this paper. This classification resulted in the table of indications for operative treatment, according to which the appropriate time for operation in urgent cases is immediately, in cases with absolute indication 5 to 6 days after the injury, in long-lasting CSF rhinorrhea or pneumocephalus 10 days after the onset, in intermittent or delayed rhinorrhea and/or pneumocephalus as soon as these signs occur, and in cases of meningitis soon after recovery. This study is based on the analysis of 52 consecutive surgically treated cases, collected from 1984 up to December 1989.

Adolescent↗

PubMed2005

Fabrication of implantable microelectrode arrays by laser cutting of silicone rubber and platinum foil.

A new method for fabrication of microelectrode arrays comprised of traditional implant materials is presented. The main construction principle is the use of spun-on medical grade silicone rubber as insulating substrate material and platinum foil as conductor (tracks, pads and electrodes). The silicone rubber and the platinum foil are patterned by laser cutting using an Nd:YAG laser and a microcontroller-driven, stepper-motor operated x-y table. The method does not require expensive clean room facilities and offers an extremely short design-to-prototype time of below 1 day. First prototypes demonstrate a minimal achievable feature size of about 30 microm.

Biocompatible Materials↗