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At least 1,279 records · Page 71Linked to original sources
PubMed2006

Achieving a predictable 24-hour return to normal activities after breast augmentation: part II. Patient preparation, refined surgical techniques, and instrumentation.

The goal of this study was to develop practices that would allow patients undergoing subpectoral augmentation to predictably return to full normal activities within 24 hours after the operation, free of postoperative adjuncts. Part I of this study used motion and time study principles to reduce operative times, medication dosages, perioperative morbidity, and recovery times in augmentation mammaplasty. Part II of the study focuses on details of patient education, preoperative planning, instrumentation, and surgical technique modifications that were identified, modified, and implemented to achieve the results reported in part I. Two groups of 16 patients each (groups 1 and 2) were studied retrospectively for comparison to a third group of 627 patients (group 3) studied prospectively. Patients in group 1 had axillary partial retropectoral breast augmentations in 1982-1983, using dissociative anesthesia, blunt instrument implant pocket dissection, and Dow Corning, double-lumen implants containing 20 mg of methylprednisolone and 20 cc of saline in the outer lumen of the implants. Patients in group 2 (1990) had inframammary, retromammary augmentations by using a combination of blunt and electrocautery dissection, Surgitek Replicon polyurethane-covered, silicone gel-filled implants, and general endotracheal anesthesia. Patients in group 3 (1998 to 2001, n = 627) had inframammary partial retropectoral, inframammary retromammary, and axillary partial retropectoral augmentations under general endotracheal anesthesia. Refined practices and surgical techniques from studies of groups 1 and 2 were applied in group 3. Videotapes from operative procedures of groups 1 and 2 were analyzed with macromotion and micromotion study principles, and tables of events were formulated for each move during the operation for all personnel in the operating room. Extensive details of surgical technique were examined and reexamined in 13 different stages by using principles of motion and time studies described in part I of this study to maximize efficiency without any change in quality. Unnecessary or unproductive motions and techniques were progressively eliminated, and essential, productive techniques were streamlined to eliminate wasted time and motion. Instrumentation and surgical techniques were evaluated in detail and modified to minimize bleeding and tissue trauma. Detailed data were presented in part I of this study that document shorter operative times, recovery times, time to discharge home, and time to return to normal activities. This part focuses on the patient education, preoperative planning, instrumentation, and surgical technique changes that were implemented on the basis of the findings in part I of the study. More extensive patient information integrated with staged informed consent resulted in a more in formed and confident patient. Applying motion and time study principles to analysis and refinement of instrumentation and surgical techniques resulted in a substantial reduction in perioperative morbidity and a simpler, shorter 24-hour return to full normal activity for 96 percent of the patients undergoing breast augmentation in group 3 compared with groups 1 and 2. More than 96 percent of patients in group 3 were able to return to normal activities, lift their arms above their heads, lift normal-weight objects, and drive their car within 24 hours after their partial retropectoral breast augmentation. Patient education, preoperative planning, instrumentation, and surgical technique modifications based on motion and time study video analyses reduced surgical trauma and bleeding, reduced perioperative morbidity, and allowed 96 percent of 627 breast augmentation patients in group 3 a predictable return to full, normal activity in 24 hours or less. Specific surgical factors that contributed to these results included (1) prospective hemostasis techniques with a zero tolerance for even the smallest amount of bleeding, (2) strict "no-touch" techniques for periosteum and perichondrium, (3) eliminating all blunt dissection, (4) performing all dissection under direct vision, (5) modified and simplified instrumentation, and (6) optimal use of muscle relaxants during subpectoral dissection.

Journal Article↗
PubMed2002

Achieving a predictable 24-hour return to normal activities after breast augmentation: Part II. Patient preparation, refined surgical techniques, and instrumentation.

The goal of this study was to develop practices that would allow patients undergoing subpectoral augmentation to predictably return to full normal activities within 24 hours after the operation, free of postoperative adjuncts. Part I of this study used motion and time study principles to reduce operative times, medication dosages, perioperative morbidity, and recovery times in augmentation mammaplasty. Part II of the study focuses on details of patient education, preoperative planning, instrumentation, and surgical technique modifications that were identified, modified, and implemented to achieve the results reported in part I. Two groups of 16 patients each (groups 1 and 2) were studied retrospectively for comparison to a third group of 627 patients (group 3) studied prospectively. Patients in group 1 had axillary partial retropectoral breast augmentations in 1982-1983, using dissociative anesthesia, blunt instrument implant pocket dissection, and Dow Corning, double-lumen implants containing 20 mg of methylprednisolone and 20 cc of saline in the outer lumen of the implants. Patients in group 2 (1990) had inframammary, retromammary augmentations by using a combination of blunt and electrocautery dissection, Surgitek Replicon polyurethane-covered, silicone gel-filled implants, and general endotracheal anesthesia. Patients in group 3 (1998 to 2001, n = 627) had inframammary partial retropectoral, inframammary retromammary, and axillary partial retropectoral augmentations under general endotracheal anesthesia. Refined practices and surgical techniques from studies of groups 1 and 2 were applied in group 3. Videotapes from operative procedures of groups 1 and 2 were analyzed with macromotion and micromotion study principles, and tables of events were formulated for each move during the operation for all personnel in the operating room. Extensive details of surgical technique were examined and reexamined in 13 different stages by using principles of motion and time studies described in part I of this study to maximize efficiency without any change in quality. Unnecessary or unproductive motions and techniques were progressively eliminated, and essential, productive techniques were streamlined to eliminate wasted time and motion. Instrumentation and surgical techniques were evaluated in detail and modified to minimize bleeding and tissue trauma. Detailed data were presented in part I of this study that document shorter operative times, recovery times, time to discharge home, and time to return to normal activities. This part focuses on the patient education, preoperative planning, instrumentation, and surgical technique changes that were implemented on the basis of the findings in part I of the study. More extensive patient information integrated with staged informed consent resulted in a more informed and confident patient. Applying motion and time study principles to analysis and refinement of instrumentation and surgical techniques resulted in a substantial reduction in perioperative morbidity and a simpler, shorter 24-hour return to full normal activity for 96 percent of the patients undergoing breast augmentation in group 3 compared with groups 1 and 2. More than 96 percent of patients in group 3 were able to return to normal activities, lift their arms above their heads, lift normal-weight objects, and drive their car within 24 hours after their partial retropectoral breast augmentation. Patient education, preoperative planning, instrumentation, and surgical technique modifications based on motion and time study video analyses reduced surgical trauma and bleeding, reduced perioperative morbidity, and allowed 96 percent of 627 breast augmentation patients in group 3 a predictable return to full, normal activity in 24 hours or less. Specific surgical factors that contributed to these results included (1) prospective hemostasis techniques with a zero tolerance for even the smallest amount of bleeding, (2) strict "no-touch" techniques for periosteum and perichondrium, (3) eliminating all blunt dissection, (4) performing all dissection under direct vision, (5) modified and simplified instrumentation, and (6) optimal use of muscle relaxants during subpectoral dissection.

Activities of Daily Living↗
PubMed2006

Interactive continuously moving table (iCMT) large field-of-view real-time MRI.

Continuously moving table (CMT) MRI is a new method that is capable of generating 3D, seamless, large field-of-view (FOV) images by acquiring readouts along the patient superior-inferior axis as the subject is translated through the scanner. For applications that require artifact-free images, such as arterial-phase contrast-enhanced (CE) angiography of the legs, a major challenge is to match the MR data acquisition and patient table motion with the dynamics of blood flow in the region of interest (ROI). Instead of restricting the CMT to predetermined constant table speeds, we adopted a more general approach in which the table motion is decoupled from the phase-encoding order. In our approach the table moves adaptively and in response to operator-provided feedback obtained from viewing real-time preview (or fluoroscopic) images. This interactivity is accomplished by integrating high temporal-spatial resolution encoding of the table position with real-time hybrid-space filling and image reconstruction. Experimental results obtained using our prototype interactive CMT (iCMT) system on a peripheral vascular phantom and five healthy volunteers demonstrate the feasibility of this robust and rapid imaging method for acquiring 3D large-FOV continuous images with patient-specific adaptive table motion profiles.

Beds↗
PubMed1987

[Combined sciatic/3-in-1 block in routine surgical care].

For decades it has been known that the combined sciatic and femoral nerve block could be used for operations on the leg. Nevertheless, it is used in very few hospitals as a routine method for surgical anesthesia and only few publications exist in this area. To highlight some practical aspects, we have produced a retrospective study of 660 cases of femoral and sciatic nerve blocks used exclusively for operating purposes. For all blocks we used a nerve stimulator. For the sciatic nerve we normally used the posterior approach. The femoral nerve was blocked in the "3 in 1" method of Winnie to include the obturator and lateral femoral cutaneous nerves as well. All patients had been premedicated (Table 3). In 67% we used bupivacaine 0.5%, in 29% prilocaine 1%, in 4% mixed agents, and in 5 cases mepivacaine 1.5%. We added epinephrine 1:400,000 in all cases except those with cardiac contraindications. The maximal dose was 80 ml or 9.76 mg/kg prilocaine and 105 ml or 7.72 mg/kg bupivacaine. Both doses were tolerated without complications. Applying strict criteria (Fig. 1 + 2), the overall failure rate was 17.7% (Table 1): depending on the anesthesiologist administering the block 7.1%-27.8% (Fig. 3) and on the type of operation 4.6%-42.3% (Table 2). The most important factor influencing the failure rate was the anesthesiologist. The individual failure rate of the first 30 blocks of each anesthesiologist (V30) was nearly equal to the overall individual failure rate (Fig. 3). The form and time of premedication and the extent of sedation did not influence the results.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1982

[Possible patient overheating by OP-table heating equipment].

The technical equipment used in the operation theatre must be safe and foolproof. We observed a complication of near overheating a patient using the thermomaquet heating pads. The conclusion of our observation is that such heating pads must have a high-temperature cut-off device.

Burns↗
PubMed1987

A surgical experience with Crohn's disease.

From 427 histories of patients with Crohn's disease admitted to St. Michael's Hospital between 1 January 1974 and 31 March 1983, 152 patients were studied as each had at least one operation related to the disease. The age at onset of symptoms, the interval between onset of symptoms and operation, the site of disease, operations performed, the type and frequency of repeat operations and the morbidity, mortality and follow-up period were studied. The small intestine only was involved in 55 per cent of the patients, the large intestine only in 16 per cent, and both the small and large intestine in 29 per cent. The most frequent indication for operation was obstruction (29 per cent); the next was perianal disease (18 per cent). The most common procedure was resection of the lowest segment of the small intestine with adjacent colon (37 per cent). The second most common operation was perianal operation (19 per cent). There were three deaths (2 per cent mortality rate). One hundred and thirty patients (93 per cent) have been examined within the past three years. Life tables show the cumulative chance of having an operation for Crohn's disease.

Actuarial Analysis↗
PubMed1979

[Chiari pelvic osteotomy in treatment of sequellae of hip osteochondritis (author's transl)].

The authors analyze the results of Chiari pelvic osteotomy in treatment of sequellae of hip osteochondritis with 11 cases of children 6 to 10 years old, operated and reviewed with an average follow up of 21 months. They used the operative procedure decided by Chiari, on orthopaedic table, followed by plaster cast immobilisation for 3 weeks. The Xray results are specially analyzed as the peroperative functional troubles were absent. This procedure is mainly effective on articular congruence with gain not only in lateral but also in anterior head-coverage. The secondary modelling appears to affect either the head and the acetabulum. But the medialization remains poor, which is explained by an analyze of the lower fragment operative displacement. Actually, this operative procedure may be used in late osteochondritis with a coxa magna and specially when a coxa vara or a short neck contra-indicate a femoral osteotomy.

Child↗
PubMed2006

Commissioning and quality assurance protocol for dual energy X-ray absorptiometry (DEXA) systems.

This study reports on the development and evaluation of a protocol for testing DEXA systems, which can be incorporated into a routine medical physics/engineering service. Methodologies are reported for (1) scatter measurement, (2) estimation of reference dose and (3) enquiry into potential sources of overexposure. Results show that fan-beam and cone-beam systems require shielding if the walls or operator are within 1 m of the table. Patient reference dose was estimated using the dose-area product (DAP). This varied over an order of magnitude from 2 to 36 mGy cm2 in the range of systems studied. The inquiry into potential sources of overexposure revealed some weaknesses in current practise including a design which prevents the inclusion of DAP metres; beam non-uniformity; incorrect specification of patient dose and the risk of overexposure when tube operates during patient positioning.

Absorptiometry, Photon↗
PubMed1995

Diving at altitude: a review of decompression strategies.

Diving at altitude requires different tables from those at sea level due to the reduction in surface ambient pressure. Several algorithms extrapolating sea-level diving experimental data have been proposed to construct altitude diving tables. The rationale for these algorithms is reviewed together with the conservatism of the resulting tables and decompression computer outputs. All algorithms are based on the adaptation of critical tissue tensions to altitude. These are linear extrapolation (LEM), constant ratio translation (CRT), and constant ratio extrapolation (CRE) of maximum permissible tissue tensions (M values). Either new tables using the altitude-adapted M values were put forward or sea-level tables are to be used through an operation called correction. In this review it is shown that for a given set of M values, CRT and CRE give the same result for no-decompression-stop dives; they always yield more conservative results than LEM. When decompression stops are used, CRT is more conservative than CRE. When applied to different sets of M values, the conservatism becomes a function of bottom time, depth, and altitude. The analysis shows that the tables derived using CRT of U.S. Navy (USN) schedules and CRE Boni et al. tables give more conservative results than LEM Bühlmann tables for higher altitude, longer bottom time, and deeper dives. Aviation altitude exposure decompression sickness (DCS) data are also addressed to compare different model outputs. When applied to USN and Royal Navy tables, LEM yields an altitude DCS limit of 8,581 and 8,977 m, respectively. On the other hand, the altitude limit calculated using CRE applied to USN M values and LEM Bühlmann tables is found to be below 6,000 m.

Aerospace Medicine↗
PubMed2001

[Mechanical study of spinal interbody implants--characteristics and limits of standardized testing].

Spinal interbody fusion has proved to be a useful procedure for the surgical stabilization of spinal segments, for which fusion cases made of metal or reinforced polymers are increasingly being used. For the mechanical testing of spinal interbody implants, a test setup has been developed on the basis of an ASTM proposal. Initially, testing of lumbar fusion cages made of CFRP (carbon fibre reinforced polymer) was carried out. The implants (UNION Cages, Medtronic Sofamor Danek), which are characterised by their radiolucency on radiography, NMR and CT scans, have a cube-shaped body with three table-tracks on the under and upper surfaces. The cages were tested at different loads. Modifications of the proposed standardized method were carried out to enable implementation of implant-oriented testing. The tested cages were shown to have adequate axial compression, shear and torsional strengths with regard to the implant body. The maximum axial compression force tolerated by the table-tracks was less than the maximal potential loading of the lumbar spine, and, with account being taken of implant design, consequences with regard to surgical technique were drawn. As dictated by the geometry of the table-tracks, parallel grooves have to be made intra-operatively in the vertebral end plates. Axial compressive loads then act on the implant body, and the table-tracks are protected from damage. To avoid in vivo failure, the tested cages should be implanted only when this specific surgical technique is employed. Using supplementary anterior or posterior instrumentation, in vivo failure of the table-tracks under physiological spinal loading is not to be expected.

Biomechanical Phenomena↗
PubMed1980

The significance of vein wall thickness and diameter in relation to the patency of femoropopliteal saphenous vein bypass grafts.

Two hundred and twenty-five reversed saphenous vein femoropopliteal bypass graft procedures were performed on 186 patients with occlusive vascular disease. These grafts were followed for a mean of 19 months, with the longest period being 64 months. Numerous factors ascertained before, during, and after operation were analyzed using a life-table technique to see how these factors correlated with graft patency. The internal diameter and wall thickness of the vein grafts appeared to significantly influence graft patency. The best results were obtained using veins with a large internal diameter and a thin wall. In contrast, none of the other factors studied (which included age, sex, blood pressure, height, weight, indication for surgery, diabetic state, serum lipids, angiographic data, the site of the upper and lower anastomoses, the use of spliced vein segments, the type of vein preparation and the consumption of cigarettes before operation) were useful predictors of graft patency. It is suggested that vein diameter and vein wall thickness should be taken into consideration when analyzing the results of saphenous vein femoropopliteal bypass graft procedures, and also that the assessment of these factors may influence the choice of graft material for a femoropopliteal bypass graft.

Adult↗
PubMed2005

Suburethral sling inserted by the transobturator route in the treatment of female stress urinary incontinence: preliminary results in 117 cases.

OBJECTIVE: Assessment of the transobturator out-in technique in the treatment of female urinary incontinence. STUDY DESIGN: Obtape, a non-woven, 5% polypropylene tape was inserted via the transobturator route in patients suffering from stress or mixed urinary incontinence. From 1 February 2003 to 30 April 2004 117 patients have been operated. Mean age was 55 years (37-82). Follow-up range from 7 to 22 months (median follow-up time 16.3 months). All patients were assessed before surgery by clinical gynaecological examination and an urodynamic workup (post-void residual urine, flowmetry, voiding urgency thresholds and urethral profile). RESULTS: There were no major complications and no deaths. There were six (5.1%) minor intraoperative problems and three (2.5%) tape erosions. The subjective level of complete and partial patient satisfaction was 92.3% (108 patients) and 4.2% (5 patients), respectively. Four patients (3.4%) felt that the situation was unchanged. No patients felt that their situation had deteriorated (Table 4). There is a concern in operating the subgroup of patients suffering from low MUPC with dysuria as the cure rate is very low. CONCLUSIONS: Obtape transobturator tape is a safe, simple and rapid procedure for treating female stress urinary incontinence, avoiding the major risks of the retropubic approach. Evaluation of the results after a longer follow-up period is necessary to confirm the superiority of this technique.

Adult↗
PubMedDate not supplied

[Long-term patency of reversed and in situ femoro-popliteal bypasses].

INTRODUCTION: The small choice of graft materials is one of the greatest problems in femoro-popliteal (F-P) bypass reconstructions. Besides all biosynthetics(2-5) and synthetics(6) graft materials, there is no right alternative for autologous saphenous vein graft in F-P reconstructions. There are two main techniques for F-P reconstructions: "reversed" and "in situ". The aim of this study is the comparison of the long-term patency between "reversed" and "in situ" F-P bypasses. PATIENTS AND METHODS: In the study were included 191 patients with "reversed" and 99 patients with "in situ" F-P bypass grafts operated on between 1988 and 1994. There were 153 (80.10%) male and 38 (19.90%) female patients in the group with "reversed" bypass, and 78 (78.78%) male and 21 (21.22%) female patients in the group with "in situ" bypass. The average age of all patients was 59.04 (27-80) years. Eighty five (44.5%) patients in the group with "reversed" F-P bypass had diabetes mellitus and 43 (43.43%) in the group with "in situ" bypass. One hundred and fifty two (79.68%) patients in the group with "reversed" bypass were cigarette smokers and as 80 (80.8%) in the group with "in situ" bypass. In Table 1 the Fontain classification of occlusive diseases in operated patients is presented. The early proximal reconstructions were performed in 49 patients with "reversed" and 16 patients with "in situ" bypasses (Table 2). The associated proximal reconstructions were performed in 21 patients with "reversed" and in 14 patients with "in situ" bypasses (Table 3). All patients were controlled by physical and Doppler ultrasonographic examination immediately after the operation, after 1, 3, 6 months, and then every year postoperativelly. In cases with suspected graft occlusion or any other complication, control angiographic examinations was also performed. The statistical analysis of the results was done using "Life table" analysis. RESULTS: The patients were followed-up from 3 to 10 years. The results of "life-table" analysis are presented in Tables 4-8 and Graph 1. The "in situ" technique showed statistically significant better long-term patency compared to "reversed" technique, after 2 and 10 years (p < 0.05). The immediate patency in cases with "reversed" bypass was 98.96%, while limb salvage was 97.91%. In the same group long-term patency was 72.8% and limb salvage 73.9%. In the group with "in situ" bypasses the immediate patency as well as limb salvage were 96.97%. In the same group long-term patency was 73.8% and limb salvage 77.2%. In Table 5 potential advantages of the "in situ" F-P bypass technique are shown (16-21). However, there are controversial data on clinical results of both bypasses. Some authors described better long-term results of the "in situ" F-P bypass technique (28-30), while according to other data there are no significant differences between these two bypass groups (31-33). Most authors emphasized the two advantages of "in situ" bypasses in F-P reconstructions: a small diameter of the saphenous vein; in cases with pure run off (34-36).

Adult↗
PubMed1999

[Contrast medium-enhanced MR angiography of the pelvic and leg vessels with an automated table-feed technique].

PURPOSE: To evaluate contrast enhanced magnetic resonance angiography (ceMRA) with an automated table-feed technique in patients with arterio-occlusive disease for imaging of the pelvic and peripheral arteries. METHODS: Twenty-two patients underwent three-dimensional gadolinium-enhanced MR angiography in a three-step automatic table-feed technique on a Magnetom Symphony operating at 1.5 Tesla. Maximum intensity projection images (MIP) were generated from the subtracted and original studies. Image quality and venous contrast were evaluated by two groups of observers. 304 vessels (17 patients) were compared with DSA as the standard of reference. RESULTS: All examinations were performed without any technical problems. Diagnostic quality of the MIP of subtracted data sets was superior to that of the unsubtracted images. Venous overlay was 61% in the lower leg. In a total of 599 observations, a sensitivity of 96% (95%, 82%) and a specificity of 87% (88%, 99%) were high compared to DSA in the detection of significant stenoses > or = 50% (> or = 75%, occlusions). Interobserver correlation was good (linear correlation 0.9). CONCLUSION: Stepping-table digital subtraction contrast enhanced MRA is a promising technique in the diagnosis of peripheral arterio-occlusive disease.

Aged↗
PubMed1996

Femoral nailing without a fracture table.

This retrospective trail was designed to evaluate the effectiveness and safety of femoral nailing on a radiolucent table with manual traction only. Eighty-three femoral shaft fractures treated by antegrade nailing were included in this study. Group 1 consisted of 24 femur fractures that were reduced and nailed with manual traction. Group 2 consisted of 59 femur fractures treated with the aid of a fracture table. There were 10 patients in Group 1 and 19 patients in Group 2 needing multiple procedures. In Group 1, significantly fewer redrapings and table transfers were necessary. There was no increase in operative time. There were no operative complications in Group 1 and there was 1 operative complication in Group 2--a radial nerve palsy. Postoperative malalignment was minimal in both groups. Intramedullary nailing of femoral shaft fractures on a radiolucent table using manual traction is associated with no increase in morbidity. It also facilitated quicker and more effective treatment of the patient with polytrauma. No undue risks or contraindications were identified; however, the help of an assistant was invaluable.

Femoral Fractures↗
PubMedDate not supplied

Restenosis and occlusion after carotid surgery assessed by duplex scanning and digital subtraction angiography.

In a study of 140 patients operated upon with 143 carotid endarterectomies (mean follow-up time 5.2 +/- 2.3 years, range 1 month - 9.3 years), vessel morphology was examined with duplex scanning in 113 patients and with digital subtraction angiography (DSA) in 82 patients. The operative mortality was 1.4%; persisting stroke morbidity 3.6% and the combined operative mortality/morbidity 5%. During the follow-up time a further 20 patients (14.5%) died, 13 had new strokes and 14 new TIAs. By life table analysis, the annual rate of stroke including the operative period was 2.7% (1.7% on the operated side and 1.0% on the non-operated side). Fourteen new occlusions (12%) of the operated carotid artery was found and restenosis (greater than 50%) in 13 patients (11.2%). Progression of the atherosclerotic disease in the contralateral non-operated carotid artery was found in 41 patients (37%) including 3 new occlusions. Agreement DSA/duplex was 88% on the operated side and 92% on the non-operated side. New strokes or TIAs on the operated side were more common in patients with occlusions or restenosis (p less than 0.05), whereas no symptoms were referable to occlusions on the non-operated side. Risk factor analysis revealed an increased risk of atherosclerotic progression on the non-operated side in smokers and those with two or more risk factors. The risk of restenosis in the operated carotid artery was higher in females (p less than 0.025).

Carotid Arteries↗
PubMed2001

Intraoperative magnetic resonance imaging combined with neuronavigation: a new concept.

OBJECTIVE: Intraoperative image data may be used not only to evaluate the extent of a tumor resection but also to update neuronavigation, compensating for brain shift. To date, however, intraoperative magnetic resonance imaging (MRI) can be combined only with navigation microscopes that are separated from the magnetic field, thus requiring time-consuming intraoperative patient transport. To help solve this problem, we investigated whether a new navigation microscope can be used within the fringe field of the MRI scanner. METHODS: The navigation microscope was placed at the 5-G line of a 0.2 MRI device. Patients were positioned lying down directly on the table of the scanner, with their heads placed approximately 1.5 m from the center of the magnet, fixed in an MRI-compatible ceramic head holder. Standard operating instruments were used. For intraoperative imaging, we slid the table into the center of the magnet in less than 30 seconds. RESULTS: By use of this setup, we operated on 22 patients. In all patients, anatomic neuronavigation could be used in combination with intraoperative MRI. In addition, in 12 patients, functional data from magnetoencephalographic or functional MRI studies were integrated, resulting in functional neuronavigation. We did not encounter adverse effects of the low magnetic field during navigation. Moreover, intraoperative imaging was not disturbed by the navigation microscope and vice versa. CONCLUSION: Functional neuronavigation and intraoperative MRI can be used essentially simultaneously without the need for lengthy intraoperative patient transport. The combination of intraoperative imaging with functional neuronavigation offers the opportunity for more radical resections and fewer complications.

Adolescent↗
PubMed1997

[Reoperations on the biliary system].

Reoperations of the biliary apparatus is a branch of biliary surgery still not well enough clarified and difficult to cope with. A total of 169 patients are subjected to operation and investigation in the clinic of abdominal surgery. In 71 of them reoperation is undertaken over the period 1952-1973, and in 97--in the period 1974 through 1993, representing 8.7 per cent of all biliary operations done for benign diseases of the biliary apparatus. In 95 per cent of cases the primary operation is related to cholelithiasis (ChL). One-hundred fifty-five cases (92.6 per cent) are reoperated once, nine (5.3 per cent)--twice, and four (0.7 per cent)--three, four and five times. What is more, 56 of the patients are operated in the clinic of abdominal surgery, and 112--elsewhere in surgical units and departments throughout the country. The severer clinical picture, prolonged postoperative period, increased operative risk and worsened prognosis in the latter group are underscored. The underlying causes necessitating secondary corrective intervention are analyzed--76 per cent are conditioned by ChL, and 24 per cent--by the primary operation. The indications for reoperation are classified in three groups: a) failure to remove or partially removed gallbladder, b) in case of preexisting primary, or secondary postoperative development of various forms of cholelithiasis, c) in surgery induced morbid conditions. A table is presented illustrating the character of secondary operations, performed in the series of 168 patients under study, namely: in 20 per cent the gallbladder is operated on, and in 80 per cent--the extrahepatic bile ducts. Postoperative morbidity is higher as compared to the one in primary operations and not infrequently it is conditioned by preexisting complications. Postoperative mortality rate amounts to 10 per cent.

Adult↗