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Decomposition of nifedipine in Adalat tabl. and Cordafen drops and nitrendipine in Nitrendipine tabl. preparations under influence of UV radiation operation and temperature of 50 degrees C was tested. Chromatographic methods of TLC and HPCL and spectrophotometry were used for evaluation of the decomposition processes.
Image-guided surgery is currently considered to be of undisputed value in microsurgical and endoscopical neurosurgery, but one of its major drawbacks is the degradation of accuracy during frameless stereotactic neuronavigation due to brain and/or lesion shift. A computed tomography (CT) scanner system (Philips Tomoscan M) developed for the operating room was connected to a pointer device navigation system for image-guided surgery (Philips EasyGuide system) in order to provide an integrated solution to this problem, and the advantages of this combination were evaluated in 20 cases (15 microsurgical and 5 endoscopic). The integration of the scanner into the operating room setup was successful in all procedures. The patients were positioned on a specially developed scanner table, which permitted movement to a scanning position then back to the operating position at any time during surgery. Contrast-enhanced preoperative CCTs performed following positioning and draping were of high quality in all cases, because a radiolucent head fixation technique was used. The accuracy achieved with this combination was significantly better (1.6:1.22.2). The overall concept is one of working in a closed system where everything is done in the same room, and the efficiency of this is clearly proven in different ways. The most important fact is the time saved in the overall treatment process (about 55 h for one operating room over a 6-month period). The combination of an intraoperative CCT scanner with the pointer device neuronavigation system permits not only the intraoperative control of resection of brain tumors, but also (in about 20% of cases) the identification of otherwise invisible residual tumor tissue by intraoperative update of the neuronavigation data set. Additionally, an image update solves the problem of intraoperative brain and/or tumor shifts during image-guided resection. Having the option of making an intraoperative quality check at any time leads to significantly increased efficiency, improves the operating work flow because of the closed-system concept, and offers an integrated solution for improved patient work flow and clinical outcome.
BACKGROUND: Prevalence of the occupational disease laboratory animal allergy could be reduced if aeroallergen reduction strategies are identified. OBJECTIVE: To reduce worker exposure to Mus m 1, an allergen from laboratory mice, the effect of filter cage tops, increased room ventilation, negatively pressurized ventilated cages, and ventilated cage-changing tables were evaluated. METHODS: Aeroallergen was collected in the ambient air and in the breathing zone and quantified by using a competitive immunoassay. RESULTS: When mice were housed in unventilated cages, ambient allergen was reduced from 5.1 ng/m3 with no cage top to 1.3 ng/m3 with a simple filter-sheet top and 0.8 ng/m3 with a fitted filter-bonnet top (P <. 05). Room ventilation was increased from 6 to 10, 15, and 20 air changes per hour and had little effect on aeroallergen levels and no impact on airborne particulate matter. When mice were housed in ventilated cages, ambient allergen was significantly reduced from 1. 1 ng/m3 at positive cage pressure to 0.3 ng/m3 at negative cage pressure (P <.05). Negative cage pressure combined with handling animals under a ventilated table reduced breathing zone allergen from 28 ng/m3 with neither control strategy in place to 9 ng/m3 (P <. 05). Use of a ventilated table controlled bacterial contamination, measured as colony forming units, found in negatively pressurized cages. CONCLUSION: Three aeroallergen control strategies are use of filter cage tops, operation of negatively pressurized cages, and use of ventilated changing tables.
To study regularities of donor flaps location in scleroplasty after Pivovarov, 13 operations were performed on cadavers with fixation of the flaps with glue "Moment", subsequent removal of the eye ball and sketching of the grafts position. Three main variants of flap location were distinguished, when the flaps overlapped either the posterior pole or each other in 2-3 layers. By means of the method of factor-geometric analysis using a computer DVK-3, mathematic calculations of the effectiveness of the operation were made. With the help of the computer, a table was created showing the dependence between the anteroposterior axis of the eye and the length of the transplanted grafts, thus allowing to individualize the operation. A positive effect of 260 operations using the sclera dehydrated in the absolute alcohol was achieved in 94.0% of cases.
During the past decade, selective criteria for elective surgery for abdominal aortic aneurysms have been refined based on natural history and aneurysm expansion information. Using these criteria, contemporary preoperative preparation and newer intraoperative technical adjuncts, 123 consecutive patients underwent elective resection with 1 death (mortality rate: 0.8%). These include all patients operated on with both elective and urgent aneurysms at this institution since 1978, with the exception of those with frank rupture. Most importantly, however, the 5-year life-table survival of all of these patients (average age: 71.3 years, range 46-96 yr) was 72%, including both hospital and late mortality rates. More than half of the patients were over 70 years old (78 cases), with no hospital deaths and a 5-year life-table survival probability of 67%. For those under 70 years of age at the time of operation, the 5-year life-table probability of survival was 79%. We believe that these accomplishments were a direct result of an aggressive policy of screening for and selectively treating coronary disease and carotid stenosis preoperatively and the utilization of such intraoperative adjuncts as routine Swan-Ganz monitoring, autologous blood transfusion, the cell saver, and the frequent use of the tube grafting (50%). Thus, with proper selection, the outlook for the patient over 70 years old with an elective abdominal aortic aneurysm resection now approaches that of the normal population (67% vs. 69%).
After external decompression for a case of head trauma, epidural abscess formation resulted in extensive cranial bone and dura mater loss, for which two-stage reconstructive surgery was conducted. In the first operation, after thorough debridement of the infected wound, the dura mater was reconstructed using a bipedicle pericranial flap with posterior and anterior pedicles. After the infection had completely subsided, the second operation was performed, reconstructing the cranium with grafted outer-table calvarial bone and cutting bone to reposition an old zygomatic fracture. At this point, the pericranial flap used for dura mater reconstruction in the first operation became a satisfactory graft bed for the grafted bone. The postoperative course was satisfactory, and there was no cranial bone absorption after roughly 2 year, and a favorable shape has been maintained for an extremely satisfying result.
Cesarean section instrument tables are often not prepared in advance because of concern of contamination risk. The Association of Operating Room Nurses Standards decries the use of pre-preparation of surgical instrument tables because of this risk, although there are no scientific data to support this claim. We evaluated the contamination risk of pre-preparation of surgical instrument tables, prolonged table coverage and table uncovering using a specific technique referred to as the "sardine can roll." Colony counts were positive in only seven of 180 cultures (< or = 15 colonies per plate in each instance) from six tables evaluated after prolonged coverage or uncovering, or both. These data suggest that contamination risk is slight for the uncovering technique described herein and advance table preparation (24 hours or less, never recovered) is a reasonable clinical option in units in which table preparation reduces response time in emergent clinical situations, such as cesarean section for acute fetal distress.
During the last 3 1/2 years, 40 bypasses to a tibial or peroneal artery (distal bypass) were performed for severe leg ischemia in 34 patients who were 80 years of age or older (range, 80-91; mean, 85). The operative mortality rate was 5 per cent. Cumulative life-table limb salvage rates for the 40 extremities were 91 per cent at 1 year and 81 per cent at 3 years. Graft patency rates at 1 and 3 years were 88 per cent and 56 per cent, respectively. Survival rates for the 36 patients were 91 per cent and 58 per cent at 1 and 3 years, respectively. Among 134 patients younger than 80 years who underwent 142 distal bypasses during the same 3 1/2-year period, no operative deaths occurred. In this younger group, cumulative life-table rates at 1 and 3 years were 89 per cent and 89 per cent, respectively, for limb salvage, 86 per cent and 85 per cent, respectively, for graft patency, and 93 per cent and 78 per cent, respectively, for survival. There were no statistically significant differences in these figures for the younger group when compared with corresponding figures for the older group. Among the 36 very elderly patients who underwent distal bypass for limb salvage, 24 patients (67%) with 25 revascularized limbs are alive and have a salvaged, functional extremity after follow-up as long as 41 months (mean, 21 months). These results suggest that an aggressive approach using distal bypass is warranted for limb salvage in very elderly patients.
In this first of three parts, operational parameters (power consumption with and without aeration, aeration number, oxygen volumetric transfer coefficient and hold up) of the system used are presented, together with graphs and tables to show the relation between these parameters and controlable operating variables. Later the values here presented will be correlated with KLa determined by SOM, the kinetics of oxygen transfer in yeast cultures.
This review is a survey of prospective studies on the clinical performance of posterior resin composites published between 1996 and 2002. Material, patient- and operator-specific data, observation periods, isolation methods of the operative field, and failure rates are detailed in tables. The data were evaluated statistically in order to assess the role of materials (filler size, bonding system, base materials [e.g. glass ionomer cements], and lining materials), study design, and personnel on failure rates. The primary reasons for composite failure were secondary caries, restoration fracture, and marginal defects. The influence of different commercial material brands on failure rates was not evaluated due to the great variety of test substances and the lack of material-specific documentation. Effects of the isolation method of the operative field (rubber dam or cotton rolls) and the professional status of operators (university or general dentist) on composite failure rates were not found to be significant. Observation periods varied from 1 to 17 years, and failure rates ranged between 0% and 45%. A linear correlation between failure rate and observation period was found (P<0.0001). Thirteen of 24 studies were terminated after 3 years, while seven studies continued for more than 10 years, indicating that favourable results for composite materials are frequently based on short-term results, despite higher dropout rates in longer studies. To determine accurately the risk for patients, long-term, randomised, controlled clinical trials of treatment outcomes with composites used in posterior teeth are clearly needed.
This article examines the cost competitiveness of the food irradiation process. An analysis of the principal factors--the product, physical plant, irradiation source, and financing--that impact on cost is made. Equations are developed and used to calculate the size of the source for planned product throughput, efficiency factors, power requirements, and operating costs of sources, radionuclides, and accelerators. Methods of financing and capital investment are discussed. A series of tables show cost breakdowns of sources, buildings, equipment, and essential support facilities for both a cobalt-60 and a 10-MeV electron accelerator facility. Additional tables present irradiation costs as functions of a number of parameters--power input, source size, dose, and hours of annual operation. The use of the numbers in the tables are explained by examples of calculations of the irradiation costs for disinfestation of grains and radicidation of feed.
OBJECTIVE: To assess risk factors for important neurosurgical effects in patients who reattend after head injury. DESIGN: Retrospective study. SUBJECTS: 606 patients who reattended a trauma unit after minor head injury. MAIN OUTCOME MEASURES: Intracranial abnormality detected on computed tomography or the need for neurosurgical intervention. RESULTS: Five patients died: two from unrelated causes and three from raised intracranial pressure. On multiple regression analysis the only significant predictor for both abnormality on computed tomography (14.4% of reattenders) and the need for operation (5% of reattenders) was vault fracture seen on the skull radiograph (P < 10(-6)); predictors for abnormal computed tomogram were a Glasgow coma scale score < 15 at either first or second attendance (P < 0.0001) and convulsion at second attendance (P < 0.05); predictive for operation only was penetrating injury of the skull (P < 10(-6)). On contingency table analysis these associations were confirmed. In addition significant associations with both abnormality on computed tomography and operation were focal neurological abnormality, weakness, or speech disturbance. Amnesia or loss of consciousness at the time of initial injury, personality change, and seizures were significantly associated only with abnormality on computed tomography. Headache, dizziness, nausea, and vomiting were common in reattenders but were found to have no independent significance. CONCLUSIONS: All patients who reattend after head injury should undergo computed tomography as at least 14% of scans can be expected to yield positive results. Where this facility is not available patients with predictors for operation should be urgently referred for neurosurgical opinion. Other patients can be readmitted and need referral only if symptoms persist despite symptomatic treatment or there is neurological deterioration while under observation. These patients are a high risk group and should be treated seriously.
Both the numbers and species of airborne bacteria were studied during 263 surgical procedures. The numbers of bacteria isolated were reduced by 95 percent in a horizontal laminar flow room compared with a conventional room and a further 4 percent reduction occurred when a suction-mask system was used. The species of bacteria isolated differed notably at the operative site where a slit sampler was used, as compared with the instrument table and the periphery of the room where settling plates were used. Studies done during simulated surgical operation suggested that light fixtures, pass-through doors, floor contamination and the draped patient were not important sources of airborne contamination in this horizontal laminar flow system. The exact role of airborne bacterial contamination of operative wounds in the development of clinical wound infections is still unknown. Therefore, installation of laminar flow systems must be considered unnecessary at this time.
BACKGROUND: Type I gastric ulcers occur at the gastric incisura and do not coexist with duodenal or pyloric ulcers. Antrectomy and Billroth I anastomosis are the most frequent operations used for treatment of patients with this lesion. STUDY DESIGN: Postoperative results, including recurrence, were evaluated in 48 patients with a Type I gastric ulcer who were treated by parietal cell vagotomy and mucosal excision of the ulcer and had a mean follow-up of eight years. RESULTS: There was no operative mortality and no major operative complications occurred. The patients have had follow-up examination for a mean of eight years. All but four patients were in Visick I and II categories when last examined. Four patients were in category IV because they required a second gastric operation. The cumulative probability of recurrent ulcer rate calculated by life table analysis was 6.5 plus or minus 9.5 (standard error of the mean) percent at nine years. CONCLUSIONS: Parietal cell vagotomy and ulcerectomy is an excellent operation for patients with Type I gastric ulcers and provides an alternative to antrectomy for patients with this lesion.
PURPOSE: To assess the operating characteristics of positron emission tomography (PET) by using fluorine 18 fluorodeoxyglucose (FDG) in the diagnosis of Alzheimer disease. MATERIALS AND METHODS: Articles published between 1989 and 2003 were identified in the MEDLINE, CINAHL, and HealthSTAR databases. Articles were selected if FDG PET was performed with a dedicated scanner and the resolution was specified, if standard criteria were used for the diagnosis of Alzheimer disease, if at least 12 human subjects with Alzheimer disease were enrolled in the study, if clinical diagnosis or histopathologic findings were used as the reference standard, and if sufficient data were provided to construct a 2 x 2 table. Two reviewers independently abstracted data regarding the operating characteristics (sensitivity and specificity) of PET and evaluated the study quality. A meta-analysis was performed by constructing a summary receiver operating characteristic curve and by combining the sensitivity and specificity values by using a random-effects model. RESULTS: Fifteen articles that met the inclusion criteria showed heterogeneity in sensitivity and specificity estimates that were not related to quality features with no plausible explanations. The summary sensitivity of PET was 86% (95% CI: 76%, 93%), and the summary specificity was 86% (95% CI: 72%, 93%). CONCLUSION: The specificity and sensitivity of FDG PET are limited by both study design and patient characteristics. Therefore, the clinical value of these parameters is uncertain; future research on the use of PET in the diagnosis of Alzheimer disease needs to focus on current limitations to be of practical relevance in clinical settings.
Two juvenile patients, ages 5 and 8, had traumatic fractures of the frontal sinus that included involvement of the nasal-frontal ducts and posterior tables. Principles of management are discussed and the techniques for the operative procedures described. While rare in occurrence in children, it is felt that traumatic involvement of the nasal-frontal ducts or posterior tables of the frontal sinus requires an osteoplastic flap--fat obliteration of the frontal sinus cavity in order to preclude subsequent mucocele development or mucosal ingrowth into the anterior fossa.
BACKGROUND: Redo cardiac surgery is considered high-risk surgery as accidental injury to the aorta, the innominate vein, the ventricles and the atria is a possibility. Such accidental injury occurs when the cardiac chamber is adherent to the undersurface of the sternum. Closure of pericardium at the time of primary surgery can prevent adherence of cardiac chambers to the sternum, but may increase the risk of tamponade. This study aimed to show that covering heart with a pedicled pericardial fat pad not only serves the purpose of cover but also avoids the adverse haemodynamic effects of primary pericardial closure. METHODS: Forty patients undergoing elective cardiac surgery were randomised into two groups depending on the way pericardium was managed. Both techniques were already in routine use in our unit and in other units around the country. One method is to leave the pericardium widely open, the other is to loosely oppose the pericardial fat pad over the surface of the aorta and right ventricle. Twenty-three patients had a pedicled pericardial fat pad covering the heart: Closure Group. Seventeen patients had no pericardial fat pad cover over the heart: Open Group. A haemostasis clip was used as a radio-opaque marker over the epicardium in both groups. Post-operation heart rate, central venous pressure, pulmonary artery diastolic pressure, mean arterial pressure and cardiac index were measured and recorded 1, 3 and 8h after surgery. The distance between the haemoclip and the posterior table of the sternum was measured at 6 days and 6 months post-operation. Haemodynamic parameters and the retrosternal space depth were compared between the two groups. RESULTS: There were no important differences in haemodynamic parameters between the two groups. Post-operative lateral chest Roentgenograms showed that the distance between epicardial surface and the posterior table of sternum was larger in the Closure Group compared to Open Group on post-operative day 6, 17.5+/-1.0mm versus 13.4+/-1.3mm (P=0.0013) and 6 months later, 12.3+/-0.8mm versus 6.0+/-1.2mm (P<0.001). There was no mortality in either group. CONCLUSION: Pedicled pericardial fat pad cover is a good alternative to primary pericardial closure as there are no adverse haemodynamic effects in early post-operative period and the long-term benefit of protection of heart at the time of re-sternotomy can be expected.
PURPOSE: Doubtlessly modern high voltage radiation treatment has less side effects than former techniques. It may be better than conventional methods with respect to 5-year survival rates, but that has to be proven using a large number of cases. PATIENTS AND METHODS: Retrospective study using the material of one department of gynecology and obstetrics, practicing both operation and irradiation. 1830 cervical carcinomas are differentiated in stages and then divided in 3 historical collectives. From 1959 to 1968 there was a combination of traditional contact therapy with conventional X-ray irradiation. The period from 1969 to 1972 is characterized as a changing one with partly therapy as described above, partly traditional contact therapy was combined with biaxial telecobalt therapy. From 1973 to 1986 a reduced contact therapy doses was applied to pelvic high voltage irradiation. RESULTS: Five-year survival rate in stage I was 79% in conventional treatment and with ultra high energy 77%. The corresponding figures in stage II are 56% respectively 52%, in stage III 26% respectively 25% (Table 1) of gynecology and obstetrics, practicing both operation and irradiation. CONCLUSION: Application of ultra high energy radiation in higher doses in Rostock had not the consequence of elevating the 5-year survival rate, but the quality of life is much better.