SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
A simple device for grasping, cutting, and extracting sutures from subcutaneous granulomas has been used in more than fifty patients. It is especially useful in removing sutures embedded deeply beneath the skin level in obese patients.
Thirty gastrointestinal anastomoses were created in dogs by stapling with singly placed staples, using a commercially available skin and fascial stapler. The exercise served to illustrate the advantages of automation of individual sutures rather than the whole suture line, pointing out a new direction for the future development of gastrointestinal staplers.
A new hemostatic scalpel has been developed to control bleeding between the cut edges of wound tissue. The scalpel blade resembles conventional scalpel blades, except that it can be heated and its temperature controlled within narrow limits. Cutting is accomplished by the blade's sharp edges, and hemostasis results from the direct transfer of heat from the blade to the tissue. This experimental study has demonstrated that the hemostatic effect of the scalpel is associated with damage to the tissue's defenses against infection and impaired wound healing.
A surgical technique for treatment of benign intrahepatic or extrahepatic biliary stenosis is described. It is based on the use of annular prostheses of Teflon placed around the outside of the anastomotic line using appropriate surgical instruments. This procedure leaves the blood supply to the bile duct intact, achieves hermetic apposition of epithelia, and prevents leakage of bile. It eliminates the use of intraductal splints, avoids retraction of scar tissue around the anastomotic zone, and increases or maintains the internal diameter of the biliary duct on the anastomotic line. The technique has been used in 33 patients with follow-up from 1 to 10 years. Excellent results were achieved in 32 patients, with 1 patient having a poor result. The average postoperative hospital stay was only 6 days.
A technique for laparoscopic reduction, crural repair, and total fundoplication for large symptomatic hiatal hernia is described. The procedure entails the mobilization of the esophagogastric junction with crural repair by a continuous suture technique employing a special pre-formed jamming loop knot, followed by total fundoplication that is fixed proximally to the anterior margin of the diaphragmatic hiatus and distally to the esophagogastric junction. The procedure has been performed in eight elderly patients with a good outcome and accelerated recovery to full activity.
A prospective, randomized, blinded clinical trial was conducted to determine whether electrocautery as a means of creating abdominal or thoracic wounds would result in increased wound infection rates. Over a 15-month period, 492 consecutively studied patients were randomly placed into 1 of 2 groups: scalpel or electrocautery. There were no differences in age grouping, use of steroids, incidence of diabetes, number of days preoperative, operative time, use of preoperative antibiotic prophylaxis, use of drains, number of obese patients, or gender ratio. Wound infections developed in 38 of the 250 scalpel patients (15%) and in 30 of the 242 cautery patients (12%). The use of electrocautery to create surgical wounds does not increase wound infection rates.
The therapeutic role of thoracoscopy has expanded with advances in endoscopic surgical instrumentation and laser technology. We report a complete thoracoscopic resection of an encapsulated (stage I) thymoma with lymphocytic predominance in an elderly woman without myasthenia gravis. The patient had an uncomplicated postoperative course and was discharged on the third postoperative day. Median sternotomy with its attendant morbidity was avoided. Thoracoscopic resection of thymic neoplasms may be a useful approach in carefully selected patients.
In 1923 Elliot Carr Cutler, in conjunction with his cardiology colleague, Samuel Levine, performed a closed transventricular mitral commissurotomy with a tenotomy knife on a 12-year-old patient dying of rheumatic mitral stenosis at the Peter Bent Brigham Hospital. This operation was carried out after several years of experimentation regarding resuscitation of the heart, appropriate incisions, and the pathophysiology of mitral stenosis. The interest in mitral stenosis was rampant at the time because of the huge number of patients suffering from this public health problem. The patient survived and went on to die of pneumonia 4 years postoperatively. Subsequent to this, Cutler performed seven more operations using his new cardiovalvulotome, which was to create controlled mitral regurgitation. Unfortunately, this concept did not promote long-term success and a moratorium for these operations was called in 1929. Nevertheless, this pioneering effort in 1923 was the first successful operation to treat valvular heart disease by a surgical technique.
In the field of Augmented Reality in Surgery, building a hybrid patient's model, i.e. merging all the data and systems available for a given application, is a difficult but crucial technical problem. The purpose is to merge all the data that constitute the patient model with the reality of the surgery, i.e. the surgical tools and feedback devices. In this paper, we first develop this concept, we show that this construction comes to a problem of registration between various sensor data, and we detail a general framework of registration. The state of the art in this domain is presented. Finally, we show results that we have obtained using a method which is based on the use of anatomical reference surfaces. We show that in many clinical cases, registration is only possible through the use of internal patient structures.
The standard technique for Norplant implants removal was compared with a new technique called the "U" technique, which employs the use of a modified no-scalpel vas deferens holding forceps to grasp and remove the capsules. Seventy-six women requesting Norplant implants removal were randomly assigned to Group 1 (standard removal technique) or Group 2 ("U" removal technique). Variables measured included: (a) time required for complete removal, (b) number of capsules not broken or damaged during removal, and (c) number of incisions required for removal of all six capsules. In clients with visible or palpable capsules, the standard removal technique required significantly more time to remove all six capsules, on average, than the "U" technique (19 versus 7 minutes, p < 0.001); also more capsules were damaged during removal (5.6 undamaged versus 6.0, p < 0.01). In addition, with the standard technique, five clients required two incisions for removal of all six capsules while none of the clients required more than one incision with the "U" technique. Our conclusion is that the "U" technique is a quicker and easier method of removing Norplant capsules than the standard technique.
Explore the source record for details and available documents.
The emergence of behavioral states is one of the most significant aspects of development. The rat is very immature at birth and in some structural and functional aspects of CNS (central nervous system) development it is comparable to a 7-month-old human fetus. At this stage of development synchronization of different state criteria is poorly organized. Infant rats spend very little time in wakefulness and, once asleep, they still display a very high level of motor activation, with frequent rapid eye movements and uncoordinated myoclonic jerks. Although it is questioned whether the activated state of sleep in the newborn rat is comparable to rapid-eye movement sleep (REM) in adults, it has been shown that the CNS displays an increased level of endogenous neuronal activation even in very immature animals during this state. To study the functional significance of REM in early life, rat pups were deprived of this state from 1 to 3 wk of age and tested as adults. In the rat, chronic suppression of REM by interfering with monoamines during early development induced hyperactivity, hyperanxiety, attentional distractability, sleep disturbances, reduced sexual performance and reduced cerebral cortical size. In studies using instrumental, surgical or other pharmacological treatments to suppress REM similar effects on the development of brain and behavior were found. Taken together, these findings point to a role for REM during early development, so that more attention should be given to the potential hazards of medicines (and/or pathologic conditions) which induce reduced levels of REM and or disturbed monoamine activities in the brain during late prenatal and early postnatal life.
The ultrasonic surgical aspirator (USA) is a new surgical instrument that allows precise and selective tissue dissection. Ultrasonic cell destruction is combined with continuous irrigation causing a cloud of fine droplets, which sometimes contains viable tumor cells, hanging above the operative field. We present a patient who developed massive recurrent vulvar carcinoma in the subcutaneous tissue in the proximity of the incisions of the vulva and both groins 3.5 months after a USA-assisted radical vulvectomy and inguinal lymphadenectomy. The atypical pattern of recurrence in the entire operative field suggests that tumor cells might have been spread by the irrigation fluid of the USA. Further investigation is needed to assess the risk of tumor dissemination with USA before the instrument can be used safely in patients with early cancer.
Explore the source record for details and available documents.
The surgical Ultrasonic Aspirator (USA) is a fairly new surgical instrument used for an increasingly wide range of procedures. This paper introduces a new application: debridement of vulvovaginal necrotic ulcers resulting from intracavitary radiation therapy. The ultrasonic aspirator allowed removal of the soft, necrotic tissue while preserving underlying healthy, firm tissue and blood vessels.
The effect of single and repeated maternal marijuana smoke exposure on fetal breathing movements (FBMs) was investigated in 13 fetal lambs in the third trimester. These animals were surgically instrumented for long-term intrauterine recording of diaphragmatic electromyogram (EMG). Maternal inhalation of marijuana smoke [1.84% tetrahydrocannabinol (THC)] increased FBMs and resulted in a more continuous and regular breathing pattern. There was a significant increase in the number of breaths/h (p < 0.01) and the incidence of FBMs (p < 0.001) in the second hour. Breathing activity returned to presmoke level by the third hour. Duration of the longest breathing epoch was significantly increased from 16.8 +/- 3.3 min to 31.9 +/- 5.2 min (p < 0.005). Instantaneous breathing rate was much more stable in the second hour after marijuana exposure (p < 0.01). Inhalation of placebo smoke did not result in any significant change in either overall breathing activity or continuity and stability of the breathing rate. The effects of marijuana smoke on fetal breathing were not observed after repeated smoke exposure. These results suggest that tolerance develops rapidly to the respiratory stimulating effect of marijuana smoke in the fetus.
Surgical instruments are described which have been developed for use in high tibial wedge osteotomy. This operation is a treatment for degenerative arthritis of the knee in which one compartment of the joint is predominantly affected resulting in a deformity. Realignment of the bones alters the load distribution on the joint which can relieve pain. Tools have been designed to facilitate the removal of a wedge of bone cut at a precise angle calculated from load bearing radiographs. The tools are a marker pin guide and a saw guide; their use has resulted in accurate bone realignment confirmed by postoperative radiographs.