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At least 1,405 records · Page 78Linked to original sources
PubMed1987

Preoperative risk assessment in cardiac surgery: comparison of predicted and observed results.

In the present climate of quality-assurance policies, rigorous requirements for informed consent, and a constantly changing patient population, a system of preoperative risk assignment and postoperative correlation was developed to monitor and evaluate surgical performance. Patients were categorized by operation, priority (emergent, urgent, elective), New York Heart Association Functional Class, and risk. Risk was assigned before operation using data from the Coronary Artery Surgery Study (CASS) and the recent literature. Data were collected by a full-time data manager and were stored and analyzed by computer. From January 1, 1984, to July 1, 1985, 1,303 patients underwent operation for acquired disease. This group included 913 patients undergoing isolated primary coronary artery bypass grafting (CABG). The comparison of predicted and observed results showed: (Table: see text). For patients undergoing isolated primary CABG, the elective group had an operative mortality of 0.6% (2/329); the urgent group, 1.1% (5/450); and the emergent group, 5.2% (7/134). Preoperative risk assignment is an effective method of quality assurance. Female sex and age older than 60 years, which predicted an operative mortality of 2 to 5% in the CASS study and other recent series, did not predict a similar risk in our series.

Adult↗
PubMed1985

Retroperitoneal inflow procedures for iliac occlusive vascular disease.

We reviewed our experience over the past six years with retroperitoneal inflow procedures (aortofemoral and iliofemoral bypass grafts) in high-risk patients with aortoiliac occlusive disease. There were 57 limbs in 40 patients. Twenty percent of the patients were diabetic, 80% were smokers, 40% had heart disease, 54% had hypertension, and 25% had symptomatic chronic obstructive pulmonary disease. The average patient age was 64 years. There was no operative mortality and cumulative patency rate by life-table analysis at four years was 84%. The site of the proximal anastomosis (aorta vs iliac) or the configuration of the graft (unifemoral vs bifemoral) did not influence the patency rate. Retroperitoneal inflow procedures are an excellent alternative in patients who present an unacceptably high risk for standard aortofemoral reconstruction.

Adult↗
PubMed2006

[Guidelines given by the DSG and DGN concerning stroke therapy--new therapeutic aspects].

Surgeries of symptomatic carotid stenose should not be operated on later than 14 days after stroke; until the operation inhibitors of platelet aggregation have to be administered (Table 1). The application of anticoagulants like warfarin or phenprocoumon in case of intracranial stenoses is no longer recommended. Instead 100-300 mg aspirin should prophylactically be given. The risk of suffering a stroke is significantly reduced by the application of antihypertensives. Patients with focal cerebral ischemia should be given 40 mg of Simvastatin which leads to a significant decrease of vascular risk. After the first cerebral ischemic incidenz patients with open foramen ovale of the heart should be given 100-300 mg aspirin. In case of aspirin relapse an oral anticoagulation has to be carried out with an INR of 2.0 up to 3 for at least one year.

Aged↗
PubMed1981

The treatment of femoral shaft fractures by closed Küntscher nailing (without reaming).

Closed medullary nailing for fracture of the femoral shaft was carried out in 101 cases. The operation was performed with the patient in the supine position and without reaming the medullary canal, using the conventional instruments and rigid guide pins. The diameter of the medullary canal was gauged from standard radiographs taken at 1 m tobe-to-film distance. To secure alignment and reduction of the fracture, heavy traction before and during the operation was necessary. The traction applied on a fracture table against the restraining perineal bar caused trauma to the perineal structures in 7 cases. There was no case of deep infection. The fixation of the fracture was by no means rigid but was adequate for early walking and partial weight bearing. When nails with diameters of less than 9 mm were used, a number of complications occurred. These included angulation, rotational instability at the fracture site, fracture of the nail and non-union. Union occurred within 3 months in all except 2 cases. Nearly 60 per cent of the patients were in hospital for less than 2 weeks. Closed medullary nailing of the femur is preferable to the open method, which carries a much higher risk of infection.

Adolescent↗
PubMed2004

A quantitative risk assessment model for Salmonella and whole chickens.

Existing data and predictive models were used to define the input settings of a previously developed but modified quantitative risk assessment model (QRAM) for Salmonella and whole chickens. The QRAM was constructed in an Excel spreadsheet and was simulated using @Risk. The retail-to-table pathway was modeled as a series of unit operations and associated pathogen events that included initial contamination at retail, growth during consumer transport, thermal inactivation during cooking, cross-contamination during serving, and dose response after consumption. Published data as well as predictive models for growth and thermal inactivation of Salmonella were used to establish input settings. Noncontaminated chickens were simulated so that the QRAM could predict changes in the incidence of Salmonella contamination. The incidence of Salmonella contamination changed from 30% at retail to 0.16% after cooking to 4% at consumption. Salmonella growth on chickens during consumer transport was the only pathogen event that did not impact the risk of salmonellosis. For the scenario simulated, the QRAM predicted 0.44 cases of salmonellosis per 100,000 consumers, which was consistent with recent epidemiological data that indicate a rate of 0.66-0.88 cases of salmonellosis per 100,000 consumers of chicken. Although the QRAM was in agreement with the epidemiological data, surrogate data and models were used, assumptions were made, and potentially important unit operations and pathogen events were not included because of data gaps and thus, further refinement of the QRAM is needed.

Animals↗
PubMed1995

X-ray analysis after repair of scaphoid non-union through a dorsal approach.

The consequences of non-union of the scaphoid with or without deformity were evaluated before and after surgery with non-parametric tests, MANOVA and discriminant analysis, and Spearman correlation and contingency tables. 18 consecutive cases of scaphoid non-union, operated upon through a dorsal approach preserving the carpal ligaments since 1987, were used for measurements. Carpal height, radio-lunate and radio-scaphoid angles, lunate covering ratio, and apparent translation of the capitate and lunate were analyzed on standard views of the wrist before and after scaphoid repair. We found that the lunate covering ratio combined with the radio-lunate angle was the main indicator of deformity before the repair as suggested by the strong correlation between the ratio-lunate angle and lunate covering ratio (P = 0.0001). After repair, the only indicator of mal-union was the apparent translation of the lunate on frontal views (P = 0.0033) as suggested by the strong correlation between mal-union and lunate translation (P = 0.0001). Translation of both the lunate and capitate correlated well before and after repair. Radio-scaphoid angle and carpal height showed no significant changes and are not informative in the presence of subtle carpal alteration. Repair of the scaphoid produced an improvement in the radio-lunate angle in all cases, even in the presence of mal-union. However, full restoration was never achieved even in the absence of mal-union. More precise techniques of measurement might contribute to a better understanding of the carpal mechanics in relation to well-defined diagnoses such as scaphoid non-union.

Adolescent↗
PubMed2004

Ergonomic evaluation of the work area of the scrub nurse.

Current ergonomic solutions in the operating room focus on patients and surgeons. The work environment of the scrub nurse has not been studied before. In this article the work environment is described and the potential ergonomic problems are addressed. Practical short-term solutions are provided and our design vision for future operating rooms is presented. Neck and back problems result from attempts of the scrub nurse to create an unobstructed view of the operating field and from reaching for instruments on instrument tables. Height-adjustable foot stools, better monitor placement and ergonomically designed instrument tables will help to decrease neck and back torsion. Soft supports placed on resting points of instrument tables will decrease pressure on arms, abdomen, and legs. Standing supports, allowing semi-standing postures will decrease leg fatigue. The current state of the work environment of the scrub nurse is not optimal. Future studies should focus on problems in the ergonomics of their work environment to enable optimal product design for the scrub nurse.

Journal Article↗
PubMedDate not supplied

Enhancement of electron beam dose distributions by longitudinal magnetic fields: Monte Carlo simulations and magnet system optimization.

A Monte Carlo electron-photon transport code was developed in order to determine the effects of static, longitudinal, magnetic fields on dose distributions produced by high-energy electron beams, and to optimize the design of a superconducting magnet system. As a result of these simulations, a 20-cm-i.d., 30-cm-o.d., 15-cm-tall, single-coil, magnet system was designed that could be incorporated into a mobile treatment table for use with a standard radiation therapy accelerator. Operating at a current density of 18 kA/cm2, the magnet would produce field strengths of 1-4 T in the phantom and 0.01 T at the accelerator exit window. Magnetically enhanced dose distributions, calculated for 20- and 30-MeV electron beams, show a pronounced Bragg peak, steeper gradients to the sides and rear, and a roughly fourfold increase in the peak dose to entrance dose ratios relative to those similarly calculated without a magnetic field. These magnetically enhanced dose distributions have the potential for sparing intervening tissue when high-energy electrons are used for the treatment of deep-seated tumors.

Electrons↗
PubMed1995

Value of laparotomy in the diagnosis of obscure gastrointestinal haemorrhage.

Over a nine year period a total of 137 patients were investigated for obscure gastrointestinal bleeding on one surgical unit. In 20 patients visceral angiography strongly suggested the presence of caecal or right colonic angiodysplasia. These patients were treated by an appropriate colectomy and they are not considered further in this study. Similarly lesions of the small bowel detected by preoperative investigations are not considered here. Fifty five patients were offered diagnostic laparotomy after the failure of other investigations to establish a diagnosis. Two patients refused. A diagnostic laparotomy was performed in the remaining 53. At operation if no visible lesion was seen an on table enteroscopy was performed using a colonoscope passed per oram and, if necessary, per anum. In nine (17%) patients no cause for bleeding was found. In 18 (34%) patients there was a small bowel vascular anomaly, in 14 (26%) a small bowel tumour, in four (7.5%) a bleeding Meckel's diverticulum, and in eight (15%) other miscellaneous lesions. Laparotomy, with on table enteroscopy where indicated, elucidated the cause of bleeding in 44 patients (83%). It was associated, however, with a postoperative death rate of 7.5% (four patients). After seemingly appropriate surgery, rebleeding occurred in 14 patients (26%). Of 18 patients with small bowel vascular anomalies seven rebled (39%), at an average follow up interval of 32 months.

Aged↗
PubMed2004

Intraoperative diffusion-tensor MR imaging: shifting of white matter tracts during neurosurgical procedures--initial experience.

PURPOSE: To prospectively evaluate the location of white matter tracts with diffusion-tensor imaging (DTI) during neurosurgical procedures. MATERIALS AND METHODS: Ethical committee approval and signed informed consent were obtained. A 1.5-T magnetic resonance imager with an adapted rotating surgical table that is placed in a radiofrequency-shielded operating theater was used for pre- and intraoperative imaging. DTI was performed by applying an echo-planar imaging sequence with six diffusion directions in 38 patients (20 female patients, 18 male patients; age range, 7-77 years; mean age, 45.6 years) who were undergoing surgery (35 craniotomy and three burr hole procedures). Color-encoded maps of fractional anisotropy were generated by depicting white matter tracts. A rigid registration algorithm was used to compare pre- and intraoperative images. RESULTS: Intraoperative DTI was technically feasible in all patients, and no major image distortions occurred in the areas of interest. Pre- and intraoperative color-encoded maps of fractional anisotropy could be registered; these maps depicted marked and highly variable shifting of white matter tracts during neurosurgical procedures. In the 27 patients who underwent brain tumor resection, white matter tract shifting ranged from an inward shift of 8 mm to an outward shift of 15 mm (mean shift +/- standard deviation, outward shift of 2.5 mm +/- 5.8). In 16 (59%) of 27 patients, outward shifting was detected; in eight (30%), inward shifting was detected. In eight patients who underwent temporal lobe resections for drug-resistant epilepsy, shifting was only inward and ranged from 2 to 14 mm (9 mm +/- 3.3). In two of the three patients who underwent burr hole procedures, outward shifting occurred. CONCLUSION: Intraoperative DTI can depict shifting of major white matter tracts that is caused by surgical intervention.

Adolescent↗
PubMed1996

Mechanical malfunction of the Leksell Gamma knife during patient treatment.

During the course of a patient treatment with a North American U-type gamma unit, the remote hydraulic valve controlling the direction of couch motion failed to change state. The couch, helmet and patient remained in treatment position after the expiration of treatment time for one of the target shots. No unusual equipment warning indications had been observed prior to the malfunction. The gamma unit was new, having been used to treat approximately 20 patients since it had begun to be used clinically 11 weeks previously. This specific situation was not addressed in our posted Emergency Procedures, which dealt explicitly with loss of electrical power, and loss of hydraulic pressure. In the present case, the hydraulic gauges indicated full pressure. After attempts to disengage the patient remotely proved unsuccessful, personnel entered the room. The table clutch at the foot of the couch was operated to disengage the couch/helmet assembly from its docked position. While this was not mentioned in our emergency procedures, the act had the effect of causing the cobalt-60 sources to be misaligned with the collimator apertures, thereby immediately terminating the patient treatment. This also had the unanticipated effect of substantially reducing radiation leakage exposure rate next to the couch near the tunnel opening. The patient was released from the helmet trunnions using a manufacturer-supplied long-handled special Allen key. The key was used conventionally, to release the trunnion locking mechanism, and also unconventionally to force a separation of a trunnion from the docking slot on the patient head frame. The patient was then removed from the tunnel by sliding out the pad on which she was lying. Anesthesiology personnel accompanied the patient out of the room. The unit functioned properly upon the replacement of the valve by manufacturer service personnel the next day. The patient returned for completion of treatment 1 week later. There were only minor changes to the overall patient dosimetry as a result of the malfunction. Personnel exposures were very low. The malfunction was reported to State authorities, who conducted an investigation, that was in turn followed up by an investigation by the Nuclear Regulatory Commission.

Dose-Response Relationship, Radiation↗
PubMed2000

Inflammatory bowel disease after 1932.

The clinical diseases of ulcerative colitis (UC) and Crohn's disease (CD) were defined by 1932-1933. After that, the major conceptual developments were the recognition that regional enteritis could clearly involve the colon, and that cancer and toxic megacolon could occur in both CD and UC. In the last half of the 20th century the main thrust of gastroenterology at The Mount Sinai Hospital has been in inflammatory bowel disease (IBD), with contributions to extra-intestinal manifestations, measurement of clinical activity in CD, the natural history of the placebo arm of controlled trials, complications and therapy with corticosteroids, 5-ASA, 6-mercaptopurine, immunomodulators and cyclosporine. Actuarial life tables were introduced for postoperative recurrence and re-operation rates, as well as for quality of life analysis. Two forms of CD were defined, perforating and non-perforating, and the role of the fecal stream was explored in light of the higher risk of recurrence after operations with anastomosis as compared with ileocolostomy.

Gastroenterology↗
PubMed1987

[Carcinoma of the colon. Statistico-epidemiologic study carried out at Casale Monferrato Hospital].

The authors report here on the results of a statistical and epidemiological review of cases of carcinoma of the large bowel observed in the General Surgery Division of the Casale Monferrato Hospital. After supplying introductory data on the diffusion of the disease, risk factors and statistical aspects, the authors report data on 137 cases of large bowel carcinomatous neoplasms observed and treated over the period 1978-1984, complete with tables summarising the neoplastic localizations aid the types of operation performed. After calculating the operative mortality and both the absolute and relative survival rates, the authors analyze the results of the survey, comparing the findings obtained with those reported in the literature by various authors.

Adenocarcinoma↗
PubMed1981

Effect of laminar air flow and clean-room dress on contamination rates of intravenous admixtures.

The effect of laminar air flow conditions and clean-room dress on the microbial contamination rates of intravenous admixtures was investigated. Intravenous admixtures were prepared by one investigator using aseptic technique under four environmental conditions: laminar air flow conditions with clean-room dress; laminar air flow without clean-room dress; clean table top with clean-room dress; and clean table top without clean-room dress. In each environmental condition, 350 admixtures were compounded. Negative-control samples (n = 150) were also tested, as were 10 positive-control samples. Samples were tested in each of two growth media and incubated at 35 degrees C for 14 days or until growth occurred. The incidence of contamination of admixtures compounded in laminar air flow conditions was significantly less than the contamination of those compounded on a clean table top (p less than 0.05) regardless of the operator's dress. The incidence of contamination of admixtures compounded while wearing clean-room dress was not significantly different from those prepared while not wearing clean-room dress regardless of the environment in which the admixture was prepared. The overall low level of contamination [0.79% (11/1400)] was inconclusive regarding the effect of dress on the incidence of contamination when admixtures were prepared under LAF conditions. It is concluded that, when one adheres to aseptic technique, the environment in which admixtures are compounded is the most important variable affecting the microbial contamination rate.

Drug Compounding↗
PubMed2003

Mini-open intramedullary nailing of acute femoral shaft fracture: reduction through a small incision without a fracture table.

BACKGROUND: Femoral shaft fractures are usually treated with intramedullary nailing. In this study, we report on a modified surgical technique with reduction through a small incision for this type of fracture. METHODS: From 1994 to 1997, this technique was used on 74 patients with 82 femoral shaft fractures. Seventy patients (76 fractures) with at least 3 years of postoperative follow-up were included for clinical evaluation. The surgical technique involves a mini-wound at the fracture site, and fracture reduction is performed with 1 finger or a bone hook without the use of a fracture table. RESULTS: Seventy-four fractures (97%) healed in the first 6 months. In 2 patients, there was little evidence of fracture union at 6 months. One of these 2 patients was treated with an open bone graft, and the other was treated with a closed exchanging nail. Finally these 2 patients healed. The mean operation time for this procedure was 75 minutes. CONCLUSION: The advantages of this procedure include that no fracture table is needed, there is a shorter operation time, there is a small amount of blood loss, and it is especially suitable for multiple trauma patients.

Acute Disease↗
PubMed1990

[Evaluation of coronary risk in arterial surgery].

To evaluate the incidence of coronary artery disease in peripheral vascular surgery, three groups of patients (table. I) were studied retrospectively: 286 patients who had vascular surgery with no concern for the location of arterial lesions (group I); 130 patients electively operated for infra-renal abdominal aortic aneurysm (group II); and 120 patients who had 139 carotid endarterectomies (group III). The frequency of cardiac history (table II) evaluated in the three groups of patients, was respectively 42.6%, 41.4.% and 27.5%. Operative mortality in the three groups was respectively 6%, 3.8% and 1%. In group I, mortality of cardiac origin was 2.2% and cardiac morbidity 7%. In this group, analysis of results showed that the existence of cardiac history is a significant risk factor (table III) for the mortality and incidence of cardiac complications (p less than 0.005). In groups II et III, operative mortality of cardiac origin was respectively 1.5% and 0%; cardiac morbidity was respectively 4.6 and 2.2%. On the basis of this analysis, we can conclude that cardiac complications are the main cause of mortality and morbidity in peripheral vascular surgery and that the existence of cardiac history is a significant predictive factor in evaluation of operative risk in vascular surgery.

Aged↗
PubMedDate not supplied

A review of papillomas of the third ventricle. One case report.

The Authors present one case of choroid plexus papilloma localized in the third ventricle. This is in fact the only case in a series of about 4,000 patients operated on for brain tumors at the Neurosurgical Institute of the University of Rome. They consider 56 cases reported in the literature. Out of these, 43 are described and summarized in a table according to the clinical, radiological and surgical features. Twentyfive were the patients operated on, the average mortality in the cases which underwent indirect or not specified operation was 80%; that of patients submitted to a direct approach or to subtotal excision was 50%; and finally 3 patients out 13 (about 23%) who had total resection, died after surgery.

Adolescent↗
PubMed1974

Bacteriological evaluation of a laminar cross-flow tunnel for surgery under operational conditions.

A transportable surgery cross-flow unit has been tested under ;operational conditions'. By the use of artificial aerosols and a volunteer surgical team, or dummies, it was found that, at an air velocity of 0.45 m./sec., a detectable transfer to above the table occurred only when quite highly concentrated aerosols (of more than 10(3.6) bacteria/m.(3) of air or more) existed underneath the table. The short disappearance time under these conditions and the quite stable flow pattern above the table found when a surgical team was working, standing along both sides of the table, make it unlikely that an aerosol of detectable concentration can develop during surgery, at this site. The chance that particles, liberated from the heads of the surgical team, settle on the table, was found to be strongly reduced when a cross-flow tunnel operated at an air velocity of 0.45 m./sec. The transfer from outside the unit to the inside was prevented by closing the upper part of the open front side.

Aerosols↗