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PubMed2002

[Endovascular therapy of aneurysms of the abdominal aorta: report of 4,291 patients of the Eurostar Register].

BACKGROUND: The Eurostar project is a multicentred database of the outcome of endovascular repair of infra-renal aortic aneurysms. From 1996 to March, 2002, 113 European centres of vascular surgery have contributed. The purpose of this article is to review the medium term (up to 7 years) results of endovascular aneurysm repair as reported to Eurostar. PATIENTS AND METHODS: Patients intended for endovascular aneurysm repair were notified to the Eurostar Data Registry Centre before treatment in order to eliminate bias due to selective reporting. The following data was collected on all patients: (1) their demographic details and the anatomical characteristics of their aneurysms, (2) details of the endovascular device used, (3) procedural complications and the immediate outcome, (4) results of contrast enhanced CT imaging at 1, 3, 6, 12, 18 and 24 months after operation and at yearly intervals thereafter, (5) all adverse events. Life table analysis was performed to determine the cumulative rates of: (1) death from all causes, (2) secondary intervention. RESULTS: By March 2002, pre- and postoperative data of 4291 patients had been registered. The median duration of follow-up was 12 mo (range 0-96). Successful deployment was achieved in 97.8% of the patients with a perioperative (30 day) mortality of 2.4%. Early conversion to open repair occurred in 1.3%. Late rupture of the aneurysm occurred in 35 patients. The significant factors were endoleaks, graft migration and kinking. Late conversion to open repair occurred at an annual rate of approximately 2%. Risk factors (indications) for late conversion were endoleaks, graft migration and kinking. CONCLUSIONS: Endovascular repair of infra-renal aortic aneurysms using the first and second-generation devices that predominated in this study is associated with a risk of early or late failure of 3% per year, based upon an analysis of observed primary endpoints of rupture and conversion.

Adult↗
PubMed2000

The snuffbox arteriovenous fistula for vascular access.

OBJECTIVES: to determine the applicability, patency rates and factors influencing patency of snuffbox arteriovenous fistulae for haemodialysis access. DESIGN: retrospective non-randomised study. MATERIALS AND METHODS: patency was determined by reference to an ongoing database and dialysis records of 645 vascular access procedures between 1985 and 1997, including 210 snuffbox fistulae in 201 patients. RESULTS: snuffbox fistulae comprised 189/376 (50%) primary procedures. Records of 208 snuffbox fistulae were available for patency analysis by the life-table method. Twenty-two (11%) thrombosed within 24 hours of operation. After six weeks 80% were used for dialysis. Cumulative patency was 65% at 1 year and 45% at 5 years. After thrombosis of snuffbox fistulae, ipsilateral wrist fistulae could be constructed in 45%. Fistula patency was significantly better in men than women (p<0.001) and for left- than right-sided fistulae (p<0.001). Diabetes, age >70 years, and the prior commencement of haemodialysis did not significantly affect fistula survival. CONCLUSIONS: the snuffbox AV fistula gives a long segment of arterialised vein for needling and preserves proximal vessels. It is feasible in 50% of patients requiring primary access and has good long-term patency, especially in men. A more proximal fistula may be preferable in women with smaller vessels.

Arteriovenous Shunt, Surgical↗
PubMed1989

Soluble oil dermatitis: a follow-up study.

A pilot follow-up study of patients with soluble oil dermatitis was designed to investigate the effects on prognosis of aetiology and of stopping working with soluble oils. A questionnaire was sent to 121 machine operators who had been diagnosed over a 5-year period. Life table analysis of the 100 replies (83%) revealed a poor prognosis both for those who had continued to work with soluble oils and for those who had stopped. 78% (95% confidence intervals: 63%-94%) of those who continued to work with soluble oils had not healed 2 years after diagnosis. 70% (95% confidence intervals: 56%-83%) of those who stopped working with soluble oil had not healed 2 years after discontinuing contact. Both groups were divided into 4 subgroups with different combinations of aetiological components: allergic and endogenous, non-allergic and endogenous, allergic and non-endogenous, non-allergic and non-endogenous. No significant difference in outcome emerged in either the discontinued contact group or the continued contact group between any aetiological subgroups. Patients who discontinued contact with soluble oils fell into 2 groups: those who healed rapidly and those who developed a chronic dermatitis. 11 of the 15 patients who had healed after 2 years had done so within the first 3 months following cessation of contact. No factor could be identified to distinguish those with the more favourable prognosis. The implications of this study for the management of soluble oil dermatitis are discussed.

Adolescent↗
PubMed2004

A practical approach to prevent gantry-couch collision for linac-based radiosurgery.

Gantry-couch collision is a serious concern for treatment planning of the linear accelerator (linac) based stereotactic radiosurgery (SRS). The ability to detect collision at the time of planning eliminates the need for backup plans and preserves the useful beam angles that would be deemed unsafe and discarded otherwise. Most collision-detection schemes embedded in commercial planning software guard only against the most apparent collisions. On the other hand, a fool-proof collision-map or lookup table often requires detailed measurement of machine geometry and complex graphic operations. In this study, we have developed a simple analytical method for collision detection with the use of quick machine-specific measurements. The collision detection is mathematically solved by determining whether two facets in three-dimensional space, representing gantry and couch surfaces, intersect with each other. A computer code was implemented and tested on a Varian Clinac 600C linac equipped with a BrainLab micromultileaf collimator (MLC) device. To measure machine-specific parameters, the lesion isocenter was set to the origin of the stereotactic coordinate system. The reference coordinates of couch bracket corners and micro-MLC to the linac isocenter were measured only once in the treatment room before they were incorporated into the computer program. Couch, gantry, and collimator were subsequently translated and rotated to study the clearance of various beam arrangements and lesion locations. Predicted results were verified at the machine. Our method correctly confirmed clearance for a retrospective study of 54 previously treated SRS plans (76 isocenters). It also accurately predicted the collisions for all ten artificially created cases. In conclusion, we have developed an analytical method for SRS collision detection that is accurate, easy to implement, and computationally inexpensive.

Algorithms↗
PubMed2006

Simultaneous image-guided and endoscopic navigation without rigid cranial fixation: application in infants: technical case report.

OBJECTIVE AND IMPORTANCE: Infants and young children demonstrate a variety of intraventricular and periventricular lesions. Endoscopy has proven useful in the treatment of many of these lesions, but its benefit is limited if it is applied to complex loculated cysts or if the disease is concealed by normal ependymal boundaries. In adults and older children, endoscopy can be augmented by the simultaneous use of frameless stereotaxy, but this combined modality has not been possible in infants and young children without rigid cranial fixation. We describe a method of achieving simultaneous stereotactic and endoscopic navigation in infants and young children by using a pinless, frameless stereotactic assembly. CLINICAL PRESENTATION: The first patient was a 6-week-old boy with macrocephaly and a bulging fontanelle. Computed tomographic and magnetic resonance imaging revealed a complex arachnoid cyst and obstructive hydrocephalus. The second patient was a 7-month-old, ex-premature (27-wk gestational age) boy who developed posthemorrhagic hydrocephalus. He underwent multiple shunt revisions, one of which was complicated by enterococcal ventriculitis. Despite bilateral ventriculoperitoneal shunts, he developed increasing head circumference, listlessness, and irritability. Imaging revealed an enlarged, multiloculated, and asymmetric ventricular system. INTERVENTION: Simultaneous image-guided and endoscopic neuronavigation was implemented in both patients. Before the procedure, a cranial reference arc was secured to the outer table of the cranium through a small incision adjacent to the operative field. After the stereotactic apparatus was registered, the software was used to plan a trajectory for the approach. A burr hole was then made, and a rigid 6-mm endoscope was inserted for direct visualization. Once advanced past the endoscopic port tip, the electromagnetic coil stylet was used to stereotactically track position and identify areas for fenestration, biopsy, and catheter insertion. CONCLUSION: Endoscopic views of complex hydrocephalus and arachnoid cysts alone are often difficult to interpret. Simultaneous image-guided and endoscopic neuronavigation may be advantageous in the management of complex cases that are anatomically related to the ventricular system in infants for whom rigid cranial fixation could lead to increased procedure-related morbidity.

Brain Diseases↗
PubMed2005

Incisional administration of local anesthetic provides satisfactory analgesia following port access heart surgery.

AIM OF THE STUDY: To evaluate the new method of postoperative pain relief following port access (PA) heart surgery. METHODS: Patients scheduled for PA heart surgery under cardioplegic arrest were enrolled in the study. At the end of the operation an epidural catheter was placed in the surgical wound. Analgesia was started with a bolus of 20 mL 0.75% ropivacaine through the catheter followed by 0.15% ropivacaine administered via patient control analgesia pump. Metamizol was also given to the patient every 12 hours intravenously (IV), and, in the case of inadequate analgesia, the rescue analgetic piritramid IV was used. The variables recorded were the visual analogue scale (VAS), the number of bolus applications of local anesthetic, and the number of bolus applications of rescue analgetic piritramid. RESULTS: The pain control at the end of the operation was satisfactory with all patients who were extubated on the table. In the first 24 hours the mean VAS pain score was 2.5, the number of bolus applications of local anesthetic was 2.0, and the number of applications of rescue medication was 1.5. There were no wound infections related to the catheter and no complications related to local anesthetic. CONCLUSION: The incisional administration of local anesthetic provides satisfactory pain control after PA heart surgery.

Anesthetics, Local↗
PubMedDate not supplied

Sucrose concentration in blood: a new method for assessment of gastric permeability in horses with gastric ulceration.

A urine sucrose test has recently been reported to be a reliable method of detecting gastric ulcers in horses; however, technical difficulties associated with urine collection have limited the practical value of the test. The objective of this pilot study was to determine whether gastric sucrose permeability, as evaluated by serum sucrose concentration, could be used to detect gastric mucosal injury in horses. Twelve adult horses with naturally acquired gastric ulceration were studied. After a 20-hour nonfeeding period, each horse was dosed with 250 g of sucrose via nasogastric intubation. Blood samples were collected at 0, 15, 30, 45, 60, and 90 minutes, and horses underwent gastroscopy 4 hours later. The severity of gastric ulceration in each horse was defined by means of a 4-point ulcer-scoring system, and the relationship with serum sucrose concentration was analyzed by means of a linear mixed-effects model. Serum sucrose concentration was measured by liquid chromatography operating in tandem with electrospray mass spectrometry. After nasogastric administration of table sugar, horses with moderate to severe gastric ulceration had significant increase in serum sucrose concentration at 30, 45, 60, and 90 minutes, relative to earlier times (P < .05). Peak sucrose concentration was observed at 45 minutes, and was correlated with ulcer severity (Spearman's rank correlation coefficient = 0.898, P < .05). These data indicate that determination of sucrose concentration in equine serum may be a useful test for identifying horses with endoscopically visible gastric ulceration and has potential use as a noninvasive method for screening and monitoring horses engaged in racing training and other performance-related disciplines.

Animals↗
PubMed1997

Reality check: using stimulation modeling to plan and sell change.

As anyone who has worked with a computer knows, technology doesn't always solve problems. But when it comes to planning for health care institutions, operation simulation modeling can help executives make better decisions and create more efficient operations--by bringing more information, issues and communication power to the table.

Computer Simulation↗
PubMedDate not supplied

Accuracy of tissue polypeptide specific antigen (TPS) in the diagnosis of ovarian malignancy.

This paper evaluates the usefulness of determining the level of serum Tissue Polypeptide Specific Antigen (TPS) by TPS ELISA in the diagnosis of ovarian malignancies and compares it with the results of histological examination of the ovaries. The study covers 92 patients who had been clinically diagnosed with ovarian tumors by history, physical examination and pelvic examination with or without pelvic ultrasonography. All of them underwent surgical treatment by exploratory laparotomy in Siriraj Hospital between May 1, 1996 and 31 March, 1997. None of the patients had been treated with chemotherapy or hormonal therapy, and in no case were there any previously diagnosed malignancies. TPS was measured in the serum of 92 patients who were preoperatively diagnosed with ovarian tumor: 52 patients had benign pelvic masses and 40 patients had malignant ovarian tumors. Using the criterion for TPS positivity defined by the manufacturer (80 U/L), TPS levels were elevated in 28.8% of benign pelvic mass patients and in 90% of malignant ovarian tumor patients. Statistical analysis using a two-by-two table at every cut-off TPS level and a receiver operating characteristic (ROC) curve, the optimal accuracy, sensitivity, specificity, positive predictive value, negative predictive value, false positive rate and false negative rate were 79.4, 90.0, 71.2, 70.6, 82.9, 28.9 and 10.0%, respectively using the positivity criterion of 80 U/L. We conclude that determination of serum TPS level by TPS ELISA in the diagnosis of ovarian malignancy is good and clinically acceptable. A TPS level greater than 80 U/L is a useful positivity criterion for screening for malignant ovarian tumors, while a TPS level greater than 180 U/L is a positivity criterion for differentiating malignant ovarian tumor from benign pelvic mass. Because of its high false positive rate, any patient with TPS greater than 80 U/L should be further investigated for malignant ovarian tumor.

Adolescent↗
PubMed1992

Intramedullary interlocked tibia nailing: a new technique (preliminary report).

This paper presents a modified surgical technique for interlocked intramedullary stabilization of tibia fractures. An external distractor is used to achieve an indirect fracture reduction on a fluoroscopy table. This method avoids the potential traction complications associated with conventional fracture tables. The fluoroscopy unit remains in one position during the entire operation. This technique decreases set-up time, provides complete control over the involved extremity, facilitates an accurate reduction, allows for compression at the fracture site, and simplifies the interlocking procedure. Twenty patients with 20 tibia shaft fractures were treated with this technique. No complications occurred during acute fracture care. Alignment was anatomic or near anatomic in all cases and physician satisfaction was 100%. At follow-up, averaging 5.2 months, there has been no change in fracture alignment, and most tibias are demonstrating clinical and radiographic healing. Distraction at the fracture site with a statically locked tibia nail may impede healing. The external distractor can be used to compress the fracture site prior to static interlocking, and this may facilitate healing. Dynamization of the nail should be considered when early signs of healing are absent. This technique is simple, accurate, and safe, and should be considered when treating an unstable tibia shaft fracture with a locked intramedullary nail.

Adolescent↗
PubMed1990

New peer review reporting and disclosure requirements--Part I.

This article reviews the reporting and disclosure provisions of the Health Care Quality Improvement Act of 1986, the Medicare and Medicaid Patient and Program Protection Act of 1987, the Texas Medical Practice Act, and federal regulations promulgated in late 1989 to establish the operating rules and policies of the National Practitioner Data Bank. A table on pages 56-57 outlines the reporting requirements of these laws and regulations. Discussion focuses on the requirements the new federal regulations place on physicians and other health care practitioners, health care entities, and insurers.

Humans↗
PubMedDate not supplied

[The obstetrical bed KA-2].

An obstetric bed is intended for disposition of parturients during labor as well as for performing obstetric non-cavitary operations and manipulations. The new bed is equipped with a small table for a hand to do intravenous injections. It is also fitted out with a detachable pan representing a vessel stamped of stainless steel, designated for liquid collection and with a detachable step for the sake of convenience of parturients' disposition on the bed, which makes it possible to tilt the bed into Trendelenburg's position. The bed is convenient in handling, modern in appearance, enabling one to carry out wet sanitary treatment.

Equipment Design↗
PubMed1989

[The Danop Data System for decentralized postoperative surveillance of wound infections].

The Danop Data System is a microcomputer system designed for the local (ward) surveillance of postoperative surgical infections. The system is served by a simply operated microcomputer program capable of tabulating data input in four standard tables providing continuous information sufficient for surveillance purposes. The aim is that, within a five-year period, 50 per cent of all Danish hospitals will adopt this or similar systems. The system is envisaged as a preliminary to more systematic surveillance of all nosocomial infections.

Computer Systems↗
PubMed1987

[A new instrument for computerized tomography-guided brain biopsy].

The authors present a new stereotaxic brain biopsy method. After establishment of the CT-and angiographic diagnosis follows the marking of the best suited needle track by means of the CT-scanner Somatom DRG. The trephination is then performed at the operation-theatre during local anesthetization. Repeatedly laying on the CT-table, a low contrasted stereotaxic device is fixed on the patients head. Direction and depth of the puncture are measured and predetermined with an accuracy of +/- 5 mm with a few CT-scans. After guided insertion of a thin-wall nonpaque Teflon-sleeve it is possible to obtain artefactless tomograms or localization control and multiple biopsy probes for histologic evaluation without repeated punctures. Therapeutical interventions may be performed in the same way.

Biopsy, Needle↗
PubMed1988

Displaced acetabular fractures.

Displaced acetabular fractures occur primarily in young adults involved in high energy trauma and can lead to disabling posttraumatic arthritis. An initial roentgenographic evaluation with accurate delineation of all fracture lines provides the key to decisions about whether to give closed or open treatment. When open treatment is indicated, a surgical approach can be chosen that will almost always lead to reduction without the necessity of a second approach. The authors have found that the Kocher-Langenbeck, ilioinguinal, and extended iliofemoral approaches are the most useful. A fracture table and specialized reduction instruments aid fracture reduction and fixation. Satisfactory operative reduction of the fracture is the factor that correlates best with a satisfactory clinical result. The rate of satisfactory operative reductions improved gradually over the first 50 operations of a prospective study of 121 displaced acetabular fractures. Overall, there were 80% satisfactory clinical results in this series. Complications included a 3% infection rate and a 5% incidence of nerve palsy. Open reduction and internal fixation are indicated for the majority of displaced fractures. However, closed treatment can produce satisfactory results in selected patients.

Acetabulum↗
PubMed1986

[47-year course of severe lymphedema of the right lower limb. 6 successive operations from 1941 to 1950. Satisfactory condition 36 years after the last operation].

Mrs. T... (born in 1920) consulted Pr R. Leriche in 1941 for severe lymphoedema of the right leg present since 1939 following fly bites. Elastic contention was insufficient. Lumbar sympathectomy performed in 1941, subcutaneous-aponeurotic resections of the lateral aspect of the leg in 1942, extended in 1946 (R. Leriche) and completed by a wide excision of the posterior aspect in 1948 (Pr Goinard, Alger) only provided temporary improvements. In 1949, five polyethylene tubes were inserted under the skin of the calf at the root of the thigh (Kunlin and Boely). Three catheters had to be removed after several months because of the risk of cutaneous perforation and secondary infection. In 1950, in view of the inadequate results, ten nylon threads were inserted into the subcutaneous tissue from the ankle to the lower abdominal wall and a very extensive resection of the subcutaneous tissue (to the level of the dermis) and the aponeurosis was performed on the medial aspect of the leg (K. and B.). A dramatic improvement was obtained, which persisted until the beginning of 1986, i. e. 36 years after this last operation. Unfortunately, oedema has gradually appeared in the other leg over the last 4 to 5 years. Despite the various treatments attempted, the volume of this leg is now greater than that of the operated leg and is associated with increasing discomfort for the patient (Table of measurements). A calcified sheath has formed around the two remaining polyethylene tubes.

Adipose Tissue↗
PubMed1984

[Open-heart surgery after 70 years of age. Results in 136 patients].

Between 1975 and 1983, 136 patients aged over 70 underwent open heart surgery: aorto-coronary by-pass in 67 cases, valve replacement in 46 cases, combined valve and coronary surgery in 20 cases, resection of a left ventricular aneurysm in 2 cases and closure of a ruptured septum in 1 case. There were 13 deaths in the short-term (9.6%). Operative mortality for aorto-coronary by-pass was 4.5%, and that of valve replacement 4.4%, whereas for the combined procedures it was 35%. Non-fatal post-operative complications were frequent, occurring in 40% of patients. Life-table analysis showed 77% survival at 5 years. Of the 111 patients who left hospital, only one was lost to follow-up. At an average follow-up of 26 months, there were 84 patients in functional class I, 17 in class II and 9 in class III. Complications related to the presence of a prosthetic valve occurred in only 3 patients, none of whom required reoperation during the follow-up period. In the elderly, open heart surgery can therefore be carried out at relatively low risk, except where combined procedures are concerned. The long term history, together with the degree of functional improvement achieved, justify cardiac surgery even in the elderly.

Aged↗
PubMed1994

[Relation between surgical outcome and preoperative end-systolic volume of the left ventricle in patients with regurgitant valvular heart disease].

The relation between the end-systolic volume index of the left ventricle (ESVI (ml/m2)) and the early and late results after valve replacement were reviewed in 249 patients with pure aortic regurgitation (AR) and 189 patients with pure mitral regurgitation (MR). The patients with AR were classified into 4 groups (A1-A4) and those with MR were classified into 3 groups (M1-M3) according to the ESVI. The ESVI, the number of patients (No of P), early mortality rate (EM) and the actuarial survival rate at 12 years after valve replacement (AS at 12 yr) in each group are shown in the following Table. [table: see text] The actuarial survival rate at 12 years after operation in A1 and A2 were significantly lower than that in A3 and A4. In 57% of the late deaths in A1 and A2 patients, the cause of the death was thought to be rhythm disturbance. In contrast, there were no differences in late survival among the three groups with MR (M1, M2 and M3). The minor axis of the left ventricle at end-diastole and at end-systole (Dd and Ds) and shortening fraction of the left minor axis (FS), evaluated by echocardiography, were normalized early after the operation in A1 patients only. The Dd, Ds and FS in A2 and A3 returned to normal late after the operation. However, in A4, these parameters still remained abnormal. Thus, patients with a deteriorated left ventricle can survive the operation. However, the long-term results in patients with AR with ESVI more than 150 ml/m2 were unsatisfactory.(ABSTRACT TRUNCATED AT 250 WORDS)

Aortic Valve Insufficiency↗