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PubMed1993

[Surgery of glaucoma: intrascleral trabeculo-irido encleisis].

The objective of this work is to appraise a surgical proposal for the treatment of glaucoma which attempts to avoid the relapses and complications. The technique consists of the fulfillment of a filtering blister (chamber of pressure derivation) using a support of corneoscleral trabeculae together with a support of iris placed into the sclera through a scleral flapping. 70 patients (125 eyes) with more than 7 years after surgery with this technique were selected at random. Their field of vision and eye pressure were evaluated and biomicroscopy and gonioscopy were practiced. The efficiency was of 95%, and patients with a field of vision between 10 and 20 degrees, and with pressures higher than 40 mmHg before surgery showed an improvement of an average of 5 degrees. The results are based on the successful endothelization of the accessory chamber achieved and in the building of a bond that stops the closing of the channel between the anterior and accessory chambers. The results of this long term follow-up suggest that the technique analyzed offers a good alternative to the surgery of glaucoma.

Follow-Up Studies↗
PubMed1990

The dangers of laser plume.

In this issue, we evaluate seven general-purpose laser smoke evacuators (one with two different filters) from seven manufacturers. All evacuators are specifically designed and marketed for use in the OR during general surgery. Studies have demonstrated that laser smoke contains particles and gases that are hazardous to the respiratory tract, and current standards of practice include the use of a dedicated smoke evacuator during open surgical laser procedures. Not enough information is yet available to determine whether a smoke evacuator should be used during any surgical procedure in which airborne particles are generated. We based our ratings primarily on the units' ability to capture the airborne particles generated at the surgical site and remove them from the air that is recirculated to the environment. Because filtration efficiency does not adequately describe a unit's performance, users should not base purchasing decisions on filtration efficiency alone, but should emphasize the unit's performance as demonstrated by our evaluation. We rated both the C.L.A.S.S.B-1 with its HEPA filter and the Coherent Evaculase XSE-500 Unacceptable because they failed to adequately reduce smoke concentration with optimal nozzle placement. We rated the C.L.A.S.S.B-1 with its ULPA filter, Gyne-Tech Microvac, Lase System II, Pfizer S.A.F.E. System, Stackhouse Point One System, and Surgimedics Surgifresh Acceptable; preferences among these units will depend on how they are used. We caution clinicians to base purchasing decisions on a thorough understanding of the issues behind our conclusions, which can be gained only by reading this evaluation in its entirety.

Air Pollutants, Occupational↗
PubMed2004

Image-guided robotic surgery.

Medical image processing leads to an improvement in patient care by guiding the surgical gesture. Three-dimensional models of patients that are generated from computed tomographic scans or magnetic resonance imaging allow improved surgical planning and surgical simulation that offers the opportunity for a surgeon to train the surgical gesture before performing it for real. These two preoperative steps can be used intra-operatively because of the development of augmented reality, which consists of superimposing the preoperative three-dimensional model of the patient onto the real intraoperative view. Augmented reality provides the surgeon with a view of the patient in transparency and can also guide the surgeon, thanks to the real-time tracking of surgical tools during the procedure. When adapted to robotic surgery, this tool tracking enables visual serving with the ability to automatically position and control surgical robotic arms in three dimensions. It is also now possible to filter physiologic movements such as breathing or the heart beat. In the future, by combining augmented reality and robotics, these image-guided robotic systems will enable automation of the surgical procedure, which will be the next revolution in surgery.

Humans↗
PubMed1987

Ophthalmic surgical complications in Werner's syndrome: report on 18 eyes of nine patients.

In ten of 18 eyes from nine patients with Werner's syndrome cataract surgery was complicated by wound dehiscence and its consequences: peripheral anterior synechiae (4X), secondary epiretinal gliosis (4X), cystoid macular edema (3X) in the framework of Hruby-Irvine-Gass syndrome, unplanned filtering bleb (2X), and postoperative anterior ischemic optic neuropathy (1X). Additionally, corneal endothelial decompensation occurred in eight eyes. In view of the fibroblasts' reduced growth potential, we suggest small surgical incisions, extracapsular cataract surgery using phacoemulsification, intraocular irrigation solutions protecting corneal endothelium, nonabsorbable single knot sutures not removed before 1 year after surgery, and no local or systemic use of cortisone.

Adult↗
PubMed1987

The detection of microemboli in the middle cerebral artery during cardiopulmonary bypass: a transcranial Doppler ultrasound investigation using membrane and bubble oxygenators.

Twenty-seven patients were examined who were undergoing cardiopulmonary bypass (CPB) surgery with either a bubble oxygenator or a capillary membrane oxygenator. The latter incorporated an arterial filter and bubble trap. A noninvasive Doppler ultrasound technique is described for monitoring irregularities in the Doppler flow signals attributable to gaseous microemboli detected in the middle cerebral artery during CPB. The ultrasound index for detecting gaseous microemboli (MEI) indicated the presence of such microemboli in 22 of the 27 patients during insertion of the aortic cannula. Measurements during CPB showed the MEI ranged from 4 to 39 in the 17 patients with a bubble oxygenator. However, all 10 patients with a membrane oxygenator had an MEI of 0. Varying the gas flow rates in 3 patients with bubble oxygenators showed a change in MEI from 4 +/- 4 (SD) at a flow rate of 2 L/min to 17 +/- 9 at a flow rate of 5 L/min. This observation supports the assumption that the MEI is providing quantitative information regarding the presence of gaseous emboli in the middle cerebral artery.

Cardiopulmonary Bypass↗
PubMed1998

Vectorial secretion of vascular endothelial growth factor by polarized human endometrial epithelial cells.

OBJECTIVE: To analyze directional vascular endothelial growth factor (VEGF) secretion in polarized human endometrial epithelial cell cultures. VEGF has distinct distribution patterns in human endometrium. Stromal cells are diffusely positive for VEGF messenger RNA and protein, whereas glandular epithelium shows focal VEGF immunostaining at the apical surface. The epithelial distribution suggests that VEGF is secreted into gland lumina, potentially influencing the nutrition and/or apposition of the developing blastocyst. DESIGN: Controlled in vitro study of protein secretion by polarized endometrial epithelial cells established on polyethylene filters. SETTING: University hospital. PATIENT(S): Endometrial biopsies were obtained from healthy, ovulatory women undergoing elective surgery. INTERVENTION(S): Primary endometrial epithelial cells were cultured. MAIN OUTCOME MEASURE(S): VEGF mRNA and protein production were measured in polarized cells. The vectorial secretion of VEGF was determined. RESULT(S): VEGF production by endometrial epithelial cells was verified by Northern blotting and immunoassays of conditioned media. The mean (+/-SD) apical secretion of VEGF was 3.9 +/- 1.4 ng per 10(5) cells every 48 hours and the mean (+/-SD) basal secretion was 0.8 +/- 0.2 ng per 10(5) cells every 48 hours. In contrast, the apical and basal secretion of a soluble cellular isoform of fibronectin were 2.76 +/- 0.96 ng per 10(5) cells every 48 hours and 2.64 +/- 1.79 ng per 10(5) cells every 48 hours, respectively. CONCLUSION(S): VEGF is secreted preferentially into the lumina of endometrial glands. Apical VEGF may be an endometrial signal for blastocyst development or implantation.

Adult↗
PubMed2003

The changing epidemiology of lung cancer in Europe.

BACKGROUND: Since the incidence and mortality of the histological subtypes of lung cancer in Europe has changed dramatically during the 20th century, we described the variation and changes in incidence, treatment modalities and survival of lung cancer. METHODS: For geographical variation and changes in incidence, data of the European cancer incidence and mortality (EUROCIM) database were used, and data on survival were derived from the EUROCARE database. For trends in treatment modalities and survival, according to histology and stage, data of the Eindhoven Cancer registry were used. RESULTS: Although the incidence of lung cancer among men in Denmark, Finland, Germany (Saarland), Italy (Varese), the Netherlands, Switzerland and the United Kingdom has been decreasing since the 1980s, the age-adjusted rate for men in other European countries increased at least until the 1990s. Among women the peak in incidence had not been reached in the 1990s. The proportion of adenocarcinoma has been increasing over time; the most likely explanation is the shift to low-tar filter cigarettes. In the 1990s more patients with localised non-small cell lung cancer received surgery than in the 1970s. Among patients with non-localised non-small cell lung cancer and among those with small cell lung cancer there was a trend towards more chemotherapy. There was fairly large variation in survival within Europe. Despite improvement in both the diagnosis and treatment, the overall prognosis for patients with non-small-cell lung cancer hardly improved over time. In contrast, the introduction and improvement of chemotherapy since the 1970s gave rise to an improvement in survival for patients with small-cell lung cancer. CONCLUSION: The epidemic of lung cancer is not over yet, especially in southern and eastern Europe. Prevention remains the best policy, but improvement in the management of lung cancer also remains very important.

Adult↗
PubMed2004

Endoilluminators: evaluation of potential retinal hazards.

The potential for retinal photic injury from exposure to endoilluminators was evaluated. The spectral irradiance for each endoilluminator configuration was weighted with the American Conference of Government Industrial Hygienists (ACGIH) aphakic action spectrum. The result was compared with the threshold limit value (TLV) published by the ACGIH and a time to TLV (timeTLV) was calculated for each configuration. The calculated timeTLV ranged from 0.27 to 3.5 min, times that are significantly shorter than typical operating times. The effects of incorporating short-wavelength cutoff filters were evaluated and found to significantly increase the timeTLV. Exposure reduction techniques for use during surgery are discussed.

Humans↗
PubMedDate not supplied

Age-dependent changes in bacterial adherence to epithelial cells of nasopharynx in vivo.

Epithelial cells were scraped from the posterior wall of the nasopharynx (NPH) of 20 consecutive patients (age range 1 to 52 years, 9 males, 11 females) undergoing ENT surgery under general anaesthesia. The cellular mixture was immediately homogenized, filtrated through a 5 microns pore filters and centrifuged (10 min, 1,500 rpm). Non-ciliated, squamous epithelial cells caught by the filter were harvested and stained with acridine orange. Epithelial cells with bacteria attached were evaluated when specimens were examined under a fluorescence microscope. A distinct difference was noted between young individuals and adult patients regarding bacterial adherence to nasopharyngeal epithelial cells, adherence in young patients being especially remarkable. Bacteria appeared not to attach to ciliated epithelial cells. The high incidence of otitis media infections among young individuals may be due to the remarkable bacterial adherence to nasopharyngeal non-ciliated epithelial cells in this age group.

Adolescent↗
PubMed1995

Impaired neutrophil chemotaxis after cardiac surgery.

Chemotaxis of circulating peripheral neutrophils was studied in 12 patients undergoing elective cardiac surgery. Tests of neutrophil chemotaxis were made preoperatively and 16-20 hours postoperatively, using a multipore filter assay. Statistically significant postoperative decrease was demonstrated in both stimulated and random neutrophil migration (p = 0.012 and p = 0.009, respectively). Although the peripheral neutrophil count showed a statistically significant postoperative increase (p = 0.001), the increase did not correlate to the decrease in neutrophil chemotaxis. Nor could correlation be demonstrated between the altered neutrophil chemotaxis and any per- or postoperative variables.

Anesthesia, General↗
PubMed2000

Use of a low-prime circuit for bloodless heart transplantation in xenotransplant of 5-7 kilogram primates.

There is a great effort to decrease blood product use during open-heart surgery in pediatrics. We were presented with a research challenge to accomplish heart xenotransplantation from donor cynomologous monkey (Macaca fascicularis) to recipient olive baboon (Papio anubis) of 5-7 kilograms without benefit of donor or banked blood products. The purpose of this study was to design and implement a practical, low-volume circuit to minimize hemodilution and avoid the use of blood products. A simple circuit was assembled using a low-volume oxygenator with hardshell venous reservoir, an 1/8-inch arterial line, an 1/4-inch venous line, and gravity drainage. Three xenotransplants were performed and evaluated. The mean recipient weights were 6.3 +/- 0.7 kg. Circuit prime volume was 228 +/- 5.8 mL, and bypass time was 85 +/- 6.7 min. Blood flow rates were 585 +/- 113 mL/min with postmembrane arterial line pressures of 344 +/- 81 mmHg, and patient mean arterial pressures (MAP) of 51.4 +/- 16.7 mmHg. Venous saturations were 63.7 +/- 8.0%. The hematocrit prebypass was 37.4 +/- 3.2, bypass 20.7 +/- 0.9, post-MUF 27.8 +/- 3.3, and 7 days postoperative 24.5 +/- 7.5%. Platelet count was 289 +/- 1.1 K/microL, 147 +/- 37.1 K/microL, and 322 +/- 292.7 K/microL prebypass, postbypass, and 7 days postoperative, respectively. Plasma-free hemoglobin prebypass was 7.5 +/- 4.4 mg/dL and postbypass 22.2 +/- 16.5 mg/dL with no noted hematuria during and after the procedure. All patients survived and were successfully weaned from cardiopulmonary bypass (CPB) with same day extubation. A low-prime circuit for bloodless heart surgery is possible. To achieve low reservoir levels, especially without the use of an arterial line filter (ALF), it is necessary to have a full armament of monitoring and alarm devices.

Animals↗
PubMed1995

The role of laser sclerostomy in glaucoma surgery.

With the recent propagation of laser systems for the treatment of glaucoma, we logically seek to understand the rationale for the application of laser energy to glaucoma filtering procedures. If lasers can provide a better means of controlling open-angle glaucoma than is currently available by the use of medications, topically or orally, or by the currently employed surgical methods, we must then ask-which lasers and techniques are currently employed to utilize this technology? In particular what is the role of laser sclerostomy in treating glaucoma? What are the advantages and disadvantages of the various lasers, procedures, and techniques for treating glaucoma? What information does it provide us for future applications of laser surgery in glaucoma? This article addresses these issues.

Glaucoma, Open-Angle↗
PubMed2000

[Surgery using master-slave manipulators and telementoring].

Master-slave manipulators enhance surgeons' dexterity and improve the precision of surgical techniques by filtering out surgeons' tremors and scaling the movements of surgical instruments. Among clinically available master-slave manipulators, the epoch-making system called "da Vinci" developed by Intuitive Surgical Inc. (Mountain View, CA, USA), equipped with 2 articulated joints at the tip of the surgical instruments allowing 7 degrees of freedom, mimics the movements of surgeons' wrists and fingers in the abdominal or thoracic cavity. Today advanced telecommunications technology provides us excellent motion images using only 3-ISDN telephone lines. Experienced surgeons at primary surgical sites have been able to perform complex procedures successfully by consulting specialists at remote sites. Because telecommunications costs have become lower each year, telementoring will be come a routine surgical practice in the near future. The usefulness of surgical telementoring has been greatly enhanced by the development of a technique to illustrate on video images from two directions. Moreover, remote advisory surgeons will be able to provide the optimal operative field to operating surgeons using robotic camera holders with voice-recognition systems. In the near future, when master-slave manipulators will also be coupled with telementoring systems, remote experts could actually perform complex surgical procedures.

Humans↗
PubMed1996

Combined cataract extraction with intraocular lens implant and mitomycin-augmented trabeculectomy.

PURPOSE: Cataract and glaucoma commonly coexist in elderly patients and present complex treatment options. This study investigates the results of simultaneous treatment of both conditions using phacoemulsification with posterior chamber lens implant and mitomycin-augmented trabeculectomy (combined surgery). METHODS: A retrospective analysis was performed of 56 consecutive patients who had undergone combined surgery. Fifty-one (91%) of 56 patients had fornix-based conjunctival flaps resutured at the limbus. A variety of postoperative interventional techniques (mechanical and pharmacologic) were used to encourage the achievement of successful filtering blebs. RESULTS: All patients had follow-up of at least 12 months. The mean preoperative intraocular pressure (IOP) was 20.2 mmHg (range, 14-43 mmHg) and the mean postoperative IOP was 10.7 mmHg (range, 4-17 mmHg). Fifty-three (95%) of 56 patients had IOPs of 15 mmHg or less at the completion of follow-up. All except two patients (96%) were able to discontinue all glaucoma medications. The filtering blebs that resulted from the fornix-based conjunctival flap procedures were predominantly large, diffuse, and noncystic. Best-corrected visual acuity was 20/40 or better in 47 (84%) of 56 of patients. CONCLUSION: Control of IOP and improvement of visual acuity can be achieved in a high percentage of patients with coexisting cataract and glaucoma by performing combined surgery using intraoperative mitomycin and fornix-based conjunctival flaps resutured to the limbus. The filtering blebs illustrated a distinctive morphology compared with blebs resulting from limbus-based conjunctival flap procedures.

Aged↗
PubMed2002

Effect of WBC reduction of transfused RBCs on postoperative infection rates in cardiac surgery.

BACKGROUND: WBC-replete blood transfusion has been suggested as an independent cause of increased postoperative infection. STUDY DESIGN AND METHODS: A total of 597 patients undergoing elective coronary artery or heart valve surgery were randomly assigned to receive plasma-reduced (PR), buffy coat-depleted (BCD), or WBC-filtered (WCF) RBCs in the event of requiring blood transfusion. Details of postoperative course were recorded. Further information was collected from the patient's general practitioner 3 months after discharge. RESULTS: No significant difference in inpatient infection rates was observed among patients randomly assigned to receive PR, BCD, or WCF RBCs. When only those receiving transfusion were analyzed (n = 509), use of PR RBCs was associated with more events coded as infections (p < or = 0.05) compared with BCD or WCF RBCs. However, when events coded as urinary tract infections were excluded, there was no significant difference among the three groups. Follow-up performed after discharge showed no difference in readmission rates, but a higher reported rate of infection in those randomly assigned to receive WCF RBCs (p < 0.02). CONCLUSION: No evidence has been found, analyzed by intention to treat, that use of WBC-reduced, BCD, or WCF RBCs reduces postoperative inpatient infection in patients undergoing cardiac bypass surgery.

Aged↗
PubMed2000

Determination of eicosanoid and cytokine production in salvaged blood, stored red blood cell concentrates, and whole blood.

STUDY OBJECTIVE: To determine the production of the eicosanoids prostaglandin 2 (PGE2) and thromboxane 2 (TxB2) and the cytokines interleukin 1 beta (IL-1-beta) and interleukin 6 (IL-6) in whole blood (WB), unfiltered red blood cell (RBC), and filtered RBC concentrates, and salvaged blood. DESIGN: Prospective study. SETTING: University hospital of Erlangen. PATIENTS: 32 healthy volunteers and 14 ASA physical status I, II, and III radical prostatectomy patients (mean age 65 yrs). INTERVENTIONS: Sixteen WB units and 16 RBC units (divided into 16 filtered and unfiltered units each) were taken from 32 volunteers. Fourteen salvaged RBC units were obtained from the 14 radical prostatectomy patients. Sixteen WB units were stored for 35 days. From the 16 WB donations, RBC concentrates (PAGGS-M) were prepared. The RBC concentrates were halved, one half had its leukocytes removed at day 0; both halves were stored for 49 days. Salvaged blood (n = 14) was stored up to 2 hours during surgery and then retransfused. MEASUREMENTS AND MAIN RESULTS: Immediately at the start of the study, in all blood units (WB, RBC filtered, and RBC unfiltered units) at days 0 and 21, and at the end of the storage period (WB: 35 days, RBC concentrates: 49 days) and in the salvaged RBC units, the following parameters were measured: PGE2, TxB2, IL-1-beta, IL-6, hematocrit, platelet number, leukocytes, blood volume, and hemoglobin. During storage, different levels of PGE2, TxB2, IL-1-beta, IL-6 for WB, filtered RBC concentrates, and unfiltered RBCs were found. The higher levels of PGE2, TxB2, IL-1-beta, and IL-6 were found in the WB and RBC salvaged units than the filtered RBCs or unfiltered RBC units. There was no statistically significant difference between WB and salvaged RBCs. Higher levels of leukocytes and platelets were found in WB units and salvaged RBCs as compared to filtered or unfiltered RBCs. CONCLUSIONS: The eicosanoid and cytokine levels in the salvaged, filtered RBC, unfiltered RBC, and WB units stayed within physiological limits, suggesting that these levels do not contribute to the risk of nonhemolytic, immunomodulated transfusion reactions, even in massive transfusions.

Adjuvants, Immunologic↗
PubMedDate not supplied

Ophthalmological aspects in patients with Werner's syndrome.

In ten of 18 eyes from nine patients with Werner's syndrome, cataract surgery was complicated by wound dehiscence and its consequences: peripheral anterior synechiae (4), secondary epiretinal gliosis (4), cystoid macular edema (3) in the framework of Hruby-Irvine-Gass syndrome, unplanned filtering bleb (2), and post-operative anterior ischemic optic neuropathy (1). Additionally, corneal endothelial decompensation occurred in eight eyes. In view of the fibroblasts' reduced growth potential, we suggest small surgical incisions, extracapsular cataract surgery using phacoemulsification, intraocular irrigation solutions protecting corneal endothelium, nonabsorbable single knot sutures not removed before 1 year after surgery, and no local or systemic use of cortisone.

Adult↗
PubMed1987

Ciliary block (malignant) glaucoma following posterior chamber lens implantation.

Ciliary block (malignant) glaucoma is a rare complication of cataract surgery. In eyes with narrow angles and acute glaucoma, ciliary block must be differentiated from pupillary block to provide appropriate therapy. We review two cases of ciliary block glaucoma following uncomplicated extracapsular cataract extraction with posterior chamber lens implantation. Previous filtering procedures in these cases resulted in protracted shallowing of the anterior chamber, possibly contributing to the pathogenesis of ciliary block. In addition, the operative trauma of cataract surgery may have resulted in the separation of the vitreous base from the pars plana. Misdirected aqueous humor then could have entered the vitreous body, displacing the iris-pseudophakos diaphragm forward, and resulting in the acute glaucoma. Vitrectomy, which resolved the acute glaucoma, is valuable in treating ciliary block glaucoma.

Aged↗