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At least 1,621 records · Page 90Linked to original sources
PubMed1997

[Laparoscopic surgery. Does smoke transport cells?].

The study was designed to test the hypothesis that whole cells can be carried as an aerosol in the pneumoperitoneum during laparoscopy. Twelve patients undergoing laparoscopic surgery for benign and metastatic disease were included in the study. Throughout the 12 procedures, the smoke and the gas of the pneumoperitoneum was evacuated through 17 filters. Twelve filters and the tubing were washed. The liquid was centrifuged and stained immunocytochemically to identify the cells. Five other filters were also photographed with an electron microscope. On immunocytochemistry, nine of the twelve samples were identified as mesothelial in origin and the electron micrograph show many other cells stuck to the filter which appeared to be blood cells and mesothelial cells. Malignant cells were not conclusively identified, but ethical considerations prevented any intentional coagulation of malignant tissue. The presence of whole identifiable cells in the pneumoperitoneum could partly explain, port site metastasis after laparoscopic surgery for cancer.

Carbon Dioxide↗
PubMedDate not supplied

Periareolar injection for localization of sentinel nodes in breast cancer patients.

The goal of this study was to evaluate the periareolar injection of technetium 99m sulfur colloid to identify axillary sentinel nodes and compare the number of sentinel lymph nodes identified with preoperative lymphoscintigraphy to intraoperative biopsy using a handheld gamma probe. A total of 104 consecutive patients diagnosed with invasive breast cancer participated in this prospective study, with 81 patients receiving an intradermal periareolar injection and 23 patients receiving an intradermal peritumoral injection of filtered technetium 99m sulfur colloid. Preoperative lymphoscintigraphy was performed for sentinel node mapping and localization. In addition to selective sentinel node biopsy, axillary dissection was performed on all patients to determine false-negative rates. Routine histologic staining was performed on all identified nodes, along with immunohistochemical staining of sentinel nodes negative on initial routine staining. With an intradermal periareolar injection, the sentinel node identification rate was 91.4% (74/81), axillary metastatic rate 35.1% (26/74), sentinel node positive only 61.5% (16/26), and false negative 3.8% (1/26). With an intradermal peritumoral injection, the sentinel node identification rate was 91.3% (21/23), axillary metastatic rate 42.9% (9/21), sentinel node positive only 88.9% (8/9), and false negative 0% (0/9). A total of 241 sentinel nodes were identified with biplanar lymphoscintigraphy and 173 sentinel nodes were harvested during surgery, yielding a 28.2% increase in sentinel nodes identified with lymphoscintigraphy. This study demonstrates that intradermal periareolar injection of filtered technetium 99m sulfur colloid is successful in identifying axillary sentinel nodes with a low false-negative rate. Preoperative lymphoscintigraphy aids in the identification and surgical planning of sentinel node biopsy and provides an objective measure of surgical performance.

Adult↗
PubMed2003

Auditory processing studied prospectively in two hemidecorticectomy patients.

Auditory processing of speech and nonspeech sounds was studied prospectively in two hemidecorticectomy patients (ages 10-11 years) with Rasmussen's syndrome. We tested auditory word recognition under four listening conditions: in quiet, in noise, after acoustic filtering, and dichotically. Recognition of environmental sounds and discrimination of tones and digitized syllables were also tested. Presurgical testing confirmed normal processing of speech and nonspeech, for both patients, under all listening conditon. One year after surgery, both patients demonstrated intact recognition of words and environmental sounds in quiet but impaired word recognition in noise. The left hemidecorticectomy patient also demonstrated impaired recognition of low-pass filtered words. These findings suggest that either hemisphere can process speech or nonspeech sounds in quiet, whereas both hemispheres are needed to process speech in background noise. Hemispheric contributions to processing speech in noise appear to differ, with the left hemisphere compensating for loss of phonologic information and the right hemisphere compensating for increased attention demands.

Acoustic Stimulation↗
PubMed2001

Günther Tulip Retrievable Vena Cava Filter: results from the Registry of the Canadian Interventional Radiology Association.

PURPOSE: To report data collected by the Canadian Registry of the Günther Tulip Retrievable Filter (GTF). MATERIALS AND METHODS: Between February 1998 and December 2000, 90 patients at eight hospitals underwent implantation of 91 GTFs. There were 45 male patients and 45 female patients, age 17-88 years, with a mean age of 49 years. Indications for filter placement were pulmonary embolism (PE) or deep vein thrombosis (DVT) with a contraindication to anticoagulation in 83 patients, prophylaxis after massive PE in one, prophylaxis for proximal free-floating thrombus in one, and prophylaxis with no DVT or PE in six patients (major trauma, n = 4; high preoperative risk, n = 2). GTF retrieval was attempted in selected patients from a right internal jugular vein approach. RESULTS: One GTF was inadvertently placed in the right iliac vein and could not be retrieved. There were no other major placement complications. GTF retrieval was attempted in 52 patients (53 GTFs); 52 GTFs were successfully retrieved from 51 patients. Implantation times were 2-25 days (mean, 9 d). Of these 51 patients, 37 underwent follow-up for 5-420 days (mean, 103 d) after filter retrieval. Four patients (8% of retrieved GTFs) required reinsertion of a permanent filter 17-167 days (mean, 78 d) after GTF retrieval as a result of bleeding from anticoagulation (n = 2) or because the patient required further surgery (n = 2). One other patient had recurrent DVT 230 days after retrieval; no PE or other complication was documented in the retrieval group. GTFs were not retrieved from 39 patients for various reasons. Of these 39 patients, 25 underwent follow-up 7-420 days (mean, 85 d) after filter placement. Two patients developed filter occlusion (5%); no other complications were documented. CONCLUSION: The GTF has a broad range of utility: it can be used as a permanent filter or retrieved after implantation periods of 15 days and possibly longer. However, indications for retrieval require further study, as does the maximum implantation time.

Adolescent↗
PubMed1999

Graduate surgical trainee attitudes toward postoperative thromboprophylaxis.

BACKGROUND: Postoperative deep vein thrombosis (DVT) results in significant morbidity and mortality. Appropriate patient risk assessment and proper use of prophylactic measures is crucial. METHODS: We conducted a confidential survey of general surgery house staff. The survey addressed DVT risk factor recognition, proximal and distal DVT absolute risk estimation, DVT prophylaxis strategies, and vena cava filter and low-molecular-weight heparin (LMWH) use. RESULTS: Obesity, immobility, malignancy, and previous DVT were overwhelmingly recognized as risk factors. Age >40, recent myocardial infarction, lupus anticoagulant, varicose veins, and factor V Leiden were inadequately recognized as risks. Deep vein thrombosis risk in the setting of cancer was underestimated. Most selected appropriate prophylactic strategies; many misunderstood vena cava filter and LMWH indications. CONCLUSIONS: We have identified specific areas of misunderstanding about DVT risk and prophylaxis that, if appropriately addressed during educational sessions, will enable young surgeons to make safer and more effective future decisions regarding thromboprophylaxis.

Adult↗
PubMed2001

Complement split products and pro-inflammatory cytokines in salvaged blood after hip and knee arthroplasty.

PURPOSE: To determine whether salvaged autologous blood collected postoperatively contains complement split products (SC5b-9), and pro-inflammatory cytokines (IL-6 and IL-8) and whether there are any differences between blood collected during hip or knee surgery. METHODS: Fifty-eight consecutive patients undergoing hip or knee replacement surgery were studied. Thirty-eight had postoperative bleeding large enough to require infusion of salvaged blood. The salvaged blood was filtered during collection through a 200 microm filter and before infusion a 40 microm filter was used. Samples for complement and cytokine determinations were drawn from the circulation and from the collected blood. RESULTS: High concentrations of SC5b-9, IL-6, and IL-8 were found in salvaged blood. The concentrations were higher than in the circulation (P < 0.05). The circulating concentrations of IL-6 and IL-8 were increased 60 min and 12-18 hr after transfusion. There were no differences regarding SC5b-9, IL-6, and IL-8 in the blood collected after hip or knee surgery. CONCLUSION: Blood collected from a surgical wound contains large concentrations of inflammatory mediators. There were no differences between blood collected during hip or knee surgery.

Adult↗
PubMed1994

Enterotoxic effect of stool supernatant of Cryptosporidium-infected calves on human jejunum.

BACKGROUND/AIMS: The clinical pattern of cryptosporidial diarrhea suggests an enterotoxic mechanism. No evidence for this mechanism has been reported thus far. This study aimed to look for enterotoxic effect elaborated by Cryptosporidium. METHODS: The effects on human intestinal transport of stool supernatant of diarrheal calves infected with Cryptosporidium parvum were examined. Aliquots of centrifuged and filtered stools were added to the mucosal or serosal side of human jejunum obtained from patients undergoing surgery and mounted in Ussing chambers. Electrical parameters were recorded. Stool supernatants of uninfected calves served as a control. RESULTS: The mucosal addition of 2.5 mg protein of fecal supernatant from diarrheal calves induced a prompt and significant increase in short circuit current with no effects on tissue conductance. The serosal addition of this material and the addition of control supernatant to either side did not induce modifications of electrical parameters. The enterotoxic effect was dose-dependent and saturable. It was reversible by withdrawing the supernatant from the incubation medium. The electrical effect was chloride- and calcium-dependent and was sensitive to heating. CONCLUSIONS: An enterotoxic activity is present in the stools of Cryptosporidium-infected calves. This activity may be responsible for secretory diarrhea in humans.

Aged↗
PubMedDate not supplied

Postlaparoscopic traumatic inferior vena caval thrombosis.

Thrombosis of the inferior vena cava (IVC) is a rare disease. It has been reported in the literature in association with a variety of noninfectious diseases, particularly carcinoma of the kidney and liver, as well as abdominal trauma and percutaneous IVC filter placement. We report a case of IVC thrombosis in a young nonpregnant patient after laparoscopic pelvic surgery. We believe it is the first case in the literature of laparoscopic-induced IVC thrombosis.

Adult↗
PubMed2002

Association of preoperative photoreceptor displacement and improved central scotoma after idiopathic macular hole surgery.

OBJECTIVE: To investigate the relationship between preoperative photoreceptor displacement and postoperative scotoma after unilateral idiopathic macular hole surgery. DESIGN: Prospective nonrandomized comparative self-controlled trial. PARTICIPANTS: Twenty patients who underwent successful surgery for unilateral idiopathic macular hole participated in the study. METHODS: Kinetic perimetry using red and green filter glasses, black binocular fixation targets, and red and green selective monocular stimuli was performed preoperatively. Scanning laser ophthalmoscope (SLO) microperimetry was performed preoperatively and postoperatively. RESULTS: Sixteen patients had photoreceptor displacement preoperatively. In preoperative SLO microperimetry, all eyes with a macular hole had a scotoma; postoperatively, 12 of 16 had no scotoma. All four eyes with no preoperative photoreceptor displacement were noted to have a postoperative scotoma. The prevalence of postoperative scotoma in patients with preoperative photoreceptor displacement (4 of 16; 25%) was significantly lower than that in patients without preoperative photoreceptor displacement (4 of 4; 100%) (P = 0.03). CONCLUSIONS: The presence or absence of photoreceptor displacement preoperatively should affect postsurgical visual function. Photoreceptor damage may occur in eyes without photoreceptor displacement preoperatively, resulting in scotoma postoperatively.

Aged↗
PubMed1994

Subclinical operating microscope retinopathy: the use of static perimetry in its detection.

Focal retinal pathology and dysfunction as a sequel to manifest damage due to operating microscope illumination is well recognised. We wished to determine whether retinal dysfunction could be identified in the absence of clinically visible lesions. We therefore have conducted a prospective controlled study on 36 patients undergoing cataract surgery and 27 control subjects. A Wild M690 zoom operating microscope was used for each procedure. No filters were used. The Humphrey visual field equipment was employed to determine threshold retinal sensitivity at predetermined loci above and below fixation in both groups. No clinically visible retinal lesions were seen in any patient. However, post-operative investigation revealed a statistically significant depression in retinal sensitivity at points most exposed to operating microscope illumination (p < 0.05). This was most noticeable following longer total operating times and in patients with the longest time intervals between lens extraction and completion of the procedure. It is concluded that operating microscope position and centration, and the position of the eye, should be adjusted to place the image of the illuminating element away from the foveola. Also retinal illumination should be kept to a minimum, particularly after an intraocular lens has been implanted.

Aged↗
PubMed2004

mRNA for genes associated with antigen presentation are expressed by human middle meatal epithelial cells in culture.

OBJECTIVES/HYPOTHESIS: Although the mechanisms underlying the initiation and maintenance of inflammation in chronic rhinosinusitis are poorly understood, the activation of memory T cells within the nasal mucosa is thought to play an important role. T-cell activation requires specialized antigen processing and presentation of antigen by immunocompetent cells in the context of cell surface immune molecules. The purpose of this study was to investigate the expression of such molecules by human sinonasal epithelial cells grown in culture at the air-liquid interface (ALI). METHODS: Middle meatal epithelium was obtained from six patients undergoing endoscopic sinus surgery. Dissociated epithelial cells were grown to confluence in serum-free, defined medium and transferred to filter inserts for culture at the ALI. Cells were harvested at 2 and 21 days of growth at the ALI and processed for real-time polymerase chain reaction (PCR). The presence and relative abundance of constitutively expressed mRNA for human leukocyte antigen (HLA)-B, HLA-DR, B7 to 1, B7 to 2, B7-H2, B7-H3, and cathepsin D were assessed. RESULTS: After 2 days at the ALI, middle meatal epithelial cells demonstrated expression of genes for each of the antigen processing associated genes tested. The expression of HLA-B and HLA-DR increased significantly with cellular maturation at the ALI. Expression of HLA-DR and B7 to 1 increased with cytokine stimulation. CONCLUSIONS: Primary human epithelial cells obtained from the middle meatus express genes associated with antigen presentation function. The pattern of gene expression is modulated by cytokine stimulation and changes as the cells differentiate at the ALI. These findings suggest that mature middle meatal epithelial cells have the cellular machinery to interact with T cells and therefore may be direct participants in the modulation of T-cell activity in chronic sinusitis.

Antigen Presentation↗
PubMed2006

Use of lymphoscintigraphy with SPECT/CT for sentinel node localization in a case of vaginal melanoma.

A 45-year-old woman with vaginal melanoma underwent Tc-99m sulfur colloid (filtered) lymphoscintigraphy with the acquisition of planar and SPECT/CT images for localization of a sentinel node before surgery. The study identified both inguinal and perirectal sentinel nodes, which proved beneficial in mapping potential anatomic spread of disease for staging and therapy planning. These results provide evidence for the use of routine SPECT/CT imaging for pelvic lymphoscintigraphic studies or as an adjunct tool for localizing sentinel nodes in cases that would not be demonstrated with planar imaging alone.

Female↗
PubMed2003

Filtering blebs at the site of sutured posterior chamber intraocular lenses.

A 78-year-old man with a traumatic giant retinal tear and phacodonesis had 3-port pars plana vitrectomy (3PPPV), lensectomy, and sutured posterior chamber intraocular lens (IOL) implantation. Two years after surgery, a filtration bleb was noted at 1 of the suture sites. In another case, a 32-year-old man with lens subluxation secondary to Marfan's syndrome had 3PPPV, lensectomy, and sutured posterior chamber IOL implantation. Two months after surgery, a filtration bleb was noted at 1 of the suture sites. Sutured posterior chamber IOL implantation is 1 of the few instances in which there is virtually a full-thickness suture through the sclera. We presume the filtering bleb formed as a direct result of the permanent passage created from the posterior chamber to the subconjunctiva due to presence of the suture. Presence of a filtering bleb can lead to complications including endophthalmitis.

Adult↗
PubMed2004

High-frequency QRS potentials as a marker of myocardial dysfunction after cardiac surgery.

BACKGROUND: High-frequency QRS potentials are sensitive to myocardial ischemia. The aim of this study was to evaluate the usefulness of high-frequency QRS potentials as a marker of myocardial dysfunction after cardiac surgery. METHODS: Seventy patients undergoing coronary artery bypass grafting or heart valve surgery were involved. High-frequency QRS potentials were measured by signal-averaged electrocardiogram, and calculated as the root-mean-square voltage of the total QRS duration (RMST). The postoperative RMST was expressed as a percentage of the preoperative RMST. The mean RMST at 1 to 2 hours after removing the aortic cross-clamp was compared with the cardiac index, inotropic agents, and aortic cross-clamping time. The occurrence of ventricular tachycardia within 24 hours and the RMST at 2 postoperative days were also evaluated. Patients were divided into quartile groups from highest to lowest at postoperative RMST (groups 1, 2, 3, and 4, respectively, from maximum to minimum). RESULTS: In postoperative states, cardiac index significantly decreased in accordance with the RMST decrease in a stepwise manner, although there were no differences in cardiac index among the four groups preoperatively. Inotropic agents and aortic cross-clamping time increased as RMST decreased. A high rate of ventricular tachycardia within 24 hours and delayed RMST recovery at 2 postoperative days were seen in group 4. The curve of sensitivity and specificity showed that severe reduction (threshold, 35%) of RMST indicated low-output syndrome. CONCLUSIONS: The severe reduction of filtered high-frequency QRS potentials was related to myocardial dysfunction. Measurement of filtered high-frequency QRS potentials could become a useful, noninvasive, real-time monitor of myocardial dysfunction after surgery.

Cardiac Output, Low↗
PubMed2000

Measurement of magnetic field in dentistry.

The principal objective was to measure the magnetic fields occurring in dental surgeries at simultaneous subtraction of direct ground component of the magnetic field. A specifically designed instrument with the Hall probe was used for the measurement. It consisted of two amplifiers and a low frequency filter. Its task was to measure mean square values of the field (RMS) dependent on the position in space. Qualitative and quantitative analyses of the investigated variables enabled making conclusions about the magnetic fields in dental surgeries. A number of studies have shown that many dental instruments produce radiation with magnetic field higher than 40 G, at a significant decrease in power of the magnetic field with increasing distance from the source. It has also been reported that instruments of older generations produce stronger magnetic fields than do the new ones.

Dental Instruments↗
PubMed2002

[Control of wound healing after glaucoma surgery. Effect and inhibition of the growth factor TGF-beta].

The main problem of the surgical failure after trabeculectomy is postoperative scarring of the filtering bleb. The treatment with anti-metabolites such as 5-fluorouracil and mitomycin C to prevent scarring shows many toxic side-effects and causes patient stress. In the search for therapeutic alternatives, the focus of current research concentrates on the pathophysiological interaction between growth factors and their role in the induction of scarring. Among the growth factors, TGF-beta 2 represents an important stimulant of scarring with a key regulatory function. The TGF-beta 2 concentration in the aqueous humor of primary open angle glaucoma is significantly elevated. In vitro and in vivo studies have demonstrated promising inhibition of scarring after subconjunctival application of human monoclonal anti-TGF-beta 2 antibody, which appears to be a safe and well tolerated therapeutic approach. Currently, several prospective studies are investigating the role of anti-TGF-beta 2 antibody as an alternative to conventional long term inhibition of scarring.

Animals↗
PubMed1996

[Blood salvage: decisive progress in vascular surgery].

There are two different methods of autotransfusion during an operation; one without blood washing and the other with wash red cells obtained after the filtering and concentration of the recovered blood. The first method has the advantage of being simple and cheap while recovering 1500-2000 ml of blood. Nevertheless it is insufficient in the case of an important or rapid bleeding. The weight of haemoglobin in the recovered blood is relatively low and the hemolysis is without clinical consequences. The rate of the coagulation factors is reduced. The autotransfusion with wash red cells requires a more important investment at the beginning. But the washing process eliminates the cell micro-aggregates and nearly all of the substances in the recovered blood. Therefore concentrated units of red cells may be obtained with hematocrits between 45 and 65%. Autotransfusion with washing offers a greater security when the bleeding is important or violent. The autotransfusion is useful for a bleeding between 1 and 3 litres. The average volume recovered corresponds to 2.5 pockets of blood extract, thus covering the costs for the kits. If the bleeding exceeds 1.5 times the blood volume, blood extract and plasma will be required in addition. The risk of homologue blood transfusion can only increase the development of autotransfusion techniques and particularly the recovery of blood during the operation process.

Blood Transfusion, Autologous↗
PubMed2003

Microbiological evaluation of various parameters in ophthalmic operating rooms. The need to establish guidelines.

PURPOSE: Postoperative infections can be caused by a contaminated environment, unsterile equipment, contaminated surfaces, and infected personnel as well as contaminated disinfectants. In order to establish guidelines for microbiological monitoring, a detailed microbiological surveillance was carried out in an ophthalmic hospital. METHOD: Over a period of 21 months, we assessed environmental Bacteria Carrying Particle(BCP) load and surface samples weekly (n = 276); the autoclaving system once a month and repeated whenever the process failed (n = 24); the air conditioning filters for fungal growth once in four months (n = 15), and the disinfectant solution for contamination once in two months (n = 10). Additionally, the personnel involved directly in surgery were screened for potential pathogens such as Staphylococcus aureus and beta haemolytic streptococci. RESULT: On 14 (5.07%) occasions the environment in the operating rooms had a significant risk of airborne infections. Sterilisation of instruments in the autoclaves was unsatisfactory on 4 (16.66%) occasions. Samples from the filters of the air-conditioning units yielded potentially pathogenic fungi on 3 (20%) occasions. Personnel sampling revealed that 5 (8.77%) individuals harboured beta haemolytic Streptococci in the throat and 4 (7.01%) harboured S. aureus in the nasal cavity. The samples of disinfectant in use were not contaminated. CONCLUSION: There is a need to standardise microbiological evaluation protocols for operating rooms.

Disinfection↗