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At least 217 records · Page 12Linked to original sources

PubMed2006

Is restricted femoral navigation sufficient for accuracy of total knee arthroplasty?

A total knee arthroplasty performed with navigation results in more accurate component positioning with fewer outliers. It is not known whether image-based or image-free-systems are preferable and if navigation for only one component leads to equal accuracy in leg alignment than navigation of both components. We evaluated the results of total knee arthroplasties performed with femoral navigation. We studied 90 knees in 88 patients who had conventional total knee arthroplasties, image-based total knee arthroplasties, or total knee arthroplasties with image-free navigation. We compared patients' perioperative times, component alignment accuracy, and short-term outcomes. The total surgical time was longer in the image-based total knee arthroplasty group (109 +/- 7 minutes) compared with the image-free (101 +/- 17 minutes) and conventional total knee arthroplasty groups (87 +/- 20 minutes). The mechanical axis of the leg was within 3 degrees of neutral alignment, although the conventional total knee arthroplasty group showed more (10.6 degrees ) variance than the navigated groups (5.8 degrees and 6.4 degrees , respectively). We found a positive correlation between femoral component malalignment and the total mechanical axis in the conventional group. Our results suggest image-based navigation is not necessary, and image-free femoral navigation may be sufficient for accurate component alignment.

Aged↗

PubMed2006

Study on the clinical application of pulsed DC magnetic technology for tracking of intraoperative head motion during frameless stereotaxy.

BACKGROUND: Tracking of post-registration head motion is one of the major problems in frameless stereotaxy. Various attempts in detecting and compensating for this phenomenon rely on a fixed reference device rigidly attached to the patient's head. However, most of such reference tools are either based on an invasive fixation technique or have physical limitations which allow mobility of the head only in a restricted range of motion after completion of the registration procedure. METHODS: A new sensor-based reference tool, the so-called Dynamic Reference Frame (DRF) which is designed to allow an unrestricted, 360 degrees range of motion for the intraoperative use in pulsed DC magnetic navigation was tested in 40 patients. Different methods of non-invasive attachment dependent on the clinical need and type of procedure, as well as the resulting accuracies in the clinical application have been analyzed. RESULTS: Apart from conventional, completely rigid immobilization of the head (type A), four additional modes of head fixation and attachment of the DRF were distinguished on clinical grounds: type B1 = pin fixation plus oral DRF attachment; type B2 = pin fixation plus retroauricular DRF attachment; type C1 = free head positioning with oral DRF; and type C2 = free head positioning with retroauricular DRF. Mean fiducial registration errors (FRE) were as follows: type A interventions = 1.51 mm, B1 = 1.56 mm, B2 = 1.54 mm, C1 = 1.73 mm, and C2 = 1.75 mm. The mean position errors determined at the end of the intervention as a measure of application accuracy were: 1.45 mm in type A interventions, 1.26 mm in type B1, 1.44 mm in type B2, 1.86 mm in type C1, and 1.68 mm in type C2. CONCLUSION: Rigid head immobilization guarantees most reliable accuracy in various types of frameless stereotaxy. The use of an additional DRF, however, increases the application scope of frameless stereotaxy to include e.g. procedures in which rigid pin fixation of the cranium is not required or desired. Thus, continuous tracking of head motion allows highly flexible variation of the surgical strategy including intraoperative repositioning of the patient without impairment of navigational accuracy as it ensures automatic correction of spatial distortion. With a dental cast for oral attachment and the alternative option of non-invasive retroauricular attachment, flexibility in the clinical use of the DRF is ensured.

Journal Article↗

PubMed2005

Sentinel lymphoscintigraphy in patients with breast cancer undergoing excisional biopsy.

UNLABELLED: Some small tumors of the breast cannot be diagnosed by needle biopsy, and an excisional biopsy is occasionally needed for the diagnosis. Sentinel node navigation surgery is frequently suitable for patients with such small breast cancers. The purpose of this study was to compare sentinel lymphoscintigrams in breast cancer patients who had previously undergone excisional biopsy with sentinel lymphoscintigrams in patients undergoing no excisional biopsy. We also investigated the possibility of clinical application of the sentinel node navigation procedure in the former group of patients. METHODS: Sentinel lymphoscintigrams of 43 patients with breast cancer undergoing excisional biopsy were compared to those of 116 patients without excisional biopsy. Lymphoscintigrams were obtained by using intradermal and/or subdermal injections of technetium-99m labeled phytate at 2 points on each side of the dermal incision in patients after excisional biopsy. Injections were performed at 2 points of the skin over the tumor in the patients who had not undergone excisional biopsy. RESULTS: Axillary lymph nodes were visualized in 42 of 43 patients undergoing excisional biopsy (98%) and in 115 of 116 patients without excisional biopsy (99%). The number of visualized axillary nodes was 1 to 5 (mean +/- SD = 2.1 +/- 1.0) and 1 to 5 (mean +/- SD = 1.9 +/- 1.0) in the two groups, respectively. No significant difference was determined between the two groups. Parasternal lymph nodes were depicted in 3 patients after excisional biopsy who had the tumor in the outer half of the breast, in contrast to 4 without excisional biopsy who had the tumor in the inner half. Intramammary hot spots were observed in 5 patients after excisional biopsy and in 2 without excisional biopsy. Lymphatic vessels were observed in 23 patients (53%) who had the excisional biopsy, and in 37 (32%) who did not have the biopsy. The former figure was significantly higher than the latter (p < 0.02). CONCLUSION: Sentinel node navigation surgery for axillary nodes was shown to be possible in patients undergoing excisional biopsy. However, the visualization of parasternal nodes, intramammary hot spots and lymphatic vessels tended to increase in number, and care must be exercised in the management of these patients.

Adult↗

PubMed2004

Navigation as a tool to visualize bone-covered hidden structures in transfrontal approaches.

A retrospective analysis of 10 patients was performed to evaluate navigation systems in extranasal frontal skull base surgery. When performing a craniotomy following a bicoronal skin incision, the surgeon has to calculate the extent of the frontal sinus to avoid unnecessary damage to the dura or mucoceles later. Due to surgical morbidity including compression of the frontal lobe, many skull base surgeons have refused to use such an approach. Malformation or bone-destruction complicates the identification of the borders and increases the risk of side-effects. Navigation systems can be an alternative for calculating the frontal sinus outlines during surgery. In the authors' surgical procedure two different navigation systems were used. Conventional surgery using the transfrontal, transbasal or subcranial approach consisting of trepanation and craniotomy were performed, while the navigated surgical procedure was evaluated. The analysis showed that computer-assisted surgery (CAS) is applicable to extranasal frontal skull base surgery. In comparison to X-ray beam-controlled craniotomy, CAS is beneficial as it constitutes a noninvasive instrument of quality management. Furthermore, the analysis indicated that under the guidance of a navigation system a precise pre-surgical simulation is available in order to perform an optimal craniotomy and reconstruction of the frontal skull base.

Adult↗

PubMed2005

Transbronchial biopsy using endobronchial ultrasonography with a guide sheath and virtual bronchoscopic navigation.

STUDY OBJECTIVES: We evaluated the feasibility, safety, and efficacy of transbronchial biopsy (TBB) using endobronchial ultrasonography with a guide sheath (EBUS-GS) and virtual bronchoscopy (VB) navigation for small peripheral pulmonary lesions < or = 30 mm in diameter. DESIGN: Pilot study. SETTING: A national university hospital. PATIENTS: We performed TBB using EBUS-GS with VB navigation for 29 patients with 30 small peripheral pulmonary lesions (average diameter, 18.6 mm) between January 1, 2004, and August 31, 2004. INTERVENTIONS: VB images were reconstructed from helical CT data. TBB was then performed using EBUS-GS with VB navigation. RESULTS: In all patients, TBB was performed safely with no complications. Bronchi seen on VB imaging were highly consistent with the actual structures confirmed using fiberoptic bronchoscopy. Following VB navigation, the endobronchial ultrasonography (EBUS) probe was inserted into third- to sixth-generation bronchi. Twenty-four lesions (80%) were visualized on EBUS images. Average durations of the initial EBUS examination of lesions, first biopsy, and the total procedure were 9.56 min, 11.99 min, and 25.72 min, respectively. Nineteen lesions (63.3%) were diagnosed from histopathologic or cytologic examination. Diagnostic sensitivities were 44.4% (8 of 18) for lesions < 20 mm in mean diameter and 91.7% (11 of 12) for lesions 20 to 30 mm in mean diameter. CONCLUSIONS: In summary, TBB using EBUS-GS with VB navigation was safely performed and was effective in diagnosing small peripheral pulmonary lesions.

Adult↗

PubMed2005

[Sentinel lymph node concept in prostate cancer].

A sentinel node (SN) validation study using a radioactive tracer and back-up extended pelvic lymph node (LN) dissection was performed in 40 patients with non-metastatic prostate cancer (PCa). The results of the study were favorable with sensitivity, specificity, and accuracy of SN biopsies revealed 90%, 100% and 97.5%, respectively. Based on our promising results to date, we examined the utility of SN navigation surgery (SNNS) in patients with LN metastasis probability of 10% or less on Partin tables. Endoscopic mini-laparotomy surgery was applied to our SN biopsies in 9 patients with clinically localized PCa. SNs were successfully resected in 7 of these patients. Endoscopic minilaparotomy SNNS is a less invasive form of radical surgery for prostate cancer with accurate diagnosis of LN status.

Endoscopy↗

PubMed2000

A new face-mounted display system: pilot trial of clinical application in therapeutic endoscopy.

BACKGROUND AND STUDY AIMS: Since fiber endoscopes evolved into video endoscopes, there has been no remarkable progression in the optical system for endoscopy. The current optical system provided by fixed cathode-ray tube (CRT) display is a monitor-oriented system. In this study, we evaluate the practical usefulness of the face-mounted display (FMD), which provides us with an operator-oriented optical system. PATIENTS AND METHODS: The FMD device, weighing 110 g, is designed for consumer video home use, consisting of two active matrix liquid crystal color panels with 180,000-pixel resolution. With the picture-in-picture capability, FMD provided us with image-navigated endoscopic procedure. Fourteen patients were enrolled in this study; seven patients for endoscopic mucosal resection, two for insertion of an esophageal metallic stent, three for clipping for the bleeding and two for dilatation of anastomotic strictures. RESULTS: The FMD device allowed us to use an ultra large screen as if there has been a 62-inch screen 2 m ahead. During endoscopy, we could concentrate more on the procedures. There were no complications attributable to the use of the device. CONCLUSION: We are convinced of a new evolution in the optical system for therapeutic endoscopy with the FMD device.

Endoscopes, Gastrointestinal↗

PubMed2003

The HEDIS performance NAVIGATOR for controlling high blood pressure: a resource to assist health plans improve patient adherence.

This article describes how the resources in the Health Plan Employer and Data Information Set (HEDIS; a registered trademark of the National Committee for Quality Assurance) Performance NAVIGATOR for Controlling High Blood Pressure (HEDIS NAVIGATOR) developed by Merck & Co., Inc. assist managed care organizations in understanding and encouraging the active involvement of their members in adhering to a treatment plan developed in partnership by physicians and patients. (HEDIS is a set of standardized performance measures that enable purchasers and consumers to make informed decisions regarding the quality of managed care organizations.) The discussion uses the Health Belief and Transtheoretical Models as a framework to better understand patient behavior change. Targeted strategies to facilitate adherence are also addressed. Examples of structured programs using nationally recommended guidelines and HEDIS NAVIGATOR resources are included to illustrate coordinated efforts to assist patients with high blood pressure adhere to their treatment plan and help managed care organizations improve patient outcomes and HEDIS scores.

Data Collection↗

PubMed2005

Results with navigated bicontact total hip arthroplasty.

The position of the cup is crucial for the overall quality of a total hip arthroplasty. A malpositioning of the cup leads to increased risk of dislocation, wear, and revision. The position of the stem influences leg length and may cause impingement and dislocation. These faults may increase with minimally invasive procedures. From November 2001 to June 2005, 1081 consecutive THA patients were evaluated. Cup navigation resulted in a better alignment and additional improvement when the cup and stem were navigated. In stem navigation, a good control of the leg lengthening and a reliable prediction of the safe range of motion could be seen.

Adult↗

PubMed2002

The use of stereotactic navigation guidance in minimally invasive transnasal nasopharyngectomy: a comparison with the conventional open transfacial approach.

The purpose of this paper is to study the efficacy of applying stereotactic navigation guidance to nasopharyngectomy via a minimally invasive transnasal approach as compared with the conventional open transfacial approaches. The nasopharynx is the centre of the anterior skull base, which is remote from the surface of the facial skeleton. It is well known that there are several surgical approaches for access to resect tumours from the nasopharynx. However, the open techniques have been associated with much morbidity and only provide access to, and identification of, the ipsilateral internal carotid artery that forms the lateral boundary and resection limit of the nasopharynx. The coupling of stereotactic navigation guidance and a minimally invasive transnasal approach for nasopharyngectomy allows the surgeon to identify and protect the internal carotid artery bilaterally at the nasopharynx. This technique reduces operating time and morbidity to a minimum and yet is oncologically sound for resecting nasopharyngeal lesions. We compare 15 patients who underwent the stereotactic navigation guidance approach with 20 patients who received a conventional open transfacial approach.

Adult↗

PubMed2004

Differential impact of parvocellular and magnocellular pathways on visual impairment in apperceptive agnosia?

The term "visual form agnosia" describes a disorder characterized by problems recognizing objects, poor copying,and distinguishing between simple geometric shapes despite normal intellectual abilities. Visual agnosia has been interpreted as a disorder of the magnocellular visual system, caused by an inability to separate figure from ground by sampling information from extended regions of space and to integrate it with fine-grain local information. However,this interpretation has hardly been tested with neuropsychological or functional brain imaging methods, mainly because the magnocellular and parvocellular structures are highly interconnected in the visual system. We studied a patient (AM) who had suffered a sudden heart arrest, causing hypoxic brain damage. He was/is severely agnosic, as apparent in both the Birmingham Object Recognition Battery and the Visual Object and Space Battery. First- and especially second-order motion perception was also impaired, but AM experienced no problems in grasping and navigating through space. The patient revealed a normal P100 in visual evoked potentials both with colored and fine-grained achromatic checkerboards. But the amplitude of the P100 was clearly decreased if a coarse achromatic checkerboard was presented.The physiological and neuropsychological findings indicate that AM experienced problems integrating information over extended regions of space and in detecting second-order motion. This may be interpreted as a disorder of the magnocellular system, with intact parvocellular system and therefore preserved ability to detect both local features and colors.

Agnosia↗

PubMed1999

Coronary artery imaging in a 0.5-Tesla scanner: implementation of real-time, navigator echo-controlled segmented k-space FLASH and interleaved-spiral sequences.

Coronary angiography techniques have been implemented on a 0.5-Tesla scanner with a view to performing coronary artery imaging. Slice-followed, segmented k-space FLASH sequences and interleaved-spiral sequences have been employed with acquisitions under real-time navigator echo control with patient feed back, enabling poor signal-to-noise levels to be overcome by averaging data acquired over multiple, variable-length, reproducible breath holds. Good-quality, millimetre-resolution coronary images were obtained in ten normal subjects with both techniques. The mean percent of data segments or interleaves acquired with the navigator echo within the 5-mm diaphragm acceptance window was 57% [standard deviation (S.D.), 11%; range, 38-85%], and the average image-acquisition times were 123+/-22 sec and 71+/-14 sec for segmented FLASH and interleaved-spiral imaging, respectively. In addition to shorter acquisition times, the interleaved-spiral sequence has superior temporal resolution, allowing the acquisition of limited, multislice data sets. However, the sequence is particularly sensitive to the off-resonance effects of residual epicardial fat surrounding the artery and to field nonuniformities, both of which lead to image blurring and, unlike segmented FLASH acquisitions (which are very robust), the spiral data sets generally require postprocessing.

Adult↗

PubMed2006

Navigated laser-assisted endoscopic fenestration of a suprasellar arachnoid cyst in a 2-year-old child with bobble-head doll syndrome. Case report.

The authors present the case of a 2-year-old boy with bobble-head doll syndrome (BHDS) associated with a large suprasellar arachnoid cyst and enlarged ventricles, who was successfully treated with neuronavigated laser-assisted endoscopic ventriculocystocisternostomy. The clinical history, surgical treatment, and clinical follow up of the patient are described. A navigated laser-assisted endoscopic ventriculocystocisternostomy of the suprasellar arachnoid cyst led to cessation of the head bobbing, and notable reduction of the cyst and ventricles was visible on the postoperative magnetic resonance images. Caused by a suprasellar arachnoid cyst, BHDS can be successfully treated with navigated laser-assisted endoscopic ventriculocystocisternostomy. The advantages of this procedure are minimal invasiveness and facilitated guidance of the neuronavigation system to the target area when normal anatomical landmarks are not visible.

Arachnoid Cysts↗

PubMed2004

Initial experience with remote catheter ablation using a novel magnetic navigation system: magnetic remote catheter ablation.

BACKGROUND: Catheters are typically stiff and incorporate a pull-wire mechanism to allow tip deflection. While standing at the patient's side, the operator manually navigates the catheter in the heart using fluoroscopic guidance. METHODS AND RESULTS: A total of 42 patients (32 female; mean age, 55+/-15 years) underwent ablation of common-type (slow/fast) or uncommon-type (slow/slow) atrioventricular nodal reentrant tachycardia (AVNRT) with the use of the magnetic navigation system Niobe (Stereotaxis, Inc). It consists of 2 computer-controlled permanent magnets located on opposite sides of the patient, which create a steerable external magnetic field (0.08 T). A small magnet embedded in the catheter tip causes the catheter to align and to be steered by the external magnetic field. A motor drive advances or retracts the catheter, enabling complete remote navigation. Radiofrequency current was applied with the use of a remote-controlled 4-mm, solid-tip, magnetic navigation-enabled catheter (55 degrees C, maximum 40 W, 60 seconds) in all patients. The investigators, who were situated in the control room, performed the ablation using a mean of 7.2+/-4.7 radiofrequency current applications (mean fluoroscopy time, 8.9+/-6.2 minutes; procedure duration, 145+/-43 minutes). Slow pathway ablation was achieved in 15 patients, whereas slow pathway modulation was the end point in the remaining patients. There were no complications. CONCLUSIONS: The Niobe magnetic navigation system is a new platform technology allowing remote-controlled navigation of an ablation catheter. In conjunction with a motor drive unit, this system was used successfully to perform completely remote-controlled mapping and ablation in patients with AVNRT.

Adult↗

PubMed2005

When patients choose faith over medicine: physician perspectives on religiously related conflict in the medical encounter.

BACKGROUND: Patients at times disagree with medical recommendations for religious reasons. Despite a lively debate about how physicians should respond to patients' religious concerns, little is known about how physicians actually respond. We explored the ways in which physicians interpret and respond to conflict between medical recommendations and patients' religious commitments. METHODS: One-to-one, in-depth, semistructured interviews with 21 physicians from a range of religious affiliations, specialties, and practice settings. Interviews were transcribed, coded, and analyzed for emergent themes through an iterative process of textual analysis informed by the principle of constant comparison. RESULTS: Conflict introduced by religion is common and occurs in 3 types of settings: (1) those in which religious doctrines directly conflict with medical recommendations, (2) those that involve an area in which there is extensive controversy within the broader society, and (3) settings of relative medical uncertainty in which patients "choose faith over medicine." In response to such conflict, physicians first seek to accommodate patients' ideas by remaining open-minded and flexible in their approach. However, if they believe patients' religiously informed decisions will cause them to suffer harm, physicians make efforts to persuade patients to follow medical recommendations. CONCLUSIONS: When religiously related conflict arises, physicians appear to intuitively navigate a tension between respecting patients' autonomy by remaining open-minded and flexible and seeking patients' good by persuading them to follow medical recommendations. In such contexts, religion and medicine are intertwined, and moral counsel inheres in physicians' medical recommendations.

Adult↗

PubMed2003

Stent-assisted embolization of internal carotid artery aneurysms.

BACKGROUND: Endovascular embolization of wide neck aneurysm often results in incomplete occlusion or aneurysm recurrence. The purpose of this study is to assess the efficacy and safety of stent-assisted embolization of wide neck aneurysms of the internal carotid artery (ICA). METHODS: A series of 10 patients with ICA aneurysms attempted treatment by stent-assisted Guglielmi detachable coil (GDC) embolization (n = 9) or by stent alone (n = 1). There were 3 men and 7 women ranging in age from 21 to 78 years, with a mean of 51 years. The indications of stenting were wide neck aneurysms (n = 9) and herniation of detached coils from aneurysmal sac into parent artery (n = 1). RESULTS: Endovascular stent placement was technically successful in 8 cases. In one case with a cervical big ICA aneurysm, a stent was placed across the neck of aneurysm without deposition of embolic material into the aneurysmal sac. The initial control angiogram revealed residual aneurysm; however, complete obliteration of aneurysmal sac was achieved as observed on angiograms in 8 months. Six cases of wide neck aneurysms were successfully treated by stent-assisted GDC embolization. One case had prolapse of coil loops into parent artery after coils detached; the coil loops were successfully pushed back to aneurysm after stent placement. Two patients had difficulties to navigate the stents across the aneurysm necks because of tortuous parent arteries; in one of them, the stent partially covered the neck of aneurysm, which made the success of subsequent GDC embolization; in the other one, advancement of the stent to the targeted site was abortive, and the aneurysm was eventually loose packing. No significant procedure-related complication was found. One patient had asymptomatic dissection of the parent artery after stent placement. One patient had a transient ischemic attack and returned to normal baseline neurological conditions later. Clinical follow-up for these patients was 0.5 to 36 months, with a mean of 14 months. CONCLUSIONS: Stent-assisted embolization is a treatment of choice for wide neck aneurysms or for patient with herniation of coil loops to parent artery after coil detached. It was proven both safe and effective over a relatively long follow-up.

Adult↗

PubMed1998

[3-dimensional MR coronary angiography with navigator technique: imaging of the proximal course of a coronary artery anomaly].

Congenital coronary artery anomalies are found in 0.3 to 1.3% of patients and can cause ischemic heart disease or sudden cardiac death, especially if the anomalous coronary artery courses between the aortic root and the pulmonary artery. Identification of the anatomic course of the anomalous vessel is not always feasible by conventional radiographic coronary angiography. With MR coronary angiography not only flowing blood but also the vessel anatomy can be imaged. In previous studies, a two-dimensional gradient-echo sequence during breathhold was used demanding both cooperation of the patient and operator skill. The navigator technique reduces respiratory artifacts by retrospective respiratory gating on the diaphragm's position, obviating the need for breathhold studies. Furthermore, the three-dimensional MR coronary angiography enables post-processing using the Volume Rendering Technique for evaluation of three-dimensional view. We report on the use of this technique for the identification of the course of anomalous coronary arteries in two patient cases.

Artifacts↗

PubMedDate not supplied

[Patient-centered consultation of "good practice guidelines": OncoDoc, a decision support system for the management of breast cancer patients].

Beyond considerations of cost-effectiveness, clinical practice guidelines (CPG) can reduce practice variations and thus improve the quality of care. However, despite the proliferation of implemented CPG and their wide diffusion thanks to Internet-based technologies, physicians' compliance with formal standards is weak. Developed according to a document-based paradigm, OncoDoc proposes an original framework for implementing CPG. Domain knowledge has been encoded as a decision tree whose branches are both exclusive and exhaustive. This generic knowledge is operationalized at the point of care by the interactive building, through hypertextual navigation, of a patient-based clinical context leading to specific therapeutic recommendations. OncoDoc has first been applied to the management of breast cancer patients and demonstrated within a full-scale experimentation in a clinical setting a compliance of 80 per cent.

Breast Neoplasms↗