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At least 37 records · Page 2Linked to original sources
PubMed1999

Anterograde and retrograde memory in children anesthetized with propofol.

Prior to anesthesia with propofol for gastrointestinal endoscopy, sets of pictures were presented to 20 children and adolescents (M age = 12 years). Word pairs (e.g., "hiking-woods") were presented via earphones after the children were anesthetized. Upon regaining consciousness, the children were tested for explicit memory of both the picture sets and word pairs by free recall, cued recall, and yes/no recognition. Implicit memory was tested by free association to category cues for the pictures and by word association for the word pairs. Postoperative testing revealed retrograde memory for material presented preoperatively but total amnesia for material presented intraoperatively. There was no evidence of implicit memory for material not available explicitly. The finding of uninterrupted ability to retain and retrieve information presented prior to anesthesia despite total anterograde amnesia has implications for preoperative communication directed toward pediatric patients as well as for intraoperative communication among surgical staff.

Adolescent↗
PubMed2006

Pituitary apoplexy associated with anterior communicating artery aneurysm and aberrant blood supply.

Pituitary apoplexy is an uncommon condition typically caused by acute, hemorrhagic expansion of the pituitary gland in patients with an adenoma that undergoes infarction. Although various risk factors have been described, the vascular events leading to apoplexy are not well understood. Disruption of microvascular blood flow is a well-known cause of morbidity from hemorrhage of an intracranial aneurysm, but pituitary apoplexy is rarely associated with aneurysmal subarachnoid hemorrhage. We report here a 46-year-old woman with pituitary apoplexy who developed subarachnoid hemorrhage from rupture of an anterior communicating artery aneurysm. Intraoperatively, she was found to have an unusual, large recurrent artery originating at the junction of the aneurysm and the A2 segment of the anterior cerebral artery that traveled to the suprasellar cistern and along the pituitary stalk. This recurrent hypophyseal artery established a direct vascular relationship between an intracerebral aneurysm and the pituitary gland.

Adult↗
PubMed1996

Medicolegal issues. An anatomic pathologist's perspective.

In the practice of anatomic pathology, the standard of care must be met in all instances if the possibility of an adverse legal action is to be avoided. Whether one practices surgical, cyto-, or necropsy pathology, one is at risk. Constant vigilance, following appropriate guidelines, and well-designed quality assurance programs are all important in reducing the possibility of litigation. During intraoperative consultations direct communication with the surgeon is often essential. If an adequate legal defense is to be had, documentation of the precautions taken in an individual case is necessary. Outside consultants should be chosen carefully based on their expertise in the area of concern, and preferably only one consultation should be requested on a particular case. House staff in training should be given graduated responsibility, but their work, in general, should be supervised by an attending pathologist who has hospital privileges. In giving testimony as a defendant, one should never admit a departure or deviation from the standard of care. As an expert witness, it is important that one's testimony be objective and impartial. One should not attempt to answer questions outside one's area of expertise.

Female↗
PubMed1994

Complete nonunion of the ureterovesical junction with preservation of renal function.

We report on a neonate with a history of failure to thrive who had a large right abdominal mass. Renal ultrasound showed a large cystic mass that arose from the upper pole of the hydronephrotic right kidney. Preoperative antegrade pyelography confirmed that the mass communicated with 1 kidney. Further evaluation revealed no communication of the ureter with the bladder or vagina. Exploratory surgery identified the mass and intraoperative pyelography revealed no communication with the bladder. After resection of the mass and nephrostomy placement, reimplantation of the right ureter demonstrated complete atresia of the distal right ureter. Preservation of the remaining renal parenchyma was possible, because the functioning lower pole collecting system communicated with the cystic mass that arose from the upper pole.

Female↗
PubMed2004

In vivo optical imaging of pleural space drainage to lymph nodes of prognostic significance.

BACKGROUND: Understanding the spatial and temporal drainage patterns of the pleural space could have profound impact on the treatment of lung cancer and mesothelioma. The purpose of this study was to identify the in vivo pattern of drainage from the pleural space to prognostic lymph node stations. METHODS: Fifty-six rats underwent pleural space injection of a novel lymph tracer composed of recombinant human serum albumin (HSA) covalently conjugated to the near-infrared (NIR) fluorophore IRDye78 via an amide bond (HSA-78). Nodal uptake was imaged at 10, 20, 30, and 60 minutes and 4, 12, and 24 hours after injection with a custom system that simultaneously acquires color video, NIR fluorescence of HSA-78, and a merged picture of the two. Six pigs underwent the same procedure with imaging at 30 minutes, 1 hour, and 24 hours. RESULTS: In both the rat model and the pig model, HSA-78 drained from the pleural space to superior mediastinal lymph nodes first, followed by other intrathoracic and then extrathoracic lymph nodes over the course of 24 hours. CONCLUSION: NIR fluorescence imaging in two species shows that the superior mediastinal lymph nodes are the first to drain the pleural space. Over the course of 24 hours, the pleural space also communicates with other intrathoracic and then extrathoracic lymph nodes. This study also demonstrates an intraoperative method for identifying nodes communicating with the pleural space, with potential utility in the staging and/or resection of lung cancer and mesothelioma.

Animals↗
PubMed2004

Preoperative assessment and management to prevent complications during high-risk vascular surgery.

OBJECTIVE: Most patients requiring vascular surgical reconstruction are at high risk for major morbidity and mortality, with certain vascular procedures at particularly high risk for complications. Although numerous comorbid conditions are precisely the risk factors that determine outcome, we review particular factors for each surgery that may be optimized to alter outcome and minimize postoperative complications. DESIGN: Literature review. RESULTS: Certain aspects of care are common to all vascular surgery procedures, including thoracoabdominal aortic aneurysm repair, pararenal and ruptured abdominal aortic aneurysm repair, mesenteric and renal revascularization, and carotid endarterectomy. Some factors that are important include careful preoperative assessment and optimization of cardiac, pulmonary, and renal function and volume status. In addition, the use of experienced teams during and after the procedure, as well as clear and continuous communication between all surgical team members, may improve outcome. Particular attention to procedural details is also crucial to achieving excellent results. CONCLUSIONS: Patients needing vascular surgery often possess management challenges that increase the risk of perioperative complications. Meticulous attention to details during all phases of care, including preoperative optimization as well as intraoperative procedural conduct and communication, helps achieve optimal results and thus minimize the risk of complications.

Aneurysm↗
PubMed2005

Assessing team performance in the operating room: development and use of a "black-box" recorder and other tools for the intraoperative environment.

BACKGROUND: The objective of this research was to develop a digital system to archive the complete operative environment along with the assessment tools for analysis of this data, allowing prospective studies of operative performance, intraoperative errors, team performance, and communication. Ability to study this environment will yield new insights, allowing design of systems to avoid preventable errors that contribute to perioperative complications. STUDY DESIGN: A multitrack, synchronized, digital audio-visual recording system (RATE tool) was developed to monitor intraoperative performance, including software to synchronize data and allow assignment of independent observational scores. Cases were scored for technical performance, participants' situational awareness (knowledge of critical information), and their comfort and satisfaction with the conduct of the procedure. RESULTS: Laparoscopic cholecystectomy (n = 10) was studied. Technical performance of the RATE tool was excellent. The RATE tool allowed real time, multitrack data collection of all aspects of the operative environment, while permitting digital recording of the objective assessment data in a time synchronized and annotated fashion during the procedure. The mean technical performance score was 73% +/- 28% of maximum (perfect) performance. Situational awareness varied widely among team members, with the attending surgeon typically the only team member having comprehensive knowledge of critical case information. CONCLUSIONS: The RATE tool allows prospective analysis of performance measures such as technical judgments, team performance, and communication patterns, offers the opportunity to conduct prospective intraoperative studies of human performance, and allows for postoperative discussion, review, and teaching. This study also suggests that gaps in situational awareness might be an underappreciated source of operative adverse events. Future uses of this system will aid teaching, failure or adverse event analysis, and intervention research.

Cholecystectomy, Laparoscopic↗
PubMed2003

Biliary cystadenocarcinoma followed up as benign cystadenoma for 10 years.

We describe a case of biliary cystadenocarcinoma that showed a longterm clinical course. A 69-year-old Japanese man was admitted to our hospital because of abdominal discomfort. The patient had been diagnosed with benign cystadenoma of the liver at another hospital in 1987 and had been followed up for 10 years. Abdominal ultrasonography (US) and computed tomography (CT) scan demonstrated a unilocular cystic lesion, which included multiple conspicuous papillary protrusions in the left hepatic lobe. Left lateral segmentectomy was performed, and intraoperative cholangiography revealed a communication between the cystic tumor and intrahepatic bile duct. The tumor contained clear mucinous fluid and enfolded multiple yellowish papillary projections on the cystic wall. Histological examination showed the tumor to be biliary cystadenocarcinoma. The patient is doing well 4 years after the operation.

Abdomen↗
PubMedDate not supplied

A perioperative nurse liaison program: CNS interventions for cancer patients and their families.

Cancer surgery causes stress and anxiety for families and patients. Knowing that communication between family and health care professionals is traditionally fragmented during the perioperative period, Memorial Sloan-Kettering Cancer Center developed a family-centered program to improve information exchange. This article describes the Perioperative Clinical Nurse Specialist program and the process by which ongoing communication of clinical information and psychosocial support for waiting relatives occurs. Good communication during the preoperative, intraoperative, and postoperative period is characteristic of quality care at a critical time. The subject program serves to bridge the gap in the continuum of perioperative care.

Cancer Care Facilities↗
PubMed2006

Confirmatory needle placement technique for scalene muscle block in the diagnosis of thoracic outlet syndrome.

Scalene muscle block is often performed to assist with the clinical differentiation of primary sources of pain and weakness in the upper limb when the differential diagnosis includes thoracic outlet syndrome. This presentation offers a simple clinical method to assess needle placement in the scalene muscle before an injection of local anesthetic which, if properly placed, weakens the scalene muscle and often leads to temporary relief of symptoms associated with neurovascular compression. An appropriate scalene block response provides assistance with medical decision making.

Anesthetics, Local↗
PubMed1983

Amnesia following the rupture and repair of an anterior communicating artery aneurysm.

Clinical analysis and neuropsychological criteria derived from experimental studies of human amnesic syndromes, particularly the alcoholic Korsakoff's syndrome, have been used to characterise an unusual form of amnesia that occurred in two patients after rupture of an anterior communication cerebral artery aneurysm. Intraoperative observation and multiple CT scans did not reveal focal brain damage. Arteriography showed that both patients had arterial vasospasm. The amnesia has persisted over three years since the surgery. Study of the characteristics of their amnesia showed several features in common with other amnesic syndromes, including severely depressed free recall, and less depressed recognition of visual and verbal material. Chronic amnesic syndromes with characteristics of classical amnesic syndromes occur infrequently after rupture and repair of intracranial aneurysms, and, if not caused by parenchymal haemorrhage, may follow pre-operative vasospasm.

Adult↗
PubMed2006

Remote anesthetic monitoring using satellite telecommunications and the Internet.

Remote collaboration for anesthesia requires considerable sharing of physiologic data, audio, and images on a consistent data platform. A low-bandwidth connection between Ecuador and the United States supported effective joint management of operative plan, airway, intraoperative decisions, and recovery. Transmission with a 64-Kbps InMarSat satellite telephone (Thrane & Thrane, Denmark) connection from hospitals in Macas and Sucúa, Ecuador, to Richmond, Virginia, included preoperative patient evaluations, video of endotracheal intubations, electrocardiogram waveforms, pulse oximetry measurements, arterial blood pressure readings, capnography readings, and auscultation of breath sounds.

Anesthesia↗
PubMed2001

The rule of three.

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Communication↗