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PubMedDate not supplied

[Computers in surgery].

The introduction of computers in medicine, particularly for what surgery is concerned, has many implications related to its optimal utilization. Possible applications as well as advantages and limits of such recording system in a surgical ward are examined. Emphasis is placed on the clinical data management model and the ways the different structures of the system are related. The computer processing of these data provides valid material for either clinical and surgical research or statistical studies.

Computers↗
PubMed1990

[Study on the simulation in planning for orthognathic surgery by using a personal computer].

This study was made in order to develop and evaluate three-dimensional simulation programs in planning for orthognathic surgery by using microcomputer system. Microcomputer system is composed of CPU (NEC, PC-9801), high resolutional color display, color printer, image scanner, and MOUSE. This simulation is composed of four procedures. 1. Data input Three-dimensional coordinate data on tracing obtained from CT films is inputted. One data file is made from one outline of structures. 2. Three dimensional reconstruction A control file is made to arrange data files constructing structures. 3. Simulation This procedure is composed of cutting and movement. The horizontal projection of mandible is displayed. After cutting simulated orthognathic surgery is designed, new data files and new control file are made. A movement consists of parallel translation and rotation. A movement data is combined with movements designed on each of three projections. 4. Three-dimensional graphic display Three-dimensional graphics of the mandible before and after a simulation for orthognathic surgery are displayed by perspective views with treated hidden lines and accurate pictures (COSMOZONE 2SA, NIKON). These simulation programs were carried out with the asymmetrical patient. The simulation was supposed that the operation was combined with sagittal splitting osteotomy of the right mandibular ramus and body ostectomy of the left lower first premolar part. Three-dimensional graphics of the mandible before and after the simulation were presented. Its three-dimensional mandibular position and form after orthognathic surgery were predicted. These three-dimensional simulation programs may be important procedure, when a treatment planning in asymmetrical prognathic case is discussed.

Computer Graphics↗
PubMed1990

Design of a measurement system for electrophysiological cardiac surgery.

The treatment of cardiac arrhythmias by surgical removal of abnormal electrical pathways across the atrio-ventricular ring or re-entrant circuits within the myocardium is dependent on the ability to accurately locate the abnormality by measuring and displaying the activation front of muscle depolarisation as it spreads across the surface of the heart. The localisation of the aberration requires induction of the arrhythmia, simultaneous measurement of activity from many (100-200) sites over the surface of the heart, attachment of fiducial markers to this data, and display of the activation sequence in the form of an isochronous map. An instrument has been built at Green Lane Hospital to provide the necessary measurement, control, and analysis facilities required by this procedure. The purpose built measurement system is a multiprocessor unit which incorporates up to 512 programmable intracardiac amplifiers, two multifunction cardiac pacing stimulators, a versatile real time data display, a patient safety isolation system, and digital storage for eight seconds of electrocardiographic data. Signals are acquired from a mesh of bipolar electrodes attached to either a 'sock' or a 'band' which is placed on the heart during open heart surgery. The analysis of data is carried out on a personal computer, connected to the measurement system via a serial command link and a high speed parallel data link. Corrective surgery is now being carried out on a routine basis for some types of arrhythmias.

Arrhythmias, Cardiac↗
PubMed1990

The technique of gait analysis using a Coda-3 motion analysis system.

Gait analysis using Code-3 provides information which allows individual gait to be characterised with little interference to the patient. It is an ideal method for analysing gait in patients with cerebral palsy. Because of the ease with which this information is now available using Coda-3, gait analysis can now be performed on all ambulant patients in whom surgery is contemplated.

Biomechanical Phenomena↗
PubMed1990

Principles and applications of Computer-Aided Design and Computer-Aided Manufacturing (CAD/CAM) technology in orthopaedics.

The principles involved in Computer-Aided Design (CAD) and Computer-Aided Manufacturing (CAM) technology is presented in this article. It also highlights the current advances and capability of this technology. Application of the CAD/CAM technology in orthopaedics is relatively new. Three broad areas of applications can be defined: (1) three-dimensional reconstructions of skeletal structure based on any of the imaging technique, i.e. CT scan, MRI or X-ray, to analyse, simulate, design and evaluate orthopaedic procedures without having to actually perform the surgery; (2) the production of plastic or wax models for surgeons to have global impressions and understanding of complex cases of bone and joint disorders and the possibility of using the physical models as templates to sculpt allograft pre-operatively; and (3) to design and manufacture geometrically optimal standard and customised implants. CAD/CAM technology is also rapidly developing in the field of prosthetics, orthotics and orthopaedics footwear. The advantages offered include shorter delivery time, more consistent design, quantifiable rectification and "modern" or remote manufacturing. Apart from these applied usage, the CAD/CAM technology is also an effective tool for education and training. The application of CAD/CAM technology in orthopaedics and its related fields has been shown to have tremendous potential, but may appear to be too esoteric, complex and costly at the present moment. However, with improved generality, simplicity and cost-effectiveness of the system, it will become more practical.

Computer Simulation↗
PubMed1990

[Noninvasive intraoperative measurement of intracapillary hemoglobin oxygenation and relative hemoglobin concentration in surgical skin flaps].

We describe the Erlangen microconducting spectrometer (EMPHO I), a device that measures the oxygen saturation and relative haemogloblin content in the capillaries. These factors determine the oxygen supply and survival of cutaneous flaps. The EMPHO I was used for intraoperative measurements in pectoralis major myocutaneous flaps and showed reproducible results, so that it is valid for intraoperative monitoring in plastic surgery.

Computer Graphics↗
PubMedDate not supplied

Volumetric 3-D imaging of computerized tomography scans.

Contiguous transaxial high resolution CT scans of more than 100 patients with craniofacial deformities and orthopedic disorders were obtained. The CT scan examinations were used diagnostically in determining the need for surgery and for planning therapy. The serial section data was reconstructed in a three-dimensional form with surface and transparent volumetric computer graphics processing techniques. Real time sequences showing the presence of internal abnormalities in these patients were produced and recorded on video tape. This study demonstrates the feasibility and technical requirements of three-dimensional volumetric visualization for diagnostic evaluation of patients with craniofacial and orthopedic disorders.

Adult↗
PubMed1989

Application of video surgery to orthodontic diagnosis.

The purpose of this project was to develop a practical methodology for predicting the visual facial changes resulting from the movement of anterior teeth. The armamentarium includes an 8-bit audiovisual computer, a video camera, a digitizer, and a cephalogram of the patient. The system outputs the patient's profile on a personal computer video display. The image is superimposed on the soft tissue line of a digitized cephalogram plot on the same display. The video profile image is transformed from analog to digital signals. The profile image digitized by the computer is modified according to average ratios of soft tissue to hard tissue changes induced by modifications to the hard tissues. The program incorporates the spline function to smooth the profile image.

Audiovisual Aids↗
PubMed1989

First model of whole body computerized stereotactic device.

The whole body computerized stereotactic device was created by a group of specialist in various professions. Its connection with computer tomography has overcome the limitation of the stereotactic method to the brain surgery and the changeability of anatomic relations inside the human body. Computing technique and special patients' fixation are new supplements in the contemporary stereotaxy.

Diagnosis, Computer-Assisted↗
PubMed1989

Preoperative planning for hallux valgus bunion surgery: photonics versus templates.

Photonic techniques such as CAD can now be applied to foot and ankle surgery for preoperative planning. Perhaps "CAS" (computer-aided surgery) or "surgitecture" would be more appropriate terms for our field and application. Achievements in this new frontier depend on present and future generations of podiatrists who are willing to challenge themselves to explore the potential of photonics and to refine its capabilities.

Computer Graphics↗
PubMed1989

Three-dimensional surface imaging from CT scans for the study of craniofacial dysmorphology.

Computer-assisted medical imaging technologies provide new tools for the study of congenital craniofacial deformities. Three-dimensional surface reconstructions have been developed to simplify the interpretation and improve the utility of CT scans of the head. While 3-D reconstructions initially were applied to assist clinical management of craniofacial deformities, these images now are finding utility in the study of unique anomalies, the definition of group characteristics for dysmorphic heads, the differentiation of similar phenotypes, and the documentation of the effects of cranial surgery on craniofacial growth. These findings should assist the formulation and evaluation of hypotheses regarding mechanisms of congenital malformation and deformation.

Adolescent↗
PubMed1989

Prospective comparison of radionuclide, computed tomographic, sonographic, and magnetic resonance localization of parathyroid tumors.

The appropriate choice of imaging techniques to localize parathyroid tumors preoperatively remains controversial. We report the first prospective, blinded study to compare the efficacy of four imaging modalities in 100 patients with primary hyperparathyroidism (pHPT). Patients were examined by computer-assisted thallium 201/technetium 99m subtraction scintigraphy (TTS), computed tomography (CT), ultrasonography (US), and magnetic resonance (MR). Each study was performed and interpreted independently. Subsequent neck exploration and "curative" parathyroidectomy allowed correlation of surgical findings with imaging reports to score their accuracy. Overall sensitivities of the four imaging modalities were TTS, 73%, CT, 68%, US, 55%; and MR, 57%; with respective specificities of 94%, 92%, 95%, and 87%. Sensitivities for lesions located below the thyroid gland (thymic tongue and mediastinum) were TTS, 90%; CT, 46%; US, 44%; and MR, 50%; with respective specificities of 100%, 99%, 100%, and 94%. There was a significant increase in overall sensitivity when TTS and CT (90%, p less than 0.01) or TTS and US (85%, p less than 0.05) were used together; however, the combination of any three or even four imaging modalities did not increase sensitivity further. For small parathyroid tumors (less than or equal to 250 mg), no imaging technique had a sensitivity of more than 50%. None of the imaging studies accurately localized small hyperplastic parathyroid glands found in patients with multiple gland disease. Preoperative parathyroid imaging may not be indicated in pHPT patients undergoing first-time neck exploration because surgeons experienced in parathyroid surgery have a 93% to 96% cure rate.

Adult↗
PubMed1989

[Diagnosis and treatment of craniosynostoses: the usefulness of CT combined with 3-dimensional reconstruction].

Craniosynostoses are craniocerebral and craniofacial dysmorphic states, characterized by early closure of one or more cranial sutures. In this pathology the perpendicular growth of the bone to the involved suture is disturbed (Virchow's theory). Craniosynostoses can be divided into: 1) single-suture synostoses (scaphocephaly, plagiocephaly, trigonocephaly), 2) multiple-suture synostoses (brachycephaly, oxycephaly) and 3) craniofacial dysostoses. From 1976 to 1987, 63 children with craniosynostosis were studied in our Institute. All patients underwent radiologic and neuroradiologic research with CT scans both before and after surgery; in the past year three-dimensional reconstructions of CT images were also employed. Major advantages of 3-DCT have been obtained in craniofacial malformations. In fact, this technique helps reduce surgical risks and allows the surgeon to evaluate partial results and to make eventual corrections in the last phase. The processing of images is useful to simulate the operation, thus allowing the surgeon to take the best therapeutic choice by computer. This technique is especially useful for postoperative follow-up. In craniosynostoses, early surgical treatment (within the first 6-8 months of life) is necessary in order to obtain excellent functional and cosmetic results.

Cranial Sutures↗
PubMed1978

Enlarged acid-base and blood gas calculations by electronical data computing in the blood gas laboratory.

A rapid anaysis of parameters of the acid-base equilibrium and blood gases during open heart surgery and emergency therapy is absolutely necessary. Computing of the several parameters of the acid-base status by slide rules or nomograms is time consuming and can be shortened by computer applications. The central blood gas laboratory consists of a blood gas analyzer for PO2, PCO2 and pH, an electronic desktop calculator, a four color X-Y-plotter and two data lines to the cardiac surgery unit and to the intensive care unit. The time needed for computing and feedback of the parameters could be decreased to one quarter. In addition to numerical data printout, a graphical representation of the several parameters is possible on a X-Y-plotter and includes the Rahn-Fenn-O2-CO2-Diagram with venous admixture, ventilation perfusion ratio, alveolar dead space ventilation and the standard and actual oxygen dissociation curve as well as the pH/HCO3- Acid-Base nomogram. Furthermore, a computer diagnosis of the actual disturbances can be plotted.

Acid-Base Equilibrium↗
PubMed1989

Basilar crescentic osteotomy. A three-dimensional computer simulation.

A three-dimensional computer simulation of the basilar crescentic osteotomy has been presented. The bunion deformity consists of hallux valgus, an increased first and second intermetatarsal angle, pronation of the great toe, and elevation of the first metatarsal head. Every foot is different and some may have more or less of each of the above noted components. Because the deformity is multiplanar, at least two roentgenograms are needed to evaluate the deformity. The weight-bearing, anterior-posterior roentgenogram is the principle radiograph used in preoperative planning. The use of a weight-bearing, sesamoid roentgenogram is recommended to quantify the anterior-posterior deflection and rotation of the first metatarsal head. A computer model (based on a cylinder) of the first metatarsal has been formulated. The osteotomy then was performed in a variety of scenarios in order to simulate the surgical correction. A great deal of flexibility is afforded by this osteotomy. The surgeon needs to be aware of the coupled motions that occur. That is, closure of the intermetatarsal angle may also cause head rotation, depression, or elevation. If the osteotomy is performed in an oblique multiplanar direction, then it is possible for the metatarsal head to elevate, pronate, and significantly shorten as the intermetatarsal angle is closed. If this scenario should occur, a poor surgical outcome will result. Excision of the medial eminence is recommended after the osteotomy has been completed and secured with stable fixation because of these rotational changes. The basilar crescentic osteotomy is an excellent method for correction of a marked metatarsus primus varus. It is important to pay close attention to a variety of anatomic considerations. The osteotomy must not be made in the diaphysis because of potential nonunion. There should be little dissection of the periosteum because of possible delayed union. As in any bunion surgery, it is essential to perform an adequate, distal, soft-tissue repair. Three dimensional preoperative planning is essential in obtaining correction of all components of a bunion. Specific guidelines, based on a three-dimensional computer model, are now available. An interactive computer program also is available to aid the surgeon in preoperative planning. We hope there will be better understanding of this technically difficult but highly versatile osteotomy.

Hallux Valgus↗
PubMed1989

Computer-assisted two-dimensional echocardiography in preoperative evaluation of left ventricular function in patients with aortic valve disease.

Seventy-six healthy adults and 228 patients with aortic valve disease were studied by means of two-dimensional echocardiography (2D-EchoCG). Functional properties of the left ventricle in patients with aortic valve disease were studied by means of computer analysis of echocardiograms and patients requiring cardiac surgery were identified. It was found that an increased left ventricular (LV) end-systolic volume (110 ml and more), assessed by 2D-EchoCG, is an unfavourable prognostic sign, and elevated risk factor of cardiac surgery. It invariably proved to be related to LV dysfunction after the surgery. A decreased diastolic LV mass/volume ratio (1.255 and less), found in 16% of patients with pressure overload, means nonadequate development of hypertrophy and an elevated risk of cardiac surgery.

Adolescent↗
PubMedDate not supplied

Automated data collection and presentation in the operating room.

An 'Operating Room Data Integration System', is described which is used to collect, present and archive all important physiological parameters during open heart surgery. The system requires very little attention, and provides an easy to understand and coherent interface to the user. The system is adaptable to a large extend and thus data can be presented to the user in a manner, with which he or she is already familiar. Simple drivers can be written to enable connection of the system to almost any other piece of medical equipment, if the latter provides an analog or digital, output signal. Automatic logging of the acquired signals is then possible.

Computer Systems↗