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At least 73 records · Page 4Linked to original sources
PubMed1998

The value of intraoperative consultation (frozen section) in the diagnosis of ovarian neoplasms.

BACKGROUND: Frozen Section is an important diagnostic tool to determine the nature of ovarian masses. However, like other diagnostic tools, frozen section also has some pitfalls. We aimed to discuss the source and the nature of inaccuracies associated with this procedure. METHODS: In this retrospective study 360 cases of ovarian masses examined by frozen section were re-evaluated. The sensitivity, specificity and predictive values of frozen section diagnosis of ovarian tumors were calculated. The reasons for the erroneous frozen-section diagnoses were discussed. RESULTS: Overall diagnostic agreement for ovarian lesions was 94.2%. Disagreements were found in nine cases (2.5%). Diagnosis was deferred to permanent sections in 12 cases (3.3%). The sensitivity for malignant tumors was 93.1% and specificity was 99.2%. The sensitivity for benign tumors was 99.2% and specificity was 92.1%. Most problematic cases were mucinous tumors, followed by tumors resembling fibrothecomas, in addition sections without viable tissue fragments or presence of extensive hemorrhage and necrosis also obscured the frozen diagnosis. Another factor was the lack of an effective communication between the surgeon and the pathologist. CONCLUSIONS: For an effective usage of this method not only the pathologist but also the surgeons must know the pitfalls of this method and also there must be good communication between the pathologist and the surgeon. Especially deferred cases should be minimized by good communication. In fact it's an intraoperative consultation method that enables the pathologist to gather all the preoperative, intraoperative findings and to be familiar with the further treatment plan of the patient.

Female↗
PubMed1997

Absence of memory for intraoperative information during surgery under adequate general anaesthesia.

Using the isolated forearm technique (IFT), we wished to determine if patients known to be unresponsive to commands during general anaesthesia with nitrous oxide, halothane and neuromuscular blocking agents had any evidence of explicit or implicit recall. Two groups of women, studied in a single-blind sequential block design, heard different tapes, either a command and information tape (n = 34) or radio static (n = 34), throughout surgery. Four women (two radio static, two command) had unequivocal evidence of explicit recall for a period near the beginning or end of the procedure, at a time when the IFT was not being used. With or without hypnosis, category generation, serial position of category exemplars and word association tests did not reveal evidence of priming. We conclude that during light general anaesthesia with nitrous oxide, halothane and atracurium, patients had neither explicit nor implicit memory for information presented during a period when they are known to be unresponsive to commands.

Adolescent↗
PubMed1998

Can providing paging devices relieve waiting room anxiety?

The purpose of this study was to evaluate the effect of providing individuals who are waiting for surgical patients with digital pagers. Twenty-eight subjects received routine waiting room procedures, and 29 subjects were given digital pagers during surgical procedures. Subjects completed questionnaires concerning activity, state anxiety, and their perceived threat while patients were undergoing surgical procedures. The group that received the paging devices reported significantly greater state anxiety (i.e., P < .03) and a greater percentage of time spent outside surgical waiting rooms (i.e., P < .00) than the group that did not receive paging devices.

Adult↗
PubMed2004

Patient communication during cataract surgery.

PURPOSE: Most cataract surgery is now performed under local anaesthesia on a day-case basis. As patients are fully conscious during the procedure, it is important that they remain still. There are a variety of reasons why patients may need to move, and it is important that the surgeon is made aware that this may happen. Some centres offer a nurse's hand as a means of perioperative patient communication. We sought to study the safety and efficacy of using an electronic patient-controlled alert device. METHOD: We compared hand-holding with the use of a patient alert device, and with both communication methods at the same time, on 150 subjects undergoing cataract surgery under local anaesthesia. Assessment of pre- and postoperative state anxiety was undertaken and patients' satisfaction with the communication strategies was assessed. RESULTS: There was a significant difference between pre- and postoperative state anxiety for each group (P<0.001) but no significant differences in pre-, peri-, or postoperative state anxiety between groups. There were no significant differences in confidence, pain, understanding, satisfaction, memory, and reassurance between the three groups. A total of 46% of all patients reported experiencing one or more of the potential problems enquired about, during the operation. Significant correlations were also identified between some of the psychological variables investigated. CONCLUSIONS: An electronic patient alert device is as effective a means of perioperative patient communication as holding a nurse's hand, during cataract surgery under local anaesthesia. It is safe, reassuring and it allows patients to communicate directly with the surgeon.

Aged↗
PubMedDate not supplied

Tibial intraneural ganglia in the tarsal tunnel: Is there a joint connection?

Intraneural ganglia are rare entities, and, as such, their pathogenesis has been extremely controversial. Recent evidence from intraneural ganglia occurring at more proximal sites-the peroneal nerve at the fibular neck (the most common site) and the tibial nerve at the knee-has suggested an articular origin rather than de novo formation. To our knowledge, of the 10 previous reports of tibial intraneural ganglia within the tarsal tunnel by others, a joint connection to the ankle joint was only identified in 2 cases. To support a hypothesis that tibial intraneural ganglia occurring within the tarsal tunnel region arise from neighboring joints, we analyzed 3 patients retrospectively, all of whom had magnetic resonance (MR) imaging and operative intervention. One of these patients was treated by a peripheral nerve surgeon specializing in foot and ankle surgery. The other 2 patients were the only ones previously published in the literature who had MR images available for reinterpretation. In none of these cases was a joint communication appreciated by radiologists interpreting the MR images preoperatively or by surgeons intraoperatively. Our review of these same cases demonstrated radiographic evidence of joint communications with the subtalar joints. Based on our findings in this article and our knowledge of intraneural ganglia occurring at more proximal sites, we believe that tibial intraneural ganglia within the tarsal tunnel originate from neighboring joints and that their connections to the joints (pedicles) are through articular branches. The importance of these connections is 2-fold: first, for their role in the pathogenesis of this entity, and second, for their potential therapeutic implications. As is highlighted by the clinical and radiographic follow-up in the 1 patient in this article and in many previously reported at other sites, intraneural cyst recurrence can occur if surgeons do not specifically address the articular connection.

Ankle↗
PubMedDate not supplied

Anomaly of the portal vein with an anomalous hepatic vein--the first case report.

An anomaly of the portal vein associated with an anomalous hepatic vein is described as the first reported case. A 44-year-old woman was incidentally found to have a huge hemangioma by ultrasonography. Computed tomography revealed an anomalous portal system with a normally located gallbladder and round ligament. Arterial portography revealed anomalous branching of the portal vein, with absence of the left umbilical portion, the curved right portal branch mimicked the right-sided umbilical portion. Hepatic venography demonstrated patent umbilical veins communicating with the left hepatic vein. Intraoperatively the hepatic vein branch was found on the surface of the right hepatic lobe and the common bile duct was dorsal to the hepatic artery. A limited excision of the involved liver was performed safely with the help of the preoperative definition of the abnormal liver anatomy.

Adult↗
PubMed1998

[Traumatic intracerebral pneumocephalus communicating with two different paranasal sinuses: a case report].

We report a case of a 17-year-old male who had hit the front of his head in a traffic accident. CT scan revealed contusional hemorrhage and pneumocephalus of the left frontal lobe 10 hours after the accident. A month later he complained of rhinorrhea and CT scan revealed intracerebral pneumocephalus. One day he complained of headache and began to vomit after he sneezed. CT scan revealed that the pneumocephalus had become worse and air had spread throughout the subarachnoid space. Bone CT scan revealed the air communicated from the frontal sinus to the intracerebral air cavity. 3D-CT scan revealed bone defect in the roof of the ethmoid sinus. The intraoperative findings revealed that the intracerebral air cavity communicated with the frontal sinus and ethmoid sinus. Though the brain which dropped into the paranasal sinus, adhered to the dura mater around the bone defect, a part of the brain had come off from the dura mater around the frontal sinus. We suspected that the intracerebral air cavity communicated with the frontal sinus initially. When the air cavity communicated with the ethmoid sinus secondarily, intracranial pressure abated and air came into the subarachnoid space from the frontal sinus.

Accidents, Traffic↗
PubMed2007

Safe atlantoaxial fixation using a laminar screw (intralaminar screw) in a patient with unilateral occlusion of vertebral artery: case report.

STUDY DESIGN: A case of atlantoaxial fusion using an intralaminar (unilateral-crossing laminar screw) screw is presented in a patient with unilateral vertebral artery communication with the basilar artery. OBJECTIVES: To document the significance of the intralaminar screw technique in the aforementioned case. SUMMARY OF BACKGROUND DATA: Vertebral artery injury is directly linked with intraoperative or perioperative death if the vertebral artery communicates only unilaterally to the basilar artery or has an obvious dominant side. In this situation, irrespective of whether the pedicle is confirmed to be sufficient for pedicle screw placement, if the vertebral artery is violated, fatal complications will occur. The literature reports that even proficient surgeons cannot guarantee 100% accuracy in pedicle screw placement. The intralaminar screw technique is currently the safest with regard to avoiding violation of the vertebral artery. Biomechanical studies have also shown this technique to ensure sufficient strength. METHODS: The patient had rheumatoid atlantoaxial subluxation, and the right vertebral artery alone communicated with basilar artery, while the left ended blind. She underwent atlantoaxial fixation with an intralaminar screw (unilateral-crossing laminar screw) of the axis and lateral mass atlas screws inserted via the posterior arch. RESULTS: The intralaminar screw (unilateral-crossing laminar screw) was completed, and comprised lateral mass atlas screws and rods. There were no complications during and after surgery. Good bone union was achieved. CONCLUSION: Patients with unilateral dominant vertebral artery are good candidates for the intralaminar screw technique, even if the pedicle anatomy is sufficient to insert pedicle screws.

Atlanto-Axial Joint↗
PubMed1991

Intraoperative monitoring of the somatosensory evoked potentials and cerebral blood flow during aneurysm surgery--safety evaluation for temporary vascular occlusion.

Somatosensory evoked potentials (SEPs) and cerebral blood flow (CBF) were monitored during temporary vascular occlusion in 67 aneurysm operations to evaluate the usefulness of SEP as an indicator for cerebral ischemia. The SEP N20 component completely disappeared during temporary vascular occlusion in 24 cases, 23 of which demonstrated complete recovery following recirculation and had no postoperative neurological sequelae. The only one with postoperative sequelae demonstrated rapid, within 1 minute, loss of N20 followed by no recovery. Another eight cases showed prolongation of central conduction time during vascular occlusion and had no postoperative sequelae. The SEP N20 attenuation reflected the CBF reduction in the middle cerebral artery (MCA) territory during MCA occlusion. However, CBF changes in the internal carotid artery (ICA) territory during ICA occlusion greatly varied. No detectable changes in SEP were found during anterior cerebral artery occlusion for anterior communicating artery aneurysms. This study indicates that intraoperative SEP monitoring is useful to detect ischemia in the MCA territory and that rapid disappearance of the N20 component is a danger signal.

Brain Ischemia↗
PubMed1990

Multilevel spine fractures: intraoperative nursing management.

Stabilization of multiple level spine fractures in blunt trauma victims is an extensive and complicated surgical procedure. A multidisciplinary approach to the thoracolumbar anatomy and subsequent stabilization poses a variety of challenges to the neurosurgical operating room staff. Transfer to the operating table and positioning for the procedure are dictated by the following treatment protocol for vertebral fractures: immobilization and stabilization of fractures with skin or skeletal traction, administration of parenteral muscle relaxants and analgesics, assessment and documentation of neurologic status, maintenance of bone and joint alignment and provision of skin care. Standard preoperative preparation and intraoperative nursing diagnoses and interventions are discussed. The importance of communication and psychological support to family members is stressed.

Humans↗