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At least 1,657 records · Page 92Linked to original sources

PubMed1999

Hand-assisted laparoscopic donor nephrectomy versus standard laparoscopic donor nephrectomy: a comparison study in the canine model.

The aim of this study was to compare live donor nephrectomy by hand-assisted laparoscopy to standard laparoscopy in a canine model. Fourteen dogs underwent a left laparoscopic nephrectomy; a standard laparoscopic nephrectomy technique was utilized in seven dogs. In a second group of seven dogs, a hand-assisted laparoscopic technique was used with a Dexterity Pneumo Sleeve hand port. All nephrectomies were performed as "donor" nephrectomies, dividing the vessels last. Total blood loss, operative warm ischemia, time and organ retrieval times were assessed for each group. The average operative time was significantly shorter for hand-assisted laparoscopic donor nephrectomy (32 +/- 8 minutes vs. 61 +/- 8 minutes; p = .02) than for the standard technique. The average warm ischemia (86 +/- 24 seconds vs. 224 +/- 52 seconds; p = .03) and average organ delivery times (4 +/- 3 seconds vs. 45 +/- 9 seconds; p < .01) also were shorter using the hand-assisted laparoscopic technique. No significant differences in average blood loss were found between the two groups (9 +/- 2 cc vs. 6 +/- 1 cc; p = 0.16, NS). Good parenchymal, ureteral, and vascular preservation was achieved by both techniques. Hand-assisted laparoscopy permits shorter operating times and warm ischemia times than standard laparoscopy in a canine model of donor nephrectomy. Hand assistance makes donor laparoscopic nephrectomy technically easier and significantly quicker to perform. If hand-assisted laparoscopy donor nephrectomy is confirmed to be a rapid and safe technique for removing an intact organ, laparoscopic nephrectomy will be a more widely accepted technique among urologists who participate in living related donor kidney transplantation.

Animals↗

PubMed1999

CATCH 22 syndrome: report of 7 infants with follow-up data and review of the recent advancements in the genetic knowledge of the locus 22q11.

CATCH 22 is a medical acronym for Cardiac defects, Abnormal facies, Thymic hypoplasia, Cleft palate, and Hypocalcemia, and a variable deletion on chromosome 22. The deletion within the chromosome region of 22q11 may occur in patients with three well-described dysmorphologic+ cardiological syndromes: DiGeorge syndrome (DGS), velocardiofacial syndrome (VCFS), and conotruncal anomaly face syndrome (CTAFS). We report in detail seven infants with a deletion of the locus 22q11 showing overlapping clinical features of DGS and CTAFS with complex congenital heart defects (double outlet right ventricle, atresia or stenosis of the pulmonary valve, atrial and ventricular septal defects, patent ductus arteriosus, tetralogy of Fallot, major aortopulmonary collateral arteries, arcus aortae dexter, and persistence of the left superior vena cava). A homograft was implanted between the right ventricle and the main stem of the pulmonary artery in 2 patients, while a balloon valvuloplastic of the pulmonary valve was performed in one patient only. Pulmonary hemorrhage, acute hypoxia, and Aspergillus pneumonia were the complications. Death occurred in three out of seven patients. Recent advancements in the genetic knowledge of the locus 22q11 are described. Since the locus 22q11 is highly heterogeneous, the CATCH 22 acronym should be used and temporarily the old eponyms should be abandoned waiting for the identification of the different genes.

Abnormalities, Multiple↗

PubMed1999

[Some aspects of sensorial asymmetries].

The present review shows the variability assessing sensoric asymmetries. There are preference and performance tests. Sensoric asymmetries are strongest and most manifest for eyedness (eye preference and performance), descending through earedness and other less known asymmetries. A vast range of testing techniques have been used to assess eyedness. Sighting dominance and self-report are two of the most popular techniques. Other preference measures include observation of how people use tools and questionnaires. Performance test assess speed and accuracy in tasks stressing sensoric dexterity. Although questionnaires are generally thought to be reliable and valid instruments, there is a disagreement as to the nature, the number and weighting of the items to be included.

Animals↗

PubMed1999

Comparison of first carpometacarpal joint arthrodesis with contralateral excision arthroplasty in a patient with bilateral saddle joint arthritis: a case report.

A post-menopausal patient with bilateral primary osteoarthritis of the first carpometacarpal joint (CMCJ) was treated by 2 different surgical techniques. The non-dominant left CMCJ was arthrodesed in 1992 while excision of trapezium and tendon suspensionplasty was done for the dominant right side in 1997. She reported good pain relief with both procedures and she was able to fully oppose both thumbs at 6 years after arthrodesis and 1 year after arthroplasty. The grip and pinch strength was stronger on the arthrodesed side while hand function tests revealed the arthroplasty side to be more dexterous. Subjectively, she preferred the right thumb. Radiographs showed no peritrapezial arthritis in the arthrodesed CMCJ and no proximal migration of the metacarpal on the reconstructed side. Both procedures offered excellent relief of symptoms and she was able to return to work as a machine operator.

Arthritis↗

PubMed1999

[Use of the Indiana-type continent reservoir: review of our series].

OBJECTIVE: To report the experience of the Hospital General de Mexico on the use of the Indiana continent urinary reservoir in cystectomized patients. METHODS: From January 1995 to September 1997, 32 Indiana continent urinary reservoirs were performed in 22 men and 12 women with a median age of 46.1 years. Operating time, immediate, early and late complications, reservoir function and capacity, and social integration of the patient after the procedure were evaluated. RESULTS: The most frequent underlying disease was bladder cancer followed by neurogenic bladder. The mean operating time was 5.5 hours for performing cystectomy and the Indiana pouch. The most frequent immediate, early and late complications were urinary tract infection (12 patients, 35%), metabolic acidosis (4 patients, 11%), one case of total pouch necrosis, one case of pouch lithiasis, one case of uretero-colonic anastomosis dehiscence and two cases of septic shock. Reservoir function was evaluated clinically, radiologically and urodynamically. CONCLUSIONS: The Indiana continent urinary reservoir is a good alternative in patients undergoing cystectomy, regardless of the underlying cause. Technical dexterity significantly reduces the operating time and surgical complications.

Acidosis↗

PubMed1999

ARTEMIS. A telemanipulator for cardiac surgery.

ARTEMIS, the Advanced Robotics and TElemanipulator System for Minimally Invasive Surgery, is designed as an integrated teleoperation and telepresence system for planning, training and performing different minimally invasive surgical procedures. The actual prototype was developed as an experimental device for exploring and testing the needed technologies and their capability and quality with respect to surgical application. The main components are two master-slave units guiding the surgical instruments and a remotely controlled endoscope guiding system. Each master-slave device consists of the slave or work unit and the master or control unit which are interconnected by a computer based control system. The work unit is operating at the patient by means of dexterous surgical instruments consisting of multifunctional endoeffectors with flexible distal section providing six degrees of freedom. The kinematic structure of the work unit ensures a precise motion around the incision point through the abdominal or thoracic wall. The master or control unit guided by the surgeon is designed to enable the surgeon to operate intuitively as if he were guiding the tip of the endoeffector manually. The powered endoscope guiding system is equipped with a 3D-endoscope. The computer based control system interconnecting control and work units has an open system architecture which allows to couple differently designed masters and slaves, monitoring systems, graphical system and user interfaces. The endoscope can be guided by a simple joystick, voice control or automatic camera tracking. For minimally invasive cardiac surgery a new concept has to be developed. In co-operation with the Cardiovascular Institute of the University of Dresden a step-by-step procedure was agreed. The state-of-the-art is described.

Cardiac Surgical Procedures↗

PubMed2000

Stereotactic surgery: what is past is prologue.

Two old and simple simple concepts, a three-dimensional positioning stage and a coordinate system, were combined in 1906 to create a new one: the stereotactic method. For 25 years, it found little application until it was rediscovered for investigations in small animals. After the first human subcortical stereotactic procedure was performed in 1947, stereotactic methods found greatest application in the placement of subcortical lesions in the treatment of movement disorders. Rapid advances in the development of instrumentation, methods, and understanding of human neuroanatomy and neurophysiology resulted. However, a dormant period followed the introduction of L-dopa in 1968. The advent of computer-based medical imaging applied to the stereotactic method encouraged adaptation of stereotactic methods to the management of intracranial tumors, the rapid development of new surgical hardware, and the rediscovery of old methods and evolution of new ones for the treatment of movement disorders. In addition, the incorporation of computer systems as stereotactic surgical instruments further increased the capabilities of stereotactic methods. Radiosurgical applications increased with the proliferation of gamma units and the development of linear accelerator-based radiosurgical methods. Computers are used to fuse and reformat imaging databases for surgical planning, simulation, and frameless stereotactic intraoperative guidance. As a result, surgical procedures have become more effective in meeting preoperative goals and less invasive. Low-cost, high-speed, microprocessor-based workstation computers and intuitive user interfaces have increased the acceptance into mainstream neurosurgery. It is anticipated that a significant portion of neurosurgery, and probably most surgical procedures in general, will comprise computer-based interventions guided by volumetric imaging-defined data sets acquired preoperatively or by intraoperative imaging systems. The stereotactic surgery of the future may employ all or a combination of the following technologies: frameless stereotactic surgery, robotic technology, microrobotic dexterity enhancement, and telepresence robotics.

Brain↗

PubMed2000

Treating carpal tunnel syndrome.

UNLABELLED: BACKGROUND CTS is a common problem caused by compression of the median nerve at the wrist resulting in hand numbness, loss of dexterity, muscle wasting, and decreased functional ability at work. This study investigated the efficacy of a corticosteroid injection just proximal (not into) the carpal tunnel for CTS. POPULATION STUDIED: Study participants included 60 patients referred to a neurology clinic in Amsterdam, Netherlands, with CTS symptoms for longer than 3 months' duration and confirmed with electrophysiological tests. Patients in the intervention and control groups had symptoms for an average of 32 months and 25 months, respectively. In patients with bilateral symptoms, the arm with the most severe symptoms was chosen for randomization. Patients aged younger than 18 years and those who had previous treatment for CTS were excluded. STUDY DESIGN AND VALIDITY: Patients were randomized to receive an injection of either lignocaine (Lidocaine 10 mg) and methylprednisolone 40 mg or a lignocaine 10-mg injection only. The site of injection was proximal to the carpal tunnel on the volar side of the forearm 4 cm proximal to the wrist crease, between the tendon of the radial flexor muscle and the long palmar muscle. Injections were given at a 10 degrees to 20 degrees angle with a 3-cm needle. At baseline, there were no significant differences between the control group and the intervention group. The study was performed at one clinic where one neurologist performed all injections. Thus, we do not know if the results of this technique can be consistently reproduced. No patients were reported lost to follow-up at 1 year. To ensure blinding of the treatment assignment, a pharmacist wrapped the syringes in paper and a second neurologist performed outcomes assessment interviews. One month after the initial injection, patients were asked whether they had no symptoms or only minor symptoms that they considered so much improved that they felt no further treatment was necessary. Investigators broke the trial code at follow-up assessment visits to offer nonresponders an injection with methylprednisolone or surgery. OUTCOMES MEASURED: Patients were considered improved if they self-reported no symptoms or only minor symptoms needing no additional treatment. Other symptoms (weakness, nighttime pain) or impact on lifestyle and occupation were not reported. RESULTS: At 1 month, 20% of the patients in the control group had improved compared with 77% of patients in the intervention group (P <.001; number needed to treat = 1.8). After 1 year, 8 of the 23 patients (35%) who initially responded to methylprednisolone required a second injection. A total of 86% of nonresponders in the control group improved after receiving a methylprednisolone injection, but 50% of these patients went on to need surgical treatment within 1 year. The investigators reported no side effects to the injection.

Anti-Inflammatory Agents↗

PubMed1998

[Relationship between health status and work ability among elderly Al exposed workers].

In this study, health status and work ability of 80 elderly male workers exposed to aluminum (Al) were assessed by physiological and neurobehaviral tests. The results showed that workers with cardiovascular or respiratory diseases had lower work ability index(WAI). Vital capacity and musculoskeletal function index(MSFI) were correlated closely with work ability. Mental performance capacity decreased with the increasing of age, and mental performance score was associated with work ability. It is suggested that vital capacity and MSFI may serve as index reflecting physical work ability of Al-exposed workers. Simple reaction time, visual memory, manual dexterity and pursuit aiming may reflect mental work ability.

Adult↗

PubMedDate not supplied

[Generalized posttetanic changes in the excitatory postsynaptic and acetylcholine-evoked currents in snail neurons].

Heteroreceptor posttetanic changes in excitatory postsynaptic currents (EPSC) and inward currents evoked by the local iontophoretic application of acetylcholine (ACh) on the dorsal surface of PLa3 and PRa3 Helix lucorum neurons were studied. The following changes in the currents were revealed over the course of 1-1.5 h after tetanization. The rhythmical ACh application (0.5-1.0 cps, 10-40 s) evokes potentiation of the orthodromic EPSC. The tetanic orthodromic stimulation of one of the nerves (n. intestinalis, n. pallialis dexter, or n. pallialis sinister; 1-5 cps, 1-2 min) causes the potentiation of the ACh current and also heterosynaptic depression of the EPSC. It is concluded that activation of subsynaptic and nonsynaptic neurotransmitter chemoreceptors evokes the development of generalized posttetanic changes in neuronal responses.

Acetylcholine↗

PubMed1999

Inhaler devices for use in asthma care.

A patient's ability to use an asthma inhaler correctly will depend on his or her age and manual dexterity. An up-to-date knowledge of the range of inhalers available on the market, and their advantages and disadvantages, will aid selection. Patients should be involved in the selection process as this will encourage compliance.

Administration, Inhalation↗

PubMedDate not supplied

Intracorporeal knot-tying and suturing techniques in laparoscopic surgery: technical details.

BACKGROUND: Intracorporeal suturing and knot-tying in laparoscopic surgery require great manual dexterity; these techniques must absolutely be mastered by every surgeon who is interested in pursuing the minimally invasive approach. METHOD: The initial and final knot of a laparoscopic continuous suture can be accomplished in several ways and with easy technical solutions that are fully illustrated in the present study. CONCLUSION: We think it is better to perform a continuous suture than an interrupted one. It is advisable, moreover, to use traditional suture materials (not specially created for laparoscopy) that cost less than the more sophisticated ones.

Humans↗

PubMed2000

The quincunx of surgery.

From the earliest days of surgery the central and unifying theme of the discipline has been the mastery of technical proficiency with the view to not only management of the diseased or damaged part but the preservation of general health and well being. This central tenet of the discipline has been supported by four critical columns of knowledge, each of which has amplified over the passage of time. Initially anatomy was the cornerstone of surgical intervention and mastery of surgery to a large part depended upon a secure grasp of the intricacies and relationships of corporeal macro structure. The second column comprised functional anatomy or physiology and the appreciation of organ activity enabled the subsequent delineation of malfunction during disease. Regardless of the level of sophistication that could be brought to bear upon the disease a requisite for most successful technical intervention was the management of pain and the prevention of sepsis. As the quincunx of surgery embraces a new century it must continue to evolve to maintain the balance of growth in the four supporting columns. Thus anatomy has been expanded into subcellular structure and the elucidation of function has amplified into the role of individual organelles. Similarly pathology has moved beyond the organ and cell into the genome and deletion may be conceived of in terms of codons and sequences rather than colons and spleens. Indeed it is feasible that antisense strategies may become more sensible than antibiotics. Manual and digital techniques will be supplanted by robotic intervention and visualization will move beyond the visible into the non-visible world of spectroscopy. Millimetric dexterity will need to become nanometric and the mantra must become molecular and intervention directed not only at adults or neonates but the fetus. In order to achieve such goals teaching and training strategies need dramatic revision to produce individuals capable of transforming from tactile to telemetric skills and from gentle technique to genomic intervention.

Adult↗

PubMed2000

[Surgery using master-slave manipulators and telementoring].

Master-slave manipulators enhance surgeons' dexterity and improve the precision of surgical techniques by filtering out surgeons' tremors and scaling the movements of surgical instruments. Among clinically available master-slave manipulators, the epoch-making system called "da Vinci" developed by Intuitive Surgical Inc. (Mountain View, CA, USA), equipped with 2 articulated joints at the tip of the surgical instruments allowing 7 degrees of freedom, mimics the movements of surgeons' wrists and fingers in the abdominal or thoracic cavity. Today advanced telecommunications technology provides us excellent motion images using only 3-ISDN telephone lines. Experienced surgeons at primary surgical sites have been able to perform complex procedures successfully by consulting specialists at remote sites. Because telecommunications costs have become lower each year, telementoring will be come a routine surgical practice in the near future. The usefulness of surgical telementoring has been greatly enhanced by the development of a technique to illustrate on video images from two directions. Moreover, remote advisory surgeons will be able to provide the optimal operative field to operating surgeons using robotic camera holders with voice-recognition systems. In the near future, when master-slave manipulators will also be coupled with telementoring systems, remote experts could actually perform complex surgical procedures.

Humans↗

PubMed2000

Human nervous system function emulator.

This paper describes a modular, extensible, open-systems design for a multiprocessor network which emulates the major functions of the human nervous system. Interchangeable hardware/software components, a socketed software bus with plug-and-play capability and self diagnostics are included. The computer hardware is based on IEEE P996.1 bus cards. Its operating system utilizes IEEE 1275 standard software. Object oriented design techniques and programming are featured. A machine-independent high level script-based command language was created for this project. Neural anatomical structures which were emulated include the cortex, brainstem, cerebellum, spinal cord, autonomic and peripheral nervous systems. Motor, sensory, autoregulatory, and higher cognitive artificial intelligence, behavioral and emotional functions are provided. The author discusses how he has interfaced this emulator to machine vision, speech recognition/speech synthesis, an artificial neural network and a dexterous hand to form an android robotic platform.

Artificial Intelligence↗

PubMed1999

Accuracy of leveling hemodynamic transducer systems.

Critically ill patients frequently have invasive catheters placed to monitor hemodynamic pressures and to calculate hemodynamic indices. Correct leveling to the appropriate anatomical structure is critical as the pressure readings guide management of fluids, drug administration, and other interventions. The authors of this study investigated the accuracy with which registered nurses and respiratory technologists were able to level hemodynamic transducers to the phlebostatic axis using visual checks, a carpenter's level, and a laser leveling device. The results indicate that both groups were unable to accurately level transducers with visual checks alone. Use of a leveling tool improved accuracy. The laser level was superior for accuracy and speed and preferred for dexterity required, ease of use and patient safety. The data supports the need for a tool to accurately level hemodynamic transducer systems and suggests that the laser leveling device is the tool of choice.

Analysis of Variance↗

PubMed2000

Hand-assisted laparoscopy for megamyomectomy. A case report.

BACKGROUND: In cases of uterine myomas of massive size, minimally invasive laparoscopic or laparoscopically assisted myomectomy techniques are not feasible alternatives to traditional laparotomy. This report introduces the use of hand-assisted laparoscopy, a novel approach that permits the insertion of the hand into the abdomen through a glove-sized incision while preserving the pneumoperitoneum, as an alternative to laparotomy for patients with massive myomas unsuitable for conventional laparoscopic myomectomy. CASE: A 28-year-old nullipara requested minimally invasive myomectomy and fertility preservation for the treatment of a massively enlarged uterus reaching the level of the liver. Myomectomy was safely performed by hand-assisted laparoscopy using the Pneumo Sleeve System (Dexterity, Blue Bell, Pennsylvania), a 7.5-cm transverse suprapubic incision and a 1-cm umbilical laparoscopic incision. Surgery lasted 120 minutes, and the estimated blood loss was 250 mL. The total weight of the myomas was 3,120 g. The patient was discharged on the second postoperative day and had an uneventful recovery. CONCLUSION: The successful outcome of this initial case suggests that hand-assisted laparoscopic myomectomy is a feasible and safe minimal-access option that could effectively replace routine laparotomy in patients with massive uterine enlargement.

Adult↗

PubMed2000

[A 67-year-old man with progressive disturbance of gait].

We report a 67-year-old man with progressive disturbance of gait. He was well until the spring of 1993 (62 years of the age), when he noted an onset of unsteady gait. He also noted that he started to have a difficulty in playing tennis, in which he became unable to hit the ball with his racket. He also noted parkinsonian features such as bradykinesia and loss of hand dexterity. He was treated with levodopa, which did not improve his symptoms. His MRI revealed marked atrophy of the cerebellum and the pons. The criss-cross high signal lesion was seen in the center of the pons. The third ventricle was dilated. The putamen was unremarkable. His subsequent course was complicated by easy to fall, difficulty in swallowing with episodes of aspiration pneumonia. He also developed nocturnal apneustic episodes. He was admitted to our hospital on November 15, 1998, when he was 67 years of the age. He had low grade fever and low blood pressure (98/70). He was anemic but not icteric. Tumors were palpated in his jaw, anterior chest, and in the left arm. He was alert but unable to convey his desire because of dyspnea and tracheostomy. His gaze was slightly restricted in the horizontal direction and markedly so in the vertical direction. Motor functions were difficult to evaluate. His clinical course was complicated by atelectasis of the right lung and pleural effusion. He developed marked edema and oliguria. He developed sudden bradycardia and expired on December 26, 1998. He was discussed in a neurological CPC and the chief discussant arrived at the conclusion that the patient had multiple system atrophy. Majority of the audience agreed with this diagnosis. Post-mortem examination revealed a lung cancer in the right lung (undifferentiated adenocarcinoma) with metastases to the liver, kidneys, lymph nodes, pericardium, pleura, skin, bone marrow, and the brain. Neuropathologic examination revealed marked atrophy of the pons and the cerebellum. The putamen showed brownish discoloration and atrophic changes. The substantia nigra showed marked neuronal loss and gliosis. Oligodendrocytic inclusion bodies (alpha-synuclein positive) were seen in the putamen, globus pallidus, substantia nigra, pontine nucleus, cerebellar white matter, internal capsule, cerebral peduncle, and the spinal cord. These findings are consistent with the pathologic diagnosis of multiple system atrophy. What was interesting to us was the presence of neurofibrillary tangles in the substantia nigra, nucleus ruber, globus pallidus, and subthalamic nucleus. Tuft-shaped astrocytes were also seen. This patient appears to be a rare example of combination of MSA and PSP.

Adenocarcinoma↗