Articles: surgery.
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Review
Plasma transfusion for bedside, radiologically guided, and operating room invasive procedures.
Frozen plasma (FP) is commonly used in an attempt to correct coagulation defects before performing bedside, radiologically guided, or operating room procedures. Use of FP prophylactically is closely linked to results for standard coagulation tests in the laboratory, including prothrombin time, but there is a general lack of evidence supporting the predictive value of abnormalities of these tests for bleeding. Use of FP has little effect on correcting abnormal coagulation tests when mild and moderate results are recorded. ⋯ When the lack of clinical effectiveness is combined with the risks of FP transfusion, such as transfusion-related acute lung injury and transfusion-associated circulatory overload, the need to challenge continued preprocedure prophylactic use of FP becomes pressing. In clinical practice, abnormalities of standard coagulation tests should not be interpreted in isolation, but alongside review of clinical bleeding history and other hemostatic markers such as platelet count. A more appropriate transfusion strategy may be one that emphasizes the therapeutic use of FP.
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J. Thorac. Cardiovasc. Surg. · May 2012
Multivessel beating heart robotic myocardial revascularization increases morbidity and mortality.
The vast majority of reports describing beating heart robotic myocardial revascularization (total endoscopic coronary artery bypass) contain very small numbers of patients undergoing single-vessel bypass. We present a large series of patients undergoing multivessel total endoscopic coronary artery bypass. ⋯ Our results suggest that addressing multivessel coronary artery disease using total endoscopic coronary artery bypass offers no obvious clinical benefits and might increase the morbidity and mortality.
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Int J Comput Assist Radiol Surg · May 2012
Comparative StudyVolume slicing of cone-beam computed tomography images for navigation of percutaneous scaphoid fixation.
Percutaneous scaphoid fixation (PSF) is growing in popularity as a treatment option for non-displaced fractures. Success of this procedure demands high-precision screw placement, which can be difficult to achieve with standard 2D imaging. This study aimed to develop and test a system for computer-assisted navigation using volume slicing of 3D cone-beam computed tomography (CBCT). ⋯ Volume-sliced navigation achieved a more repeatable and reliable central pin placement, with fewer drilling attempts than conventional 2D techniques. Volume-sliced navigation had a higher number of drill paths within the optimal zone maximizing both length of the path and depth from the surface.
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SUMMARY Spinal cord stimulation has been in clinical use for the treatment of chronic pain for over four decades. Since the initial use by Norman Shealy, the indications for its use have increased steadily over the decades to include neuropathic pain owing to failed back surgery syndrome, complex regional pain syndrome and painful diabetic peripheral neuropathies. To date, the precise mechanism of action of spinal cord stimulation remains unclear, yet it is still one of the most expensive interventional treatment modalities available in pain medicine with increasing application across the world. ⋯ Systems-based process analysis is not widely utilized in pain medicine, and there is a limited body of evidence for its application. The purpose of this article is to generate interest in the discipline of process analysis in pain medicine, as it has found value in other healthcare settings and industries. We mention the applicability across countries and specialties that we hope will increase the awareness of this concept and possibly generate interest in further examination by investigators that will lead to the development of highly efficient and effective healthcare delivery processes and systems across the globe.
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What's known on the subject? And what does the study add? We have previously shown that percutaneous radiofrequency ablation guided by image-fusion technology allows for precise needle placement with real time ultrasound superimposed with pre-loaded imaging, removing the need for real-time CT or MR guidance. Emerging technology also allows real-time tracking of a treatment needle within an organ in a virtually created 3D format. To our knowledge, this is the first study utilising a sophisticated ultrasound-based navigation system that uses both image-fusion and real-time probe-tracking technologies for in-vivo renal ablative intervention. ⋯ • Percutaneous renal RFA guided exclusively by real-time 2D US with multiplanar Global Positioning System-like probe tracking is feasible and accurate. • Near-future technologies, including elastic fusion overlay and anticipation of soft-tissue deformation, will further augment this guidance system.