Articles: surgery.
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Technol Health Care · Jan 2012
Ultrasound-based computer navigation: an accurate measurement tool for determining combined anteversion?
The present feasibility study examined the use of an ultrasound-based navigation system (UNS) for reliability of measurement the positions of both the femoral and acetabular components, a prerequisite to adjust the combined anteversion with sufficient accuracy when using a femur-first approach in total hip arthroplasty. ⋯ Our investigations suggest that the anteversion of stem and cup can be measured with accuracy sufficient enough to utilize the concept of combined anteversion using UNS. Hence, the advantage of utilizing UNS's in a femur-first approach is the ability to intraoperatively compensate for deviations from the targeted anteversion of the stem (which is often difficult to control) by adjusting the acetabular anteversion in the final step of the implantation. In doing so, the placement of the components follows the concept of combined anteversion. Avoiding extreme anteversion values of combined anteversion could be an important step towards reducing post-operative complications following total hip arthroplasty (THA).
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Comput Methods Biomech Biomed Engin · Jan 2012
Comparative StudyDeployment of self-expandable stents in aneurysmatic cerebral vessels: comparison of different computational approaches for interventional planning.
In the last few years, there has been a growing focus on faster computational methods to support clinicians in planning stenting procedures. This study investigates the possibility of introducing computational approximations in modelling stent deployment in aneurysmatic cerebral vessels to achieve simulations compatible with the constraints of real clinical workflows. The release of a self-expandable stent in a simplified aneurysmatic vessel was modelled in four different initial positions. ⋯ Comparing accuracy of the results, the final configuration of the stent is more affected by neglecting mechanical properties of materials (FVS) than by adopting 1D instead of 3D stent models. Nevertheless, the differences showed are acceptable compared to those achieved by considering different stent initial positions. Regarding computational costs, simulations involving 1D stent features are the only ones feasible in clinical context.
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Efficacy and safety of radiofrequency (RF) ablation in patients with atrial fibrillation (AF) strongly depend on the possibility of three-dimensional (3D) visualisation of atria as well as the ostia of pulmonary veins. Current angiographic systems allow 3D visualisation of anatomical heart structures using rotational angiography. ⋯ We conclude that 3D-ATG after contrast agent administration into the right atrium seems to be a safe and effective method to visualise pulmonary venous ostia and left atrial anatomy. It remains to be established whether it enables evaluation of anatomical anomalies.
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Burn pain is recognized as being maximal during therapeutic procedures, and wound debridement can be more painful than the burn injury itself. Uncontrolled acute burn pain increases the stress response and the incidence of chronic pain and associated depression. Although opiates are excellent analgesics, they do not effectively prevent central sensitization to pain. The anticonvulsant gabapentin has been proven effective for treating neuropathic pain in large placebo-controlled clinical trials. Experimental and clinical studies have demonstrated antihyperalgesic effects in models with central neuronal sensitization. It has been suggested that central neuronal sensitization may play an important role in postoperative pain. ⋯ A single oral dose of 1200mg gabapentin resulted in a substantial reduction in postoperative morphine consumption and pain scores after surgical debridement in burn patients.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2012
Thoracoscopic mediastinal lymph node dissection for lung cancer.
Mediastinal lymph node staging is an important component of the assessment and management of patients with operable non-small cell lung cancer and is necessary to achieve complete resection. During minimally invasive surgery, performance of an equivalent oncologic resection, including adequate lymph node dissection similar in extent to open thoracotomy, is absolutely necessary. ⋯ In our series, we removed about 25 lymph nodes per case in both complete VATS and R-VATS. A thorough lymph node dissection in lung cancer is possible with either VATS or R-VATS technique without oncological compromise.