Articles: surgery.
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Case Reports
Image-guided transsacral approach to presacral lesions of nerve root origin: technical note.
The utility of image guidance in fashioning a posterior transsacral operative corridor for approaching small presacral neural lesions has not previously been reported. ⋯ An image-guided transsacral approach is a viable option for accessing small to moderately sized lesions of nerve root origin located within the presacral space.
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J. Oral Maxillofac. Surg. · Oct 2005
Safety of intravenous sedation administered by the operating oral surgeon: the first 7 years of office practice.
Outpatient intravenous sedation by properly trained personnel provides a safe, cost-effective means of anesthesia for numerous surgical procedures. The goal of this study was to provide a 7-year summary (December 1994 through November 2001) of anesthesia-related problems that occurred in the practice of a single Midwestern board-certified oral and maxillofacial surgeon. ⋯ The administration of intravenous sedation by the operating surgeon for outpatient oral surgery procedures is safe and results in a low incidence of adverse events. In this series, a number of previously undiagnosed medical problems were discovered. The diagnosis and referral for management of these medical problems improved patient health.
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Within the framework of the collaborative research centre "Information Technology in Medicine--Computer and Sensor-Aided Surgery" (SFB414) new methods for intraoperative computer assistance of surgical procedures are being developed. The developed tools will be controlled by an intraoperative host which provides interfaces to the electronic health record (EHR) and intraoperative computer assisted instruments. ⋯ Intraoperative systems currently under development are intraoperative augmented reality (AR) using a projector and via a microscope, a planning system for definition of complex trajectories and a surgical robot system. The developed systems are under clinical evaluation and showing promising results in their application.
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Intracerebral haemorrhage (ICH) is much less common than ischaemic stroke (15% versus 85% in most Western studies), but is associated with a significantly worse prognosis. ICH is much more common in Asian populations, probably reflecting higher rates of small vessel disease, hypertension and genetic factors. Overall, ICH mortality rates approach 50% and there has been little effective treatment to date, except for the overall benefit from stroke unit care. ⋯ Medical therapies to reduce brain edema and intracranial pressure, including glycerol and mannitol, are not of proven value. It is accepted that corticosteroids should not be used in ICH and may worsen outcomes. The management of acute hypertension is controversial and guidelines are based on little direct evidence.
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Therapeutic hypothermia is a potentially dangerous treatment with a very narrow therapeutic index. It is of proven benefit in certain conditions, including post ventricular fibrillation cardiac arrest and intermediate severity neonatal asphyxia. ⋯ While it is clear that hypothermia decreases intracranial pressure, a major phase III trial demonstrated no improvement in neurological outcomes with hypothermia, in an unselected group of patient with severe head injury. More focused phase III trials are underway but until the results are known this treatment should not be offered to patients outside the context of a clinical trial.