Articles: surgery.
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We tried to evaluate the clinical outcomes (mortality, postoperative bleeding and perioperative myocardial infarction) of patients who underwent first elective coronary artery bypass grafting and received aspirin during the preoperative period. ⋯ Preoperative aspirin administration increased postoperative bleeding and red blood cell requirements with no effect on mortality, re-exploration rate and perioperative myocardial infarction. We recommend withdrawal of aspirin seven days prior to surgery. (Cardiol J 2007; 14: 453-457).
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Laparoscopic radiofrequency ablation (RFA) is a safe and effective method for tumor destruction in patients with unresectable liver tumors. However, accurate probe placement using laparoscopic ultrasound guidance is required to achieve complete tumor ablation. After evaluation of an ultrasound navigation system for transcutaneous and open RFA, we now intend to transfer this technique to laparoscopic liver surgery. This study aimed to evaluate an electromagnetic navigation system for laparoscopic interventions using a perfusable ex vivo artificial tumor model. ⋯ Laparoscopic RFA requires advanced laparoscopic ultrasound skills for accurate placement of the RFA probe. The use of an ultrasound-based, laparoscopic online navigation system offers the possibility of out-of-plane needle placement and could increase the safety and accuracy of punctures. The perfused artificial tumor model presented a realistic model for the evaluation of this new technique.
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The objective of our work has been to investigate the use of ultrasound image-guided high-intensity focused ultrasound (HIFU) to non-invasively produce conduction block in rabbit sciatic nerves in vivo, a technique that could become a treatment of spasticity and pain. The work reported here involved the investigation of the duration of such conduction blocks after HIFU treatment and whether they resulted in axon degeneration. The right sciatic nerves of 12 rabbits were treated, under guidance of ultrasound imaging, with repeated 5-s applications of 3.2 MHz HIFU with in situ intensity of 1930 W/cm(2) (spatial-average, temporal-average) until conduction block was achieved. ⋯ The volume of necrosis of adjacent muscle was measured to be 1.59+/-1.1 cm(3) (mean+/-SD). For all nerves, conduction block remained at the survival endpoint and the block resulted in degeneration of axons distal to the HIFU site, as confirmed by electrophysiological and histological methods. Potential clinical applications include treatment of spasticity in patients with spinal cord injury or pain in cancer patients.
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Ultrasound Med Biol · Jan 2007
Image-guided acoustic hemostasis for hemorrhage in the posterior liver.
We investigated the use of ultrasound image-guided high intensity focused ultrasound (HIFU) to stop bleeding from injuries in the posterior liver. A HIFU transducer with focal length of 3.5 cm and frequency of 3.2 MHz was integrated with an intraoperative high-resolution ultrasound-imaging probe. Wedge tissue extractions, 30-mm long, 5-mm wide and 8-mm deep, were made in the posterior liver surface of five pigs to induce bleeding. ⋯ Hemostasis was achieved in 66 +/- 18 s (mean +/- standard deviation) for 17 HIFU treatments. During 7 min of sham HIFU treatment, none of the control incisions (n = 7) became hemostatic. Ultrasound image-guided HIFU offers a promising method for hemostasis in surgical settings in which the hemorrhage site is hidden and/or not accessible.
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Anesteziol Reanimatol · Jan 2007
[Modern inhalational anesthesia in pediatric maxillofacial surgery].
The paper deals with the use of sevoflurane and isoflurane in elective pediatric maxillofacial surgery. Having outlined the major features of anesthesia in this category of patients, the authors emphasize the application of the conception of the minimum alveolar concentration (MAC) and its derivatives (MAC bar and MAC awake) reflecting the analgesic and hypnotic power of an inhalational anesthetic, respectively, and theoretically substantiate the use of certain anesthetic concentrations at particular stages of surgery. The technique described in the paper was used in 82 patients aged 1.5 months to 18 years, undergoing cleft lip and cleft palate repair, residual lip and nose deformation repair, and other elective maxillofacial procedures. ⋯ Hemodynamics was characterized by moderate controlled hypotension with an average decrease in mean blood pressure by 30% of the age-related value. Emergence occurred 5-15 min after an anesthetic was discontinued. By and large, the technique demonstrated its efficiency and safety in this group of patients.