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Operation Time (operation + time)
Kinds of Operation Time Selected AbstractsENDOSCOPIC SUBMUCOSAL DISSECTION FOR EARLY GASTRIC CANCER: TECHNICAL FEASIBILITY, OPERATION TIME AND COMPLICATIONS FROM A LARGE CONSECUTIVE SERIESDIGESTIVE ENDOSCOPY, Issue 1 2005Ichiro Oda Background:, Endoscopic mucosal resection (EMR) is a recognized treatment for early gastric cancer (EGC). One-piece resection is considered to be a gold standard of EMR, as it provides accurate histological assessment and reduces the risk of local recurrence. Endoscopic submucosal dissection (ESD) is a new technique developed to obtain one-piece resection even for large and ulcerative lesions. The present study aims to identify the technical feasibility, operation time and complications from a large consecutive series. Methods:, We reviewed all patients with EGC who underwent ESD using the IT knife at National Cancer Center Hospital in the period between January 2000 and December 2003. Results:, During the study period of 4 years we identified a total of 1033 EGC lesions in 945 consecutive patients who underwent ESD using the IT knife. We found a one-piece resection rate (OPRR) of 98% (1008/1033). Our OPRR with tumor-free margins was 93% (957/1033). On subgroup analysis it was found to be 86% (271/314) among large lesions (, 21 mm) and 89% (216/243) among ulcerative lesions. The overall non-evaluable resection rate was 1.8% (19/1033). The median operation time was 60 min (range; 10,540 min). Evidence of immediate bleeding was found in 7%. Delayed bleeding after ESD was seen in 6% and perforation in 4% of the cases. All cases with complications except one were successfully treated by endoscopic treatment. Conclusion:, The present study shows the technical feasibility of ESD, which provides one-piece resections even in large and ulcerative EGC. [source] Histologic survey of neuroblastomas after intensive induction chemotherapy,PEDIATRIC BLOOD & CANCER, Issue 5 2005Yoshiaki Tsuchida MD Abstract Background Histology after intensive induction chemotherapy is expected to become a beacon indicating when and how extensively radical surgery and lymph node dissection should be performed in advanced neuroblastoma. A thorough histologic review of surgical specimens was undertaken. Procedure All specimens from 34 patients who were pretreated intensively (,3 cycles) with recent chemotherapy were reviewed. Thirty patients were >12 months of age with stage 3/4 disease, and 4 were <12 months of age but with MYCN -amplified stage 4 diseases. After 3 to 7 cycles (mean, 4.3 cycles) of induction chemotherapy, patients underwent radical surgery of the primary tumor and lymph nodes in all retroperitoneal sections. A single pathologist reviewed all of the specimens, and histologic chemotherapeutic effects were graded as: (+++), <1% viable tumor; (++), 1%,10% viable tumor; (+), 11%,50% viable tumor; (±), 51%,90% viable tumor; and (,), >91% viable tumor. Results Grade (+++) effects were observed in 56% of patients treated with the new regimens, whereas grade (+++) was seen in only 20% treated with regimens before 1991. Operation time and blood loss were 7 hr and 6 min (P,=,0.087) and 646 ml (P,=,0.064), respectively, in patients with >5 cycles (mean, 5.3 cycles) of chemotherapy, while they were 7 hr and 50 min and 1,168 ml, respectively, in those with approximately 3 cycles (mean, 3.2 cycles). Histologically, metastases were found in the contralateral nodes beyond the aorta in 92% of those whose tumor originated on the left, and in 80% of those with tumors occurring on the right. Conclusions Five cycles of induction chemotherapy did not improve histologic chemotherapeutic effects, but helped to facilitate a shorter operation time and less blood loss than 3 cycles of chemotherapy. Surgery after 5 cycles of 98A3 also appears to be easier to perform than that after 3 cycles of A1/new A1. Only 14% of the children treated before 1985 with the St. Jude protocols experienced grade (+++) chemotherapeutic effects, and 22% of the patients treated before 1991 with regimen A1, or new A1 of the Study Group of Japan showed grade (+++) effects, whereas 56% of the patients treated after 1991 with either regimen A3 or 98A3 exhibited grade (+++) chemotherapeutic effects. Histologic chemotherapeutic effects were roughly parallel with a good prognosis. Pediatr Blood Cancer © 2005 Wiley-Liss, Inc. [source] Randomised controlled trial of LigaSure versus conventional suture ligature for abdominal hysterectomyBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 7 2005Bjørn Hagen Objective To compare the use of LigaSure with conventional suture ligature in abdominal hysterectomy. Design Pilot randomised controlled unblinded trial with block randomisation according to three operating surgeons. Setting One Norwegian teaching hospital, Department of Gynaecology and Obstetrics. Sample Thirty women who underwent total or subtotal abdominal hysterectomy. Methods Data, with regard to operation time expenditure and the occurrence of peri- and post-operative complications, were collected and compared between the two techniques. Main outcome measures Operation time, peri- and post-operative complications. Results Mean operation duration was 61.7 minutes with LigaSure and 54.5 minutes with conventional suture ligature. The corresponding operative blood loss was 303 and 298 mL, respectively. Occurrence of complications was few and not significantly different between the two techniques. Mean hospital stay was longer following LigaSure operations (10 vs 6 days), probably due to a certain age imbalance between the study groups. Conclusions Within the limitation of this pilot study, we did not uncover a time sparing effect from the use of LigaSure or any difference in the occurrence of blood loss and complications. [source] Job completion prediction using case-based reasoning for Grid computing environmentsCONCURRENCY AND COMPUTATION: PRACTICE & EXPERIENCE, Issue 9 2007Lilian Noronha Nassif Abstract One of the main focuses of Grid computing is solving resource-sharing problems in multi-institutional virtual organizations. In such heterogeneous and distributed environments, selecting the best resource to run a job is a complex task. The solutions currently employed still present numerous challenges and one of them is how to let users know when a job will finish. Consequently, reserve in advance remains unavailable. This article presents a new approach, which makes predictions for job execution time in Grid by applying the case-based reasoning paradigm. The work includes the development of a new case retrieval algorithm involving relevance sequence and similarity degree calculations. The prediction model is part of a multi-agent system that selects the best resource of a computational Grid to run a job. Agents representing candidate resources for job execution make predictions in a distributed and parallel manner. The technique presented here can be used in Grid environments at operation time to assist users with batch job submissions. Experimental results validate the prediction accuracy of the proposed mechanisms, and the performance of our case retrieval algorithm. Copyright © 2006 John Wiley & Sons, Ltd. [source] Clear Cell Acanthoma Successfully Treated with a Carbon Dioxide LaserDERMATOLOGIC SURGERY, Issue 10 2005Ching-Chi Chi MD Background. The treatment of choice for clear cell acanthoma (CCA) is excision. Resolution after cryotherapy has also been reported but requires three to four courses of treatment. Objective. To demonstrate three CCA lesions in two patients successfully treated with a carbon dioxide (CO2) laser. Methods. Under local anesthesia, these lesions were vaporized by using a CO2 laser in the Silktouch mode with a spot size of 5 mm and a fluence of 20 J/cm2. Two to six passes, as needed, were delivered until the tumor was completely removed. Results. Pain was minimal or nonexistent during and after the operation. No postoperative edema was noted. The wounds healed satisfactorily without scarring. No sign of recurrence was found following operation. Conclusion. The CO2 laser has the advantages of requiring only one course, precise tumor removal, a relatively bloodless surgical field, a short operation time, and less or no postoperative pain and edema. Postoperative wound care is convenient and easy with hydrocolloid and alginate dressings. The patient's quality of life is less adversely affected. The CO2 laser may be appropriate for multiple CCAs, giant CCA, CCA overlying or near joints, CCA refractory to cryotherapy, patients on anticoagulants, and those who cannot tolerate pain from cryotherapy, especially children and the elderly. [source] ENDOSCOPIC SUBMUCOSAL DISSECTION FOR EARLY GASTRIC CANCER: TECHNICAL FEASIBILITY, OPERATION TIME AND COMPLICATIONS FROM A LARGE CONSECUTIVE SERIESDIGESTIVE ENDOSCOPY, Issue 1 2005Ichiro Oda Background:, Endoscopic mucosal resection (EMR) is a recognized treatment for early gastric cancer (EGC). One-piece resection is considered to be a gold standard of EMR, as it provides accurate histological assessment and reduces the risk of local recurrence. Endoscopic submucosal dissection (ESD) is a new technique developed to obtain one-piece resection even for large and ulcerative lesions. The present study aims to identify the technical feasibility, operation time and complications from a large consecutive series. Methods:, We reviewed all patients with EGC who underwent ESD using the IT knife at National Cancer Center Hospital in the period between January 2000 and December 2003. Results:, During the study period of 4 years we identified a total of 1033 EGC lesions in 945 consecutive patients who underwent ESD using the IT knife. We found a one-piece resection rate (OPRR) of 98% (1008/1033). Our OPRR with tumor-free margins was 93% (957/1033). On subgroup analysis it was found to be 86% (271/314) among large lesions (, 21 mm) and 89% (216/243) among ulcerative lesions. The overall non-evaluable resection rate was 1.8% (19/1033). The median operation time was 60 min (range; 10,540 min). Evidence of immediate bleeding was found in 7%. Delayed bleeding after ESD was seen in 6% and perforation in 4% of the cases. All cases with complications except one were successfully treated by endoscopic treatment. Conclusion:, The present study shows the technical feasibility of ESD, which provides one-piece resections even in large and ulcerative EGC. [source] An intelligent logistics support system for enhancing the airfreight forwarding businessEXPERT SYSTEMS, Issue 5 2004H.C.W. Lau Abstract: Recent research related to the aircraft container loading and scheduling problem for airfreight forwarding business has seen significant advances in terms of load plan optimization, taking into account the cost and volume of packed boxes. In today's competitive industrial environment, it is essential that freight forwarders are able to collaborate with carriers (airline companies) to achieve the best possible selection of logistics workflow. However, study of contemporary research publications indicates that there is a dearth of articles related to the design and implementation of an intelligent logistics system to support decision-making on carrier selection, aircraft container loading plans as well as carrier benchmarking. This paper presents an intelligent logistics support system (ILSS) which is able to provide expert advice related to the airfreight forwarding business, enhancing the logistics operations in relevant activities within the value chain of tasks. ILSS comprises a heuristics-based intelligent expert system which supports carrier searching and cargo trading planning as well as load plan generation. The proposed approach is meant to enhance various operations in the airfreight forwarding business, adopting computational intelligence technologies such as rule-based reasoning to provide domain advice and heuristics to support the generation of load plans. After potential outcomes are generated by the heuristics-based intelligent expert system, a neural network engine is applied to support prediction of unexpected events. To validate the viability of this approach, a production system using the ILSS has been developed and subsequently applied in an emulated airfreight forwarding environment. The application results indicate that the operation time from searching for potential carriers to the execution of the order is greatly reduced. In this paper, details related to the structure, design and implementation of the ILSS are also covered with the inclusion of the actual program codes for building the prototype. [source] Results of laparoscopic splenectomy for treatment of malignant conditionsHPB, Issue 4 2001E M Targarona Background Laparoscopic splenectomy (LS) is widely accepted for treatment of benign diseases, but there are few reports of its use in cases of haematological malignancy. In addition, comparative studies with open operation are lacking. Malignant haematological diseases have specific clinical features - notably splenomegaly and impaired general health - which can impact on the immediate outcome after LS. The immediate outcome of LS comparing benign with malignant diagnoses has been analysed in a prospective series of 137 operations. Patients and methods Between February 1993 and April 2000, 137 patients with a wide range of splenic disorders received LS. Clinical data and immediate outcome were prospectively recorded, and age, diagnosis, operation time, perioperative transfusion requirement, spleen weight, conversion rate, accessory incision, hospital stay and complications were analysed. Results The series included 100 benign cases and 37 suspected malignancies. In patients with malignant diseases the mean age was greater (37 years [3,85] vs 60 years [27,82], p <0.01), LS took longer (138 min [60,400] vs 161 min [75,300], p <0.05) and an accessory incision for spleen retrieval was required more frequently (18% vs 93%, p <0.01) because the spleen was larger (279 g [60,1640] vs 1210 g [248,3100], p <0.01). However, the rate of conversion to open operation (5% vs 14%), postoperative morbidity rate (13% vs 22%) and transfusion requirement (15% vs 26%) did not differ between benign and malignant cases. Hospital stay was longer in malignant cases (3.7 days [2,14] vs 5 days [2,14], p <0.05). Conclusion LS is a safe procedure in patients with malignant disease requiring splenectomy in spite of the longer operative time and the higher conversion rate. [source] Intentional replantation of an immature permanent lower incisor because of a refractory peri-apical lesion: case report and 5-year follow-upINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 3 2004S. Shintani Summary., We performed an intentional replantation of an immature lower incisor that had a refractory peri-apical lesion. The incisor was extracted and the peri-apical lesion was removed by curettage. The root canal of the tooth was then rapidly irrigated, and filled with a calcium hydroxide and iodoform paste (Vitapex®), after which the tooth was fixed with an arch wire splint. Five years later, no clinical or radiographic abnormalities were found, and the root apex was obturated by an apical bridge formation. A team of two dentists is essential to prevent a prolonged operation time, thus eliminating any of the causes of ankylosis. Furthermore, calcium hydroxide and iodoform paste, along with an arch wire splint retained with composite resin, led to good healing of the periodontal tissue after the intentional replantation. Our results indicate that intentional replantation is a useful method for an immature tooth with refractory peri-apical problems. [source] Clinical outcomes and learning curve of a laparoscopic adrenalectomy in 103 consecutive cases at a single instituteINTERNATIONAL JOURNAL OF UROLOGY, Issue 6 2006MASATOSHI ETO Objective:, We examined the clinical outcomes and the learning curve for a laparoscopic adrenalectomy (LA) in 103 consecutive cases performed by three surgeons at our institute, according to the type of adrenal disorder. Patients and Methods:, One hundred and three patients with adrenal tumors, including 38 cases of primary aldosteronism, 33 cases of Cushing syndrome (including preclinical Cushing syndrome), 15 cases of pheochromocytoma, and nine cases of non-functioning adenoma were evaluated, while focusing on the approaches, intraoperative and postoperative data, and the learning curve of LA, according the type of adrenal disorder. Results:, There was no significant difference in the operation time, estimated blood loss, incidence of conversion to open surgery and blood transfusion, or postoperative recovery among the patients treated by LA for aldosteronoma, Cushing adenoma, pheochromocytoma, and non-functioning adenoma. In the cases of aldosteronoma and Cushing adenoma, the learning curve for the operation time and blood loss in each operator tended to decrease as the number of operations increased. On the other hand, in the cases treated by LA for pheochromocytoma, no trends in either the operation time or blood loss were observed. However, there has been neither any conversion to open surgery nor blood transfusion in cases treated by LA since 1998 (our 42nd case), even after the changes in the operators. Conclusions:, Our results clearly indicate that LA is becoming safer than before, probably due to improvements in the technique, education, and training of surgeons, in addition to the increased number of cases now treated by LA. [source] Retroperitoneoscopic heminephroureterectomy for children with duplex anomaly: Initial experienceINTERNATIONAL JOURNAL OF UROLOGY, Issue 1 2004AKIHIRO KAWAUCHI Abstract Objectives:, To evaluate the feasibility of retroperitoneoscopic heminephroureterectomy for children with duplex anomaly. Methods:, Retroperitoneoscopic heminephroureterectomy was performed in five children (four girls and one boy) with complete duplication of the ureter, of whom four (age range 1,5 years; mean age 3.3 years) had upper pole ectopic megaureters and one (3 years old) had an upper pole megaureter with ureterocele. In the patient with ureterocele, distal ureterectomy and ureterocelectomy were performed by Pfannenstiel incision. Results:, The mean operation time was 346 min (range 270,450 min) in the four patients with ectopic megaureter and 420 min (330 min for heminephroureterectomy) in the patient with ureterocele. The mean estimated blood loss was 43 mL (range 5,100 mL) in the four patients with ectopic megaureter and 40 mL in the patient with ureterocele. No postoperative complications were observed. Postoperative intravenous pyelography showed normal pyelogram and renal function of the preserved lower pole in all cases. Conclusions:, Retroperitoneoscopic heminephroureterectomy for children is feasible, safe and has good postoperative results, including cosmetic results. However, the operation time needs to be reduced. [source] Evaluation of preoperative sonography in acute cholecystitis to predict technical difficulties during laparoscopic cholecystectomyJOURNAL OF CLINICAL ULTRASOUND, Issue 3 2004Kyung Soo Cho MD Abstract Purpose The aim of this study was to evaluate the role of preoperative sonography in predicting technical difficulties during laparoscopic cholecystectomy in patients with acute cholecystitis. Methods Sonographic assessment of 14 parameters was performed in 55 patients during a 9-month period: volume of gallbladder (GB), thickness of GB wall, pattern of GB wall thickening, size of largest gallstone, gallstone mobility, adhesion of GB to its bed, fat plane between GB and hepatoduodenal ligament, free fluid in GB fossa, common bile duct (CBD) dilatation, CBD stone(s), color and power Doppler signals in GB wall, and increased color and power Doppler signals in adjacent liver. Each of the 5 operative steps of laparoscopic cholecystectomy was scored as being difficult (1) or not (0). The scores for each step were added to obtain the overall difficulty score (0,5). We evaluated prospectively whether there were significant associations among the preoperative sonographic findings and the overall difficulty score, scores for each of the 5 operative steps, and operation time. Results The overall difficulty score was significantly associated with a GB volume of 50 cm3 or more, GB wall thickness of 3 mm or more, and presence of color Doppler signals in the GB wall. Increased GB volume also made dissection of adhesions from the GB and dissection of Calot's triangle more difficult. Extraction of the GB from the abdomen was more difficult with a thickened GB wall or adhesion of the GB to its bed. The presence of a CBD stone, dilatation of the CBD (, 8 mm), color Doppler signals in the GB wall, and increased power Doppler signals in the adjacent liver were significantly associated with increased operation time. Conclusions Based on our experience, preoperative determination of GB volume, GB wall thickness, and presence of color Doppler signals in the GB wall in patients with acute cholecystitis helps predict technical difficulties during laparoscopic cholecystectomy. © 2004 Wiley Periodicals, Inc. J Clin Ultrasound 32:115,122, 2004 [source] Increased heart rate variability correlation between mother and child immediately pre-operationACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2009Y.-C. P. ARAI Background: Maternal distress would correlate with the children's mental status, thereby influencing the activity of the autonomic nervous system (ANS) of the children and mothers. We hypothesized that pre-anesthetic maternal ANS activity, when approaching close to their children's operation time, would correlate with children's ANS activity, and that the values of heart rate variability (HRV) would correlate. Methods: We calculated maternal and children's HRVs and analyzed the relationship between the two. A total of 24 pairs of mother and child were analyzed. Maternal and children's HRVs were recorded from the night before the child's surgery to the arrival to the operation room. Results: The ratios of low-frequency components (LF) to high-frequency components (HF) (LF/HF ratio) of children's and maternal HRVs obtained during the immediate pre-operative period (06:00,08:00 hours) showed a significantly, positive correlation, but no correlation was found for the LF/HF ratios obtained during the pre-operative night. Conclusion: The LF/HF ratios of HRV immediately before surgery in children and mothers showed a significant positive correlation. [source] ROLE OF SATURATED FATTY ACIDS IN LIPASE PRODUCTION , USING PSEUDOMONAS AERUGINOSAJOURNAL OF FOOD BIOCHEMISTRY, Issue 6 2007A.N. SARAVANAN ABSTRACT Complex substrates always induce substantial amount of enzyme production during hydrolysis by microorganisms. In this study, ghee was taken for its saturated fatty acid content and analyzed as an inducer for the production of lipase. With ghee emulsion, the bacterium Pseudomonas aeruginosa at optimal condition produced 60 units/min/L at 72 h. With olive oil emulsion, this organism produced only 41 units/min/L as maximum at 96 h. The saturated fatty acids present in ghee make it a hard substance for hydrolysis, which is the reason for the increased enzyme production. This was evaluated by the iodine number experiment. Ghee can also reduce the production cost whereas the costlier olive oil constitutes 25,50% of the total production cost for a commercial scale. The experimental results showed that the saturated fatty acids play an important role in lipase enzyme induction by P. aeruginosa. The use of ghee is cost-effective; hence, it can be used as a potential inducer for lipase production. PRACTICAL APPLICATIONS Lipases are industrially very important enzymes. They are used in pharmaceutical, food, soap and other industries. In lipase production, olive oil is the main constituent. Comparatively, olive oil is costlier; hence, it increases the production cost of lipase. So, this study was done to replace olive oil with a much cheaper ghee using Pseudomonas aeruginosa. The ghee-containing medium gave a very good result because of the presence of complex saturated fatty acids. The ghee-containing medium produced 60 units/min/L at 72 h. The olive oil medium, which contains mainly unsaturated fatty acids, produced only 41 units/min/L as maximum at 96 h. Hence, in the commercial scale, ghee can reduce raw material cost as well as operation time cost significantly when it is used as substrate. [source] Effect of being overweight on postoperative morbidity and long-term surgical outcomes in proximal gastric carcinoma,JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 3 2009Sung Jin Oh Abstract Background and Aim:, The prevalence of being overweight has risen remarkably in Korea. This study sought to clarify the relationship between being overweight and surgical outcomes in gastric cancer patients. Methods:, A total of 410 patients who underwent curative total gastrectomies with D2 dissection from January 2000 to December 2003 were retrospectively studied from a prospectively designed database. The patients were assigned to two groups based upon their body mass index (BMI): non-overweight, BMI < 25 kg/m2; overweight, BMI , 25 kg/m2. Perioperative surgical outcomes, postoperative morbidity, mortality, recurrence, and prognosis were analyzed. Results:, The overweight group had longer operation time and more postoperative complications than the non-overweight group. The two groups were similar in terms of transfusion volumes, postoperative bowel movement, time to initiation of a soft diet, and postoperative hospital stay. Patterns of recurrence and cumulative survival rates were similar for each group. Multivariate analysis showed that being overweight was not a risk factor for recurrence or poor prognosis. Conclusion:, Although being overweight was associated with increased operation time and higher risk of complications in gastric cancer patients undergoing curative total gastrectomy, it had no effect on recurrence or long-term survival. [source] Comparison of the use of electrothermal bipolar vessel sealer with harmonic scalpel in total laparoscopic hysterectomyJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 3 2007Fazli Demirturk Abstract Aim:, The aim of the present study was to compare the use of electrothermal bipolar vessel sealer (EBVS) with harmonic scalpel (HS) during total laparoscopic hysterectomy with respect to operation time, estimated blood loss and related complications. Methods:, A retrospective study was conducted in the university hospital. Forty patients who underwent total laparoscopic hysterectomy and bilateral salpingo-oophorectomy were enrolled. Nineteen hysterectomies were performed with HS and in 21 patients the same surgeons used EBVS. Data about the characteristics of the patients, operation time, estimated blood loss, uterine weights, related complications and length of hospital stay were registered and compared. Results:, Mean procedure time and estimated blood loss were significantly less in the EBVS arm (59.57 ± 3.71 vs 90.95 ± 5.73 min, P < 0.001; 87.76 ± 25.48 vs 152.63 ± 60.90 mL; P < 0.001, respectively). The change in hemoglobin and hematocrit values was found to be more significant in the HS group. Conclusion:, EBVS was found to be less time-consuming and caused less bleeding when compared with HS. [source] Incidence of venous thromboembolism following major abdominal surgery: a multi-center, prospective epidemiological study in JapanJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 3 2006M. SAKON Summary.,Background:,Venous thromboembolism (VTE) has been considered to be a rare surgical complication in Japan. Aim:,To investigate the incidence and risk factors of VTE in Japanese patients undergoing major abdominal surgery. Methods:,A prospective, multi-center epidemiological study was conducted from December, 2001 to August 2002 in 39 medical institutes throughout Japan. A total of 173 patients with general (n = 128), gynecologic (n = 23), and urologic (n = 22) surgery were analyzed. For the diagnosis of deep vein thrombosis (DVT), bilateral venography was performed in all patients. Lung ventilation/perfusion scintigraphy was carried out in patients suspected of pulmonary thromboembolism (PTE). Results:,There were 36 patients with distal DVT (20.8%) and five patients with proximal DVT (2.9%). One patient was diagnosed as PTE. Overall, VTE was diagnosed in 42 patients (24.3%). By univariate analysis, only age (60 years or older) was identified as a significant risk factor in the whole study population. When analyzed by the stepwise multiple logistic regression model, female gender, operation site, age, and operation time were four risk factors found to be significant. The incidence of VTE was closely related to the number of risk factors that patients had. As many as 44% of patients with three or four risk factors developed VTE while those with one or two risk factors showed about a 17% incidence of VTE. Four patients lacking any risk factors did not develop VTE. Conclusions:,Venous thromboembolism is common in Japanese patients undergoing major abdominal surgery. Pharmacologic thromboprophylaxis is considered essential, particularly in those patients with multiple, potential risk factors. [source] Service conditions and their influence on oxide scale formation on metallic high temperature alloys for application in innovative combustion processesMATERIALS AND CORROSION/WERKSTOFFE UND KORROSION, Issue 2 2006G. Teneva-Kosseva Abstract The present paper focuses on two aspects: the service conditions of a flame tube in a low-NOx recirculation burner (maximum temperature experienced by the material: 1000 °C) and the interrelationship between service conditions and both the structure and growth of the oxide scale. The flame tube is exposed to extreme thermal and atmospheric conditions during service. Due to the short burner operation time followed by a pause, rapid changes of the temperature and gaseous environment occur. Three Ni-based alloys (alloy 602 CA, alloy 603 XL and alloy 693) were investigated in cyclic oxidation tests under typical conditions for the combustion of fuel oil. Flame tube temperature measurements in both the axial and the tangential directions are presented together with results concerning the influence of the fuel quality, duration of the air ventilation after burner shut down and temperature on the thickness and composition of the oxide scale. [source] A unified model incorporating yield, burn-in, and reliabilityNAVAL RESEARCH LOGISTICS: AN INTERNATIONAL JOURNAL, Issue 5 2004Kyungmee O. Kim Abstract The correlated improvement in yield and reliability has been observed in the case studies on integrated circuits and electronic assemblies. This paper presents a model that incorporates yield and reliability with the addition of a burn-in step to explain their correlated improvement. The proposed model includes as special cases several yield and reliability models that have been previously published and thus provides a unifying framework. The model is used to derive a condition for which yield functions can be multiplied to obtain the overall yield. Yield and reliability are compared as a function of operation time, and an analytical condition for burn-in to be effective is also obtained. Finally, Poisson and negative binomial defects models are further considered to investigate how reliability is based on yield. © 2004 Wiley Periodicals, Inc. Naval Research Logistics, 2004. [source] Predicting Short-Term Urinary Retention After Vaginal Prolapse Surgery,,NEUROUROLOGY AND URODYNAMICS, Issue 3 2009Robert A. Hakvoort Abstract Aims Identification of risk factors for urinary retention after vaginal prolapse surgery. Methods The medical records of 345 women undergoing surgical correction for symptomatic pelvic organ prolapse were analyzed. Independent risk factors for the development of post-operative urinary retention were identified by performing univariate and multivariate logistic regression analysis. Variables included in the analysis were age, parity, body mass index, previous prolapse surgery, previous hysterectomy, menopausal status, degree of prolapse, type of anesthesia, type and technique of surgery, operation time, intra-operative blood loss, preoperative urinary stress-incontinence, and other co-morbidities. Main outcome measure was the occurrence of urinary retention defined as a residual volume after voiding higher than 200 ml as measured by bladder scan. Results High grade cystocele (OR 2.5, CI 1.3,4.7), performing levator plication (OR 4.3, CI 2.0,9.3), performing Kelly plication (OR 5.1, CI 1.7,15.5) and amount of intra-operative blood loss (OR 1.4 per 100 ml, CI 1.1,1.8) were identified as independent risk factors for the occurrence of urinary retention after vaginal prolapse surgery. Conclusions Urinary retention after vaginal prolapse surgery occurs more frequently in women with larger cystoceles, severe intra-operative blood loss and the application of levator plication and Kelly plication. Neurourol. Urodynam. 28:225,228, 2009. © 2008 Wiley-Liss, Inc. [source] Etomidate and thiopental inhibit platelet function in patients undergoing infrainguinal vascular surgeryACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2001A. Gries Background: Postoperative platelet hyperaggregability following general anesthesia has been reported in patients undergoing major vascular surgery. In contrast, since anesthetic agents inhibited platelet function both in vitro and in vivo, an increased risk for postoperative bleedings due to prolonged platelet dysfunction has been discussed. Nevertheless, data describing platelet-affecting properties of induction agents such as etomidate and thiopental in patients undergoing major vascular surgery are lacking. Methods: Platelet function was determined at 0, 2, 20, and 200 ,g/ml thiopental and at 0, 0.2, 2, 20 ,g/ml etomidate in vitro in blood samples drawn from 16 patients suffering from severe occlusive arterial disease. In addition, 30 patients undergoing vascular surgery were investigated before (PRE) and after anesthesia induction (T0) either with etomidate (ETO group, n=16) or thiopental (THIO group, n=14), and 2 h after the beginning of surgery (T2). Platelet function was determined according to platelet aggregation, in vitro bleeding time, and flow cytometric measurements. Results:In vitro, P-selectin expression was inhibited by etomidate at 2 and 20 ,g/ml (,28% and ,38%, respectively) and also by thiopental at 200 ,g/ml (,27%). In patients undergoing vascular surgery, anesthesia induction in the ETO group resulted in a 31% prolongation of the in vitro bleeding time and an inhibition of ADP- and collagen-induced platelet aggregation (,30% and ,17%, respectively) and of P-selectin expression (,25%) at T0. In the THIO group, only ADP-induced platelet aggregation was affected (,16%). At T2, all parameters had reached PRE level again in both groups. Furthermore, in comparison with the THIO group, operation time was significantly prolonged and transfusion volume was significantly increased in the ETO group. In addition, platelet count and hematocrit significantly decreased at T2, whereas levels of tPA, PAI-1, fibrinogen and antithrombin III and partial thromboplastin time remained unchanged in both groups during the study period. Conclusions: In the present study, etomidate and, to a minor extent, thiopental offered significant platelet inhibitory properties. Anesthetic-induced platelet inhibition may lead to higher transfusion rates and prolonged operation times. Therefore, anesthetic-related platelet inhibitory properties should be considered when searching for the anesthetic agent of choice, especially in patients with compromised hemostasis and co-existing bleeding disorders. [source] Myopexy (Faden) results in more postoperative vomiting after strabismus surgery in childrenACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2001M. Saiah Background: Strabismus correction in children is associated with a high incidence of postoperative nausea and vomiting. The purpose of this prospective, double-blind study was to examine the influence of the surgical method for correction of squint on the incidence of postoperative vomiting. Methods: One hundred and twenty consecutive children aged 2,12 years, scheduled for elective strabismus surgery, were enrolled in this prospective, double-blind study. A standardised total intravenous anaesthesia was given to all children. The development of perioperative oculocardiac reflex was noted and the number of episodes of vomiting during the first 48 h postoperatively was recorded. At the completion of the study, the children who were operated with myopexy according to Faden, were allocated to a Faden group, those without a myopexy to the non-Faden group. All the patients included in this study were operated on by the same surgeon with standardised techniques. Results: The Faden group was younger, lighter and the operation time was longer (P<0.05). The incidence of vomiting was greater in the Faden group; 53% versus 12% (P<0.05). The incidence of oculocardiac reflex was similar in both groups; 40% in the Faden versus 28% in the non-Faden group, respectively. The total dose of propofol and alfentanil was similar between the groups. Requirement of analgesics for postoperative pain was similar in both groups. The only independent risk factor for postoperative vomiting was the Faden operation. Conclusion: The surgical method used for strabismus correction in children has a great influence on the incidence of postoperative vomiting. The Faden operation is associated with a very high incidence of postoperative vomiting; this particular group of patients has to be considered as a high risk group for postoperative vomiting and deserves an antiemetic prophylaxis. [source] Histologic survey of neuroblastomas after intensive induction chemotherapy,PEDIATRIC BLOOD & CANCER, Issue 5 2005Yoshiaki Tsuchida MD Abstract Background Histology after intensive induction chemotherapy is expected to become a beacon indicating when and how extensively radical surgery and lymph node dissection should be performed in advanced neuroblastoma. A thorough histologic review of surgical specimens was undertaken. Procedure All specimens from 34 patients who were pretreated intensively (,3 cycles) with recent chemotherapy were reviewed. Thirty patients were >12 months of age with stage 3/4 disease, and 4 were <12 months of age but with MYCN -amplified stage 4 diseases. After 3 to 7 cycles (mean, 4.3 cycles) of induction chemotherapy, patients underwent radical surgery of the primary tumor and lymph nodes in all retroperitoneal sections. A single pathologist reviewed all of the specimens, and histologic chemotherapeutic effects were graded as: (+++), <1% viable tumor; (++), 1%,10% viable tumor; (+), 11%,50% viable tumor; (±), 51%,90% viable tumor; and (,), >91% viable tumor. Results Grade (+++) effects were observed in 56% of patients treated with the new regimens, whereas grade (+++) was seen in only 20% treated with regimens before 1991. Operation time and blood loss were 7 hr and 6 min (P,=,0.087) and 646 ml (P,=,0.064), respectively, in patients with >5 cycles (mean, 5.3 cycles) of chemotherapy, while they were 7 hr and 50 min and 1,168 ml, respectively, in those with approximately 3 cycles (mean, 3.2 cycles). Histologically, metastases were found in the contralateral nodes beyond the aorta in 92% of those whose tumor originated on the left, and in 80% of those with tumors occurring on the right. Conclusions Five cycles of induction chemotherapy did not improve histologic chemotherapeutic effects, but helped to facilitate a shorter operation time and less blood loss than 3 cycles of chemotherapy. Surgery after 5 cycles of 98A3 also appears to be easier to perform than that after 3 cycles of A1/new A1. Only 14% of the children treated before 1985 with the St. Jude protocols experienced grade (+++) chemotherapeutic effects, and 22% of the patients treated before 1991 with regimen A1, or new A1 of the Study Group of Japan showed grade (+++) effects, whereas 56% of the patients treated after 1991 with either regimen A3 or 98A3 exhibited grade (+++) chemotherapeutic effects. Histologic chemotherapeutic effects were roughly parallel with a good prognosis. Pediatr Blood Cancer © 2005 Wiley-Liss, Inc. [source] Using wind to power a groundwater circulation well,preliminary resultsREMEDIATION, Issue 4 2004Andrew Curtis Elmore In areas of the country where the U.S. Department of Energy has classified the available wind resources as Class 3 or greater, the use of wind turbines to provide power to relatively small remediation systems such as groundwater circulation wells may be technically and economically feasible. Groundwater circulation wells are a good candidate technology to couple with renewable energy, because the remediation system removes contamination from the subject aquifer with no net loss of the groundwater resource, while the wind turbine does not create potentially harmful air emissions. Wind data collected in the vicinity of the former Nebraska Ordnance Plant Superfund site were used to select a wind turbine system to provide a portion of the energy necessary to power a groundwater circulation well located in an area of high trichloroethylene groundwater contamination. Because utility power was already installed at the remediation system, a 10 kW grid inter-tie wind turbine system supplements the utility system without requiring batteries for energy storage. The historical data from the site indicate that the quantity of energy purchased correlates poorly with the quantity of groundwater treated. Preliminary data from the wind turbine system indicate that the wind turbine provides more energy than the remediation system treatment components and the well submersible pump require on a monthly average. The preliminary results indicate that the coupling of wind turbines and groundwater circulation wells may be an attractive alternative in terms of the system operation time, cost savings, and contaminant mass removal. © 2004 Wiley Periodicals, Inc. [source] Pulmonary Recovery After Rigid Bronchoscopic Retrieval of Airway Foreign BodyTHE LARYNGOSCOPE, Issue 2 2007Man Ki Chung MD Abstract Objective: The aim of this study was to determine how long postoperative pulmonary care is needed in patients after rigid bronchoscopic retrieval of foreign body from the airway and to identify the factors affecting pulmonary recovery. Materials and Method: A retrospective review of 98 pediatric patients who had foreign body removed from the airway by rigid bronchoscopic procedure was conducted. After the removal of the foreign body, the time required for complete clinical and radiologic pulmonary recovery was reviewed for each subject. Factors examined included age, sex, preoperative symptoms, preoperative radiologic findings, duration between the aspiration event and treatment, the type of foreign body, the location of foreign body impaction, operation time, immediate postoperative radiologic changes, and treatment outcome. Results: More than 1 week for the complete pulmonary recovery was required in 25 (25.5%) cases, whereas 74.5% of subjects fully recovered within 1 week after the removal of foreign body. In the univariate analysis, preoperative inflammatory symptoms, and radiologic findings, an operation time of over 50 minutes and the aggravation of immediate postoperative radiologic findings predicted a delayed pulmonary recovery (more than 1 week). In the multivariate analysis, three of four variables previously noted, except preoperative inflammatory symptoms, showed significant predictability for a delayed pulmonary recovery. Conclusion: The recovery time of more than 1 week after rigid bronchoscopic retrieval of airway foreign body was associated with preoperative inflammatory findings by radiologic study, a prolonged procedure over 50 minutes, and aggravation of the immediate postoperative radiologic findings. Therefore, long-term pulmonary care is required for this group of patients. [source] Retroauricular Hairline Incision for Removal of Upper Neck MassesTHE LARYNGOSCOPE, Issue 12 2005Jong-Lyel Roh MD Abstract Background/Objectives: The general population has been increasingly concerned about cosmesis and hopeless about prominent or invisible postoperative scars of the face and neck. The purpose of this study was to evaluate the benefit of a retroauricular hairline incision (RAHI) by comparing it with conventional cervical incision for removal of upper neck masses. Study Design: Prospective clinical study. Methods: Thirty-four patients with upper neck masses were divided into two surgical groups of RAHI (17) and conventional cervical incision (17) matched by age, sex, marital status and size, location, pathology of lesions. The operation time, complications, length of hospital stay, and subjective satisfaction with incision scar checked by visual analogue scale were compared between groups. Results: The lesions of each group were congenital cysts (6), abscesses (2), inflammatory masses (2), and benign (6) or malignant (1) tumors and located in the upper neck. Mean operation time was 51 ± 17 minute in the RAHI group and 41 ± 13 minutes in the controls (P = .064). Mean hospital stay and complication rates were comparable between groups. Mean score of patient's satisfaction was 8.9 ± 0.7 in the RAHI group and 4.5 ± 2.7 in the controls (P < .001). The degree of incision scarring did not differ between groups, but the scars were less visible in the RAHI group because of hiding by the auricle and hair. Conclusions: The postauricular approach leading to a potentially invisible area of operation has a clear cosmetic benefit compared with conventional cervical incision. This will be helpful for patients with surgically indicated upper neck masses who hope for invisible incision scars. [source] Early Hepatic Artery Thrombosis after Liver Transplantation: A Systematic Review of the Incidence, Outcome and Risk FactorsAMERICAN JOURNAL OF TRANSPLANTATION, Issue 4 2009J. Bekker To clarify inconsistencies in the literature we performed a systematic review to identify the incidence, risk factors and outcome of early hepatic artery thrombosis (eHAT) after liver transplantation. We searched studies identified from databases (MEDLINE, EMBASE, Science Citation Index) and references of identified studies. Seventy-one studies out of 999 screened abstracts were eligible for this systematic review. The incidence of eHAT was 4.4% (843/21, 822); in children 8.3% and 2.9% in adults (p < 0.001). Doppler ultrasound screening (DUS) protocols varied from ,no routine' to ,three times a day.' The median time to detection was at day seven. The overall retransplantation rate was 53.1% and was higher in children (61.9%) than in adults (50%, p < 0.03). The overall mortality rate of patients with eHAT was 33.3% (range: 0,80%). Mortality in adults (34.3%) was higher than in children (25%, p < 0.03). The reported risk factors for eHAT were, cytomegalovirus mismatch (seropositive donor liver in seronegative recipient), retransplantation, arterial conduits, prolonged operation time, low recipient weight, variant arterial anatomy, and low volume transplantation centers. eHAT is associated with significant graft loss and mortality. Uniform definitions of eHAT and uniform treatment modalities are obligatory to confirm these results and to obtain a better understanding of this disastrous complication. [source] Anaesthesia for proximal femoral fracture in the UK: first report from the NHS Hip Fracture Anaesthesia Network,ANAESTHESIA, Issue 3 2010S. M. White Summary The aim of this audit was to investigate process, personnel and anaesthetic factors in relation to mortality among patients with proximal femoral fractures. A questionnaire was used to record standardised data about 1195 patients with proximal femoral fracture admitted to 22 hospitals contributing to the Hip Fracture Anaesthesia Network over a 2-month winter period. Patients were demographically similar between hospitals (mean age 81 years, 73% female, median ASA grade 3). However, there was wide variation in time from admission to operation (24,108 h) and 30-day postoperative mortality (2,25%). Fifty percent of hospitals had a mean admission to operation time < 48 h. Forty-two percent of operations were delayed: 51% for organisational; 44% for medical; and 4% for ,anaesthetic' reasons. Regional anaesthesia was administered to 49% of patients (by hospital, range = 0,82%), 51% received general anaesthesia and 19% of patients received peripheral nerve blockade. Consultants administered 61% of anaesthetics (17,100%). Wide national variations in current management of patients sustaining proximal femoral fracture reflect a lack of research evidence on which to base best practice guidance. Collaborative audits such as this provide a robust method of collecting such evidence. [source] Estimating the duration of common elective operations: implications for operating list managementANAESTHESIA, Issue 8 2006J. J. Pandit Summary Over-running operating lists are known to be a common cause of cancellation of operations on the day of surgery. We investigated whether lists were overbooked because surgeons were optimistic in their estimates of the time that operations would take to complete. We used a questionnaire to assess the estimates of total operation time of 22 surgeons, 35 anaesthetists and 16 senior nursing staff for 31 common, general surgical and urological procedures. The response rate was 66%. We found no difference between the estimates of these three groups of staff, or between these estimates and times obtained from theatre computer records (p = 0.722). We then applied the average of the surgeons' estimates prospectively to 50 consecutive published surgical lists. Surgical estimates were very accurate in predicting the actual duration of the list (r2 = 0.61; p < 0.001), but were poor at booking the list to within its scheduled duration: 50% of lists were predictably overbooked, 50% over-ran their scheduled time, and 34% of lists suffered a cancellation. We suggest that using the estimates of operating times to plan lists would reduce the incidence of predictable over-runs and cancellations. [source] PREPERITONEAL GROIN HERNIA REPAIR WITH KUGEL PATCH THROUGH AN ANTERIOR APPROACHANZ JOURNAL OF SURGERY, Issue 10 2008Junsheng Li Kugel hernia repair is classically carried out through the posterior approach; in this study we investigated the effectiveness and invasiveness of a Modified Kugel (Bard-Davol Inc., RI, USA) hernia repair procedure carried out through an anterior approach. A prospective series covering a 2-year period, including 122 patients (142 hernias) were carried out using the anterior approach. Patient comfort, complications and recurrence were evaluated. A total of 142 inguinal hernias were repaired, median age was 67 years, the mean operation time was 51 ± 23 min and the average incision was 4.5 cm. There was one case recurrence 5 months after repair. Other complications were few and not severe, only slight groin discomfort was observed in two patients during follow up. This Modified Kugel hernia through anterior approach is effective, mini-invasive and easy to learn with fewer complications. [source] | ||||||||||||||||||||||||||||||||||