[The mechanoreceptor tactile diagnostics of thoracic diseases].

The novel system of tactile analysis was used in the mechanoreceptor device. The local pressure measurement is carried out in in cameras, divided by the elastic membrane from the analyzed organ. The devise allows fast and adequate real-time measurement of tissue density and elasticity. The results, acquired with the use of the mechanoreceptor device were checked microscopically. The study showed high compatibility and adequacy of the novel mechanoreceptor.

Objective assessment of the alterations in wrist mobility with the fastrak(®) system following dorsal capsulodesis.

The treatment for scapholunate dissociation is challenging and its management is varied depending on type, severity and duration of injury, and surgeon's preferred technique. This study aimed to objectively assess the variations in the range and patterns of wrist movements using the Fastrak(®) system in patients having undergone Blatt's dorsal capsulodesis (BDC). The wrist movements were successively measured between the operated and unoperated wrists, while the patients performed set tasks. Seventeen patients agreed to participate in the study. Following BDC the mean flexion loss was 23° (range 10°-38°). However, functional tasks revealed that the BDC did not adversely affect the function of the operated wrist. This novel study demonstrates objectively the functional restrictions that patients are likely to experience postoperatively following BDC. It would be interesting to note the pattern of wrist motion using the Fastrak(®) system in various other clinical settings.

[Intraoperative pedography]. / Intraoperative Pedographie : Das besondere Instrument.

THE PROBLEM: Intraoperative assessment of the restored or maintained physiological plantar force distribution during foot and ankle corrections is very difficult. THE SOLUTION: Intraoperative assessment of the restored or maintained physiological plantar force distribution during foot and ankle corrections with intraoperative pedography (IP). SURGICAL TECHNIQUE: Bilateral pedography with the "Kraftsimulator Intraoperative Pedographie" (KIOP, R-Innovation, Coburg, Germany) and a mat sensor (Pliance, custom-made, Novel, Munich, Germany) in the preparation room under anesthesia. Three measurements each side with a total force corresponding to half of the body weight are performed. Transfer of the patient to the operating room and correction including definitive internal fixation following the planning and findings. Sterile draping of the sensor mat and usage of a sterile KIOP for IP of the operated foot with three measurements, and assessment and comparison with preoperative, contralateral and physiological pedographic findings. When a correction of the force distribution is indicated, modification of the correction and internal fixation and renewed IP. POSTOPERATIVE MANAGEMENT: IP has no influence on the postoperative management. RESULTS: IP was validated in an earlier study. In a prospective, randomized, controlled clinical study, the potential clinical benefit of IP in a sufficient number of cases in comparison to cases treated without IP was analyzed. 100 cases were included until April 11, 2008. 52 patients were randomized for the use of IP. Mean interruption of the operative procedure for the IP was 321 +/- 39 s. In 24 of the 52 patients (46%), the correction was modified after IP during the same operation. The changes were done most commonly in midfoot correction arthrodeses (64%), and least commonly in subtalar joint arthrodeses (25%).

Is intraoperative pedography helpful in clinical use--preliminary results of 100 cases from a consecutive, prospective, randomized, controlled clinical study.

BACKGROUND: The purpose of this study was to assess the clinical use, and to analyze the potential clinical benefit of intraoperative pedography (IP) in a sufficient number of cases in comparison with cases treated without IP. METHODS: Patients (age 18 years and older) which sustained an arthrodesis and/or correction of the foot and ankle were included. RESULTS: One hundred cases were included (ankle correction arthrodesis, n=12; subtalar joint correction arthrodesis, n=14; arthrodesis without correction midfoot, n=15; correction arthrodesis midfoot, n=26; correction forefoot, n=33). Fifty-two patients were randomized for the use of IP. In 24 of the 52 patients (46%), the correction was modified after IP during the same operation. CONCLUSIONS: In 46% of the cases a modification of the surgical correction was made after IP in the same surgical procedure. Whether IP improve the plantar force distribution of the foot and the mid- or long-term clinical outcome has to be critically analyzed when longer follow-up is completed.

Comparative study of nail sampling techniques in onychomycosis.

Onychomycosis is a common problem. Obtaining accurate laboratory test results before treatment is important in clinical practice. The purpose of this study was to compare results of curettage and drilling techniques of nail sampling in the diagnosis of onychomycosis, and to establish the best technique and location of sampling. We evaluated 60 patients suffering from distal and lateral subungual onychomycosis and lateral subungual onychomycosis using curettage and vertical and horizontal drilling sampling techniques from three different sites of the infected nail. KOH examination and fungal culture were used for detection and identification of fungal infection. At each sample site, the horizontal drilling technique has a better culture sensitivity than curettage. Trichophyton rubrum was by far the most common pathogen detected by both techniques from all sampling sites. The drilling technique was found to be statistically better than curettage at each site of sampling, furthermore vertical drilling from the proximal part of the affected nail was found to be the best procedure for nail sampling. With each technique we found that the culture sensitivity improved as the location of the sample was more proximal. More types of pathogens were detected in samples taken by both methods from proximal parts of the affected nails.

Minimally invasive intraoperative stiffness measurement of lumbar spinal motion segments.

OBJECTIVE: To test a new tiny-tipped intraoperative diagnostic tool that was designed to provide the surgeon with reliable stiffness data on the motion segment during microdiscectomy. A decrease in stiffness after nuclectomy and a measurable influence of muscle tension were assumed. If the influence of muscle tension on the motion segment could at least be ruled out, there should be no difference with regard to stiffness between women and men. If these criteria are met, this new intraoperative diagnostic tool could be used in further studies for objective decision-making regarding additional stabilization systems after microdiscectomy. METHODS: After evaluation of the influence of muscle relaxation during in vivo measurements with a spinal spreader between the spinous processes, 21 motion segments were investigated in 21 patients. Using a standardized protocol, including quantified muscle relaxation, spinal stiffness was measured before laminotomy and after nuclectomy. RESULTS: The decrease in stiffness after microdiscectomy was highly significant. There were no statistically significant differences between men and women. The average stiffness value before discectomy was 33.7 N/mm, and it decreased to 25.6 N/mm after discectomy. The average decrease in stiffness was 8.1 N/mm (24%). CONCLUSION: In the moderately degenerated spine, stiffness decreases significantly after microdiscectomy. Control for muscle relaxation is essential when measuring in vivo spinal stiffness. The new spinal spreader was found to provide reliable data. This spreader could be used in further studies for objective decision-making about additional stabilization systems after microdiscectomy.

Handheld gamma probe used to detect accessory spleens during initial laparoscopic splenectomies.

BACKGROUND: Preoperative determination of the accessory spleen still is a major factor in the failure of both laparoscopic and conventional techniques. This study aimed to evaluate the practicability and efficacy of a handheld gamma probe in identifying accessory spleens at the initial intervention. METHODS: This study evaluated 17 patients undergoing laparoscopic splenectomy attributable to benign hematologic disorders. All the patients had preoperative ultrasonography, computed tomography (CT) scan, and nuclear scintigraphic examination of the abdominal cavity to assess the size of the spleen, and to determine the existence of the accessory spleen or spleens. For all the patients, a handheld gamma probe count was used intraoperatively as an adjuvant method to define the presence and location of the accessory splenic tissue. Control nuclear scintigraphic examinations of all the patients were performed 1 month after the surgical procedure. RESULTS: In two cases, intraoperatively accessory splenic tissue was detected by gamma probe, confirming the preoperative CT findings for the patients. One of these patients had three accessory spleens, although preoperative CT scan showed only two of them. However, by the help of the gamma probe, a third spleen located retroperitoneally was defined. For two patients, laparoscopic exploration and handheld gamma probe count did not identify any accessory splenic tissue, although preoperative CT scan indicated accessory spleens. For detecting accessory splenic tissue, the sensitivities of the studied techniques were 0% for ultrasonography, 75% for CT scan, 0% for preoperative nuclear scintigraphy, 75% for laparoscopic exploration, and 100% for perioperative gamma probe examination. CONCLUSION: Preoperative imaging methods for accessory spleen determination still have limited benefits because of their limited sensitivity. Thus, the handheld gamma probe technique may be an adjuvant method for laparoscopic exploration ensuring that no accessory splenic tissue is missed during the initial surgical treatment of benign hematologic disorders.

Hemorroidectomía con el uso del bisturí armónico / Hemorrhoidectomy using the harmonic scalpel

Presentar la experiencia obtenida por los autores en el uso del bisturí armónico en pacientes con hemorroides grado III y IV, a quienes se les practicó hemorroidectomía por nuestro equipo quirúrgico del Centro Policlínico La Viña, Valencia. Es un estudio retrospectivo donde se revisaron las historias de 40 pacientes que acudieron a la consulta quirúrgica entre enero del año 2000 y agosto de 2003 con diagnóstico de hemorroides grado III y IV, a quienes se les practicó hemorroidectomía. Centro Policlínico La Viña, Valencia hospital privado. La técnica de hemorroidectomía con bisturí armónico resultó satisfactoria: redujo el tiempo quirúrgico y el sangrado intraoperatorio minimizando el daño tisular, permitió menor estancia hospitalaria y rápido retorno a las actividades cotidianas. Se presentaron dos sangramientos posoperatorios leves, uno por actividad física prescoz. No se evidenciaron complicaciones tardias como estenosis anal ni ectropión. Los autores concluyen que la hemorroidectomía con el uso del bisturí armónico es una alternativa favorable en la técnica quirúrgica, asociada a un mínimo de complicaciones intra y postoperatorias, considerando el instrumento como una opción factible y casi ideal para dicho procedimiento.

La biopsia intraoperatoria: seguridad diagnóstica, experiencia y correlación de resultados / Intraoperative biopsy: diagnostic accuraccy, experience and correlations of results

La biopsia intraoperatoria es una herramienta de apoyo muy valorada por los cirujanos desde hace muchos años. Las indicaciones y contraindicaciones han cambiado en el tiempo y esto hace variar su seguridad diagnóstica. Se analiza una serie de 105 procedimientos consecutivos y se muestran los resultados obtenidos (95,23 por ciento de índice de aciertos, sensibilidad de 86,66 por ciento, especificidad de 98,66 por ciento y valor predictivo de 96,29 por ciento), demostrando que este procedimiento en nuestro medio se mantiene dentro del rango de series de mayores volúmenes y que es plenamente válido, confiable y vigente. Se recomienda que las mediciones de seguridad diagnóstica sean efectuadas periódicamente por los departamentos de Anatomía Patológica y Laboratorios de Histopatología.

Diagnostic mini-video assisted thoracic surgery. Effectiveness and accuracy of new generation 2.0 mm instruments.

OBJECTIVE: Recently 2.0 mm mini-VATS has aroused much interest among surgeons involved with endoscopic surgery. We report our initial experience with the first first 54 patients who underwent this procedure. The aim of this study is to evaluate the effectiveness and accuracy of mini-VATS. METHODS: 54 patients were undertaken to mini-VATS for diagnostic purposes. Patients were randomly selected and the indication for operation was set by the classic VATS criteria. 35 (65%) patients were treated under general anesthesia, while 19 (35%) patients were treated under local anesthesia. RESULTS: The average length of hospital stay was 1.8 +/- 0.9 days. The days of requirement for narcotic analgesia were 1.9 +/- 1.0. Diagnostic accuracy was 100%; morbidity and mortality rates were 0%. CONCLUSIONS: The high diagnostic accuracy and low operative danger, combined with less postoperative pain, due to minor surgical trauma and faster patient recovery, has established mini-VATS as a dynamic competitor to the classic VATS procedure. Since high technology is a strong partner in endoscopic surgery, a strong potentiality for evolution exists.

Digestive hemorrhages of obscure origin.

BACKGROUND: The diagnosis of digestive bleeding in some cases can require a diagnostic laparotomy when other methods have been ineffective. Video-laparoscopy can provide such cases with a certain diagnosis and the possibility of performing a simultaneous surgical treatment. METHODS: Our experience using video-laparoscopic to treat digestive hemorrhages of obscure origin involved 16 patients. The examined patients presented with the following diseases: Meckel's diverticulum (8 cases), gastric leiomyoma (1 case), small bowel leiomyoma (4 cases), jejunum leiomyosarcoma (1 case), small bowel melanoma (1 case), and Peutz-Jeghers syndrome (1 case). RESULTS: In all these patients the laparoscopic approach allowed us to identify the origin and site of the hemorrhages, and subsequently to treat the identified lesions. In one patient, an intraperitoneal resection of the diverticulum was performed using Endo-Gia (TM30NIF; Tyco Auto-Suture). In the remaining cases, a minilaparatomy was performed for resection of the disordered loop. CONCLUSIONS: Video-laparoscopy is very useful for avoiding explorative laparatomies on patients affected by digestive hemorrhages of obscure origin. In these cases, the video-laparoscopic approach allows full and meticulous explorations of the small bowel to be performed, and seems to be useful for diagnosis through direct observation of the lesions. Moreover, if necessary, video-laparoscopy can be used for the effective treatment of the diseases.

Early clinical experience with the 6 French Angio-Seal device: immediate closure of femoral puncture sites after diagnostic and interventional coronary procedures.

The objective of this study was to assess the early safety and efficacy of the novel 6 Fr Angio-Seal device for routine clinical use after diagnostic cardiac catheterization and coronary angioplasty. In a prospective study, we used the 6 Fr Angio-Seal device in 180 consecutive patients (131 male, 49 female, mean age 60.7 years) for closure of femoral arterial puncture sites immediately after diagnostic (n = 108) or interventional (n = 72) coronary procedures independent of the coagulation status. All patients were monitored for 24 hr after the procedure and followed for 30 days. The closure device was successfully deployed in 95.4% after diagnostic catheterization versus 98.6% after coronary angioplasty (P = 0.963). Immediate hemostasis was achieved in 91.5% versus 90.1% of the patients (P = 0.993). Major complications were observed 1.9% versus 2.8% of the patients (P = 0.885). During 30-day follow-up, no late events or complications were reported. The 6 Fr Angio-Seal device is a safe and effective device that allows for immediate closure of femoral puncture sites after both diagnostic and interventional procedures with a low rate of major complications.

Utilidad de una clasificación para el índice de riesgo cardiovascular / Usefulnes of ASA physical state classification, goldman's heart risk index and detsky's modified mltifactorial index to predict perioperative cardiovascular morbidity and mortality in patients undergone to major non-cardiac surgery

Antecedentes: se han diseñado varios métodos para determinar el riesgo cardiaco antes de una intervención quirúrgica. Los índices de riesgo son una forma de concentrarse en las variables clave para simplificar la identificación de los factores que afectan dicho riesgo. Objetivo: determinar la utilidad de tres escalas de riesgo cardiaco para predecir la frecuencia de complicaciones perioperatorias en pacientes programados para cirugía mayor. Material y métodos: se estudiaron de manera prospectiva pacientes mayores de 40 años de edad, de uno y otro sexo y que fueron programados para cirugía mayor bajo anestesia general, espinal o epidural. Se registraron los siguientes datos diagnóstico quirúrgico, tipo de cirugía, anestesia, factores de riesgo quirúrgico, clínicos y paraclinicos y riesgo quirúrgico según las escalas de ASA, Goldman y Detsky. También se señalaron las complicaciones trans y posoperatorias. Resultados: se incluyeron 143 pacientes. Las complicaciones cardiovasculares más frecuentes fueron: insuficiencia cardiaca (n=25), hipotensión (n=17), crisis hipertensiva (n=11) y arritmia (n=9). Un paciente murió por causas cardiacas. La prueba t de Student mostró que la frecuencia de complicaciones cardiovasculares perioperatorias tiene una correlación efectiva con la calse de ASA obtenida (p< 0.001). Pero con las escalas de Goldman y Detsky no hubo correlación estadística significativa. Conclusiones: la clasificación del estado físico de ASA es útil para valorar el riesgo y predecir complicaciones cardiovasculares. Los índices de Goldman y Detsky no tuvieron utilidad, debido tal vez a que estas escalas no se aplican adecuadamente en nuestro medio por la falta de estudios complementarios para integrarlas

Permanência intra-ocualr prolongada de perfluorocarbono líquido em cirurgia de descolamento da retina / Delayed intra-ocular presence of perfluorocarbn after retinal detachment surgery

Relatado caso de descolamento de retina pós-facectomia em paciente alto míope, tratado com sucesso através de vitrctomia via pars plan, com infusäo intra-ocular de perfluorotributilamina. Devido a dificuldades operatórias, foi impossível a retirada total do composto do interior do globo ocular, que al permaneceu por 45 dias. Após a retirada do perfluorocarbono, a acuidade visual foi de 0,6 e näo foram observadas danos às estruturas intra-oculares

Diverticulitis solitaria del ciego / Solitary diverticulitis of the cecum

Se presenta el caso de un divertículo cecal solitario perforado, enfermedad poco frecuente que, en ocasiones, puede confundirse con un carcinoma cecal. La hemicolectomía derecha es un procedimiento que tiene buenos resultados aunque el tratamiento conservador con diverticulectomía simple, cuando el proceso se encuentra limitado, es una variante que debe ser considerada

Endometriosis atopica: presentacion de 3 casos y revision de la entidad / Atopic endometriosis: presentation of 3 cases and review of the entity

En el presente articulo revisamos la etiopatogenia y presentacion clinica de la endometriosis haciendo hincapie en las localizaciones atopicas, reforzando lo anterior hacemos la presentacion de 3 casos diagnosticados y tratados en el servicio de obstetricia y ginecologia del hospital San Gabriel en el periodo comprendido entre el primero de enero al 31 de julio de 1994, en pacientes de consulta externa cuyas manifestaciones clinicas estuvieron relacionadas con la via de obtencion del producto de la concepcion.

[A method of calculating the parameters of multifiber optic catheters]. / Metodika raschetov parametrov mnogovolokonnykh opticheskikh kateterov.

The paper underlines the necessity of taking into account the relationship of the basic characteristics of multifiber optical catheters, such as the number, position, and diameters of some fibers, to the informational potentials of diagnostic and imaging systems of the basis of the catheters. The relationship is established by applying discretization theorems. The main points are illustrated by an example of practical angioplastic calculation.

[The application of the sample recognition theory for a system of surgical diagnosis in microsurgery]. / Primenenie teorii raspoznavaniia obrazov dlia sistem operativnoi diagnostiki v mikrokhirurgii.

The paper outlines the applicability of the sample recognition theory to process the data obtained with the use of multifiber optical catheters as part of information systems for diagnostics and visualization for microsurgery. A specific example of synthesizing the image assessment algorithm by employing the sample recognition theory is considered for the visualization system for a laser angioplastic unit.