Causes and Prevention of Failure in Varicose Vein Operations

One hundred and one patients with poor results from the operative treatment of varicose veins were studied in an effort to determine the cause of the surgical failure. In a large majority, reoperation revealed that the primary cause of the poor result was the improper performance of the original operation. A smaller number of failures were due to errors in selecting the operative procedure. Relatively few poor results in long-term follow-up were attributable to the congenital predisposition to varicosity. When operation is properly planned and executed, it produces better long-term results than the injection compression therapy of varicose veins.     

A NEW APPROACH TO CORRECTION OF D-LOOP TRANSPOSITION OF THE GREAT ARTERIES

An operative procedure is described for repair of transposition of the great arteries in which the left ventricle is the "aortic" ventricle and the right ventricle is the "pulmonic" ventricle. The technical feasibility of this procedure is supported by its successful application in experimental animals. A modified procedure, which may be applicable in certain complex forms of transposition of the great arteries and other perplexing anomalies for which there are no known repairs, is discussed.     

Diverticulitis of the colon; surgical treatment

Appropriate surgical treatment of diverticulitis of the colon can result in a highly satisfactory proportion of permanent cures, with an operative mortality of 2 to 5 per cent. Colostomy is a valuable emergency procedure for the control of severe infection or the relief of obstruction but is not a satisfactory definitive treatment for the cure of diverticulitis. Definitive surgical treatment requires resection of the involved segment of colon. Three indications for surgical intervention in "uncomplicated" diverticulitis are: (1) continued or repeated attacks, (2) persistent deformity as seen by x-ray examination, and (3) persistent blood in the stools. Although a three-stage operation is usually considered a safer procedure, one-stage resections may be safely and satisfactorily employed in many instances.     

A shortcut for multiple testing on the directed acyclic graph of gene ontology

Background

Gene set testing has become an important analysis technique in high throughput microarray and next generation sequencing studies for uncovering patterns of differential expression of various biological processes. Often, the large number of gene sets that are tested simultaneously require some sort of multiplicity correction to account for the multiplicity effect. This work provides a substantial computational improvement to an existing familywise error rate controlling multiplicity approach (the Focus Level method) for gene set testing in high throughput microarray and next generation sequencing studies using Gene Ontology graphs, which we call the Short Focus Level.

Results

The Short Focus Level procedure, which performs a shortcut of the full Focus Level procedure, is achieved by extending the reach of graphical weighted Bonferroni testing to closed testing situations where restricted hypotheses are present, such as in the Gene Ontology graphs. The Short Focus Level multiplicity adjustment can perform the full top-down approach of the original Focus Level procedure, overcoming a significant disadvantage of the otherwise powerful Focus Level multiplicity adjustment. The computational and power differences of the Short Focus Level procedure as compared to the original Focus Level procedure are demonstrated both through simulation and using real data.

Conclusions

The Short Focus Level procedure shows a significant increase in computation speed over the original Focus Level procedure (as much as ∼15,000 times faster). The Short Focus Level should be used in place of the Focus Level procedure whenever the logical assumptions of the Gene Ontology graph structure are appropriate for the study objectives and when either no a priori focus level of interest can be specified or the focus level is selected at a higher level of the graph, where the Focus Level procedure is computationally intractable.

Electronic supplementary material

The online version of this article (doi:10.1186/s12859-014-0349-3) contains supplementary material, which is available to authorized users.     

Stretching of the sciatic nerve; a means of relieving postoperative pain following removal of ruptured lumbar intervertebral discs

Stretching the sciatic nerve for the relief of "sciatica" was frequently employed before 1900 and was subsequently abandoned, probably because it was done without sufficient scrutiny of the indications. The procedure has recently been employed in cases in which "sciatica" remains following the operative removal of ruptured intervertebral discs, and it has been instrumental in relieving postoperative "sciatica" when the cause was the formation of adhesions about the lumbar nerve roots. If the nerve root is compressed by recurrent disc protrusion or by adjacent bone, the manipulation usually increases the pain, a phenomenon that has been helpful from a diagnostic standpoint.     

An experimental model of tryptic haemorrhagic enteropathy of the dog.

To study the enteropathy characteristics of the shock state of the dog a simple experimental model has been developed. The cranial mesenteric artery was perfused with 2 micrograms/kg/min norepinephrine for an hour via a diagnostic cardiac catheter inserted under fluoroscopic control. This caused a "pharmacological occlusion" of the artery by local alpha receptor stimulation, and tryptic haemorrhagic enteritis was produced without hypovolaemia or assay operative procedure.     

Improved visualization of oxytalan fibers with resorcin fuchsin

"Oxytalan" fibers in the skin are demonstrated with greater clarity and especially with greater contrast compared with other methods, when the resorcin-fuchsin procedure described by Weigert in 1898 is applied with some modification. The original formulation must be scrupulously maintained but the time of staining is increased. No prior oxidation is necessary with this method.     

Hypertrophic pyloric stenosis

Hypertrophic pyloric stenosis, a relatively common condition, is caused by hyperplasia of the musculature of the pylorus. The diagnosis is made by a history of projectile vomiting and failure to gain weight, the observation of gastric peristaltic waves, and the palpation of a pyloric "tumor." A method of palpating this tumor is described in detail. Roentgenological studies are rarely indicated. Pylorotomy for treatment of hypertrophic pyloric stenosis was not successful until the development of necessary supporting measures. Preparation for operation consists of intravenous administration of fluids and electrolytes and sometimes serum or whole blood. The position of the tumor governs the choice between two different incisions. The operative procedure herein described is essentially that devised by Ramstedt many years ago, with modifications to facilitate the procedure.     

Crystalline behavior of chitosan organic acid salts.

The crystal structures of chitosan acid salts were studied by X-ray diffraction measurements on a fiber diagram and a new procedure to obtain an anhydrous polymorph of chitosan was found. The salts prepared by immersing a chitosan into a mixture of acid solution and isopropanol were classified into two types (Types I and II) depending on their conformation. Molecular conformation of the Type I salt retains the extended 2-fold helical structure of the original chitosan, but that of Type II salt is a twisted 2-fold helix. All the Type II salts changed to the anhydrous "Annealed" polymorph of chitosan when soaking in 75% aqueous isopropanol, but when the Type I salts were immersed in the solution, they returned to the hydrated "Tendon" polymorph which is that of the original chitosan. The strange transformation observed in Type II salt may be related to the stability of the molecular conformation of chitosan in the salt.     

Comparison of auramine-rhodamine B and acridine orange for staining of acid-fast bacteria.

In cooperation of 6 laboratories in Czechoslovakia and in the GDR, the efficiency of auramine-rhodamine B (AR) and acridine orange (AO) (short-time method) for staining of acid-fast bacilli was compared. Whereas a former comparison of AR and AO (original method) pointed out the superiority of AR, the investigation of both methods used as short-time procedures showed significantly more acid-fast rods after using AO. The number of "false positive" results was somewhat higher on AR staining. However the results depend not only on the method used but also on the procedure of staining and the optical equipment, and they are essentially influenced by the experience and proficiency of the microscopist. Taking into account the results of both studies both auramine-rhodamine B and acridine orange can be proposed for the staining of slides for microscopical detection of acid-fast rods. In case of AO, the short-time method is superior to the original long-time procedure.     

Otoplasty: sequencing the operation for improved results

LEARNING OBJECTIVES:: After studying this article, the participant should be able to: 1. Understand the anatomy and embryology of the external ear. 2. Understand the anatomic causes of the prominent ear. 3. Understand the operative maneuvers used to shape the external ear. 4. Be able to sequence the otoplasty for consistent results. 5. Understand the possible complications of the otoplasty procedure. Correction of prominent ears is a common plastic surgical procedure. Proper execution of the surgical techniques is dependent on the surgeon's understanding of the surgical procedure. This understanding is best founded on an understanding of the historical bases for the operative steps and the execution of these operative steps in a logical fashion. This article describes the concept of sequencing the operation of otoplasty to produce predictable results combining the technical contributions from many authors. The historical, embryological, and anatomic bases for the operation are also discussed. Finally, the authors' preferred techniques are presented. Sequencing the steps in the preoperative assessment, preoperative planning, patient management, operative technique, and postoperative care will produce reproducible results for the attentive surgeon. Careful attention to the details of the operation of otoplasty will avoid many postoperative problems.     

Venous pseudo-aneurysm as a late complication of short-term central venous catheterisation

Background

Adrenocortical carcinoma is a rare, highly malignant tumor. Cardiac involvement of the tumor is very rare. Echocardiography facilitates the evaluation of the cardiac involvement of the tumor.

Case Presentation

We describe a patient with an adrenal tumor. Transthoracic echo showed its extension into the right atrium. Accordingly, a combined abdominal and cardiac operation was performed, monitored by transesophageal echocardiography.

Conclusion

This case highlights the importance of echocardiography in revealing the cardiac involvement by this tumor and in planning the operative procedure.     

Modification of the Falck-Hillarp formaldehyde fluorescence method using the vibratome®: simple,rapid and sensitive localization of catecholamines in sections of unfixed or formalin fixed brain tissue

Summary Two modifications of the original Falck-Hillarp formaldehyde fluorescence technique are presented, both based on a recently introduced instrument, the Vibratome^®, which permits cutting of unembedded tissue with a section thickness down to 10 ,.The first modification involves sectioning of unfixed tissue at a temperature below +5°C, subsequent air drying and reaction with formaldehyde vapours. In the second procedure formalin fixed tissue is cut and processed as described above. It is essential that both formalin fixation and cutting of the fixed tissue takes place at a low temperature to avoid diffusion of the catecholamines.The results show that with both techniques central CA neurons can be visualized with a high degree of sensitivity. Furthermore, since the sections are free from fractures—a common problem in freeze-dried tissues—the Vibratome^® technique represents a valuable tool for mapping studies. It may also be added that since many steps of the original procedure are omitted the present techniques are also more rapid and simple. It is pointed out that using the Vibratome^® procedure on formalin fixed tissue, it will be possible to combine e.g. cholinesterase staining or Fink-Heimer silver impregnation or immunofluorescent studies with the Falck-Hillarp technique on serial or even on the same sections.     

Levator muscle reconstruction: resulting velopharyngeal competence--a preliminary report

The purpose of this study was to evaluate a levator muscle reconstruction procedure on the basis of resulting velopharyngeal competence. Ages of the patients at time of surgery ranged from 5 months to 7 years. The patients were reevaluated postoperatively. If the patients were judged to have normal nasality and no nasal emission, the procedure was considered to have yielded a satisfactory result. If hypernasality and nasal emission resulted, the patients were examined utilizing nasoendoscopy and/or videofluoroscopy. If velopharyngeal incompetence was confirmed, the operative procedure was judged to be successful. Results showed that 60 percent success was achieved. The age range which yielded the best results (73 percent satisfactory) was 37 to 60 months. The data also revealed that the more severe the cleft, the less likely this operative procedure is to produce satisfactory results. The authors recommend continued evaluation of this procedure, preferably utilizing prospective studies.     

Recursive filtering for zero offset correction of diving depth time series with GNU R package diveMove

Zero offset correction of diving depth measured by time-depth recorders is required to remove artifacts arising from temporal changes in accuracy of pressure transducers. Currently used methods for this procedure are in the proprietary software domain, where researchers cannot study it in sufficient detail, so they have little or no control over how their data were changed. GNU R package diveMove implements a procedure in the Free Software domain that consists of recursively smoothing and filtering the input time series using moving quantiles. This paper describes, demonstrates, and evaluates the proposed method by using a "perfect" data set, which is subsequently corrupted to provide input for the proposed procedure. The method is evaluated by comparing the corrected time series to the original, uncorrupted, data set from an Antarctic fur seal (Arctocephalus gazella Peters, 1875). The Root Mean Square Error of the corrected data set, relative to the "perfect" data set, was nearly identical to the magnitude of noise introduced into the latter. The method, thus, provides a flexible, reliable, and efficient mechanism to perform zero offset correction for analyses of diving behaviour. We illustrate applications of the method to data sets from four species with large differences in diving behaviour, measured using different sampling protocols and instrument characteristics.     

Field gas chromatography-mass spectrometry for fast analysis

The objective of this presentation is to demonstrate the original device and procedure for fast gas chromatography-mass spectrometry (GC-MS) analysis of gaseous and liquid samples and to discuss its features and capabilities. The concept was developed in order to expand the range of compounds suitable for GC separation and to reduce the time of analysis. Field GC-MS, consisting of original "concentrator-thermodesorber" (CTD) unit, multiple module GC system and compact magnetic mass spectrometer with powerful two-stage vacuum system and multicollector ion detector, is represented. The whole weight of the device is 90 kg. Power consumption is 250 W. The device and analytical procedures allow high speed screening of toxic substances in air and extracts within 100 s per sample. The examples of applications are described, including fast screening of tributyl phosphate (TBP) in air at low ppt level at the rate 1 sample/min.     

Developing tests of successional hypotheses with size-structured populations,and an assessment using long-term data from a Ugandan rain forest

In 1947, W. J. Eggeling published an account of forest succession at Budongo, Uganda. This interpretation was based on a large-scale comparative plot study, performed in the 1930s and 1940s. This account, with its implication that species richness declines in late succession, endures as a controversial corner-stone in theories and disputes about community diversity. Data have now been collected over six decades from five of Eggeling's original plots.This paper evaluates Eggeling's successional interpretation of the Budongo vegetation. The first set of analyses assesses the consistency of the original data with the predictions of compositional progression and convergence implicit in Eggeling's model. The second analyses do the same for the time-series observations. A logical approach shows how temporal information may be derived from both between plot, and within plot, evaluations using size-structured data. A Detrended-Correspondence-Analysis (DCA) of canopy-tree composition, from the original data, ranks the plots in perfect correspondence to Eggeling's successional sequence. A development-scoring procedure is developed using passive-ordination against this sequence; this is then applied to composition by plot and stem-size class.Eggeling's original data are consistent with each prediction assessed. The analyses show compositional progression and apparent convergence across the plot series, and also progression and convergence within each plot. A monodominant-Cynometra forest is the natural end-point of this progression. The time-series results, though in apparent agreement for one early successional plot, do not generally accord with Eggeling's ideas. The analyses illustrate a general means for evaluating explicit and implicit compositional trends in communities with structured populations.     

Spectrum of peripheral neuropathies associated with surgical interventions; A neurophysiological assessment

Background

We hypothesized that a wide range of surgical procedures may be complicated by neuropathies, not just in close proximity but also remote from procedural sites. The aim of this study was to classify post-operative neuropathies and the procedures associated with them.

Methods

We retrospectively identified 66 patients diagnosed with post-procedure neuropathies between January 2005 and June 2008. We reviewed their referral cards and medical records for patient demographics, information on procedures, symptoms, as well as clinical and neurophysiological findings.

Results

Thirty patients (45.4%) had neuropathies remote from procedural sites and 36 patients (54.5%) had neuropathies in close proximity to procedural sites. Half of the remote neuropathies (15/30) developed following relatively short procedures. In 27% of cases (8/30) remote neuropathies were bilateral. Seven patients developed neuropathies remote from operative sites following hip arthroplasties (7/30: 23.3%), making hip arthroplasty the most common procedure associated with remote neuropathies. Sciatic neuropathies due to hip arthroplasty (12/36, 33.3%) accounted for the majority of neuropathies occurring in close proximity to operative sites. Five medial cutaneous nerve of forearm neuropathies occurred following arterio-venous fistula (AVF) formation.

Conclusions

An array of surgical procedures may be complicated by neuropathy. Almost half of post-procedure neuropathies occur remote from the site of procedure, emphasizing the need to try to prevent not just local, but also remote neuropathies. Mechanical factors and patient positioning should be considered in the prevention of post-operative neuropathies. There is a possible association between AVF formation and medial cutaneous nerve of forearm neuropathy, which requires further study for validation.