Ultrasound-guided stereotaxic biopsy using a new apparatus

1986 ◽  
Vol 65 (4) ◽  
pp. 550-554 ◽  
Author(s):  
Mitchel S. Berger
Keyword(s):  
Tissue Sample ◽  
Near Field ◽  
Ct Scanner ◽  
Ultrasound Guided ◽  
Content Type ◽  
Delayed Hemorrhage ◽  
Stereotaxic Biopsy ◽  
Time Required ◽  
Immunodeficiency Syndrome ◽  
Burr Holes

✓ A skull-mounted apparatus is described for use with ultrasound probes 16 mm in diameter (5.0-MHz probes for near-field and 7.5-MHz probes for far-field lesions). The system permits ultrasound-guided stereotaxic biopsy of intracranial lesions through a burr hole in awake or anesthetized patients. This apparatus has been used in 19 patients for biopsy of central nervous system lesions 1.5 to 5 cm in diameter and for drainage of abscess cavities and cysts. The time required to obtain a tissue sample after incision of the skin ranged from 25 to 40 minutes. The only complication was a delayed hemorrhage in a patient with acquired immunodeficiency syndrome. The advantages of this method over those guided by computerized tomography (CT) include less time required for the entire procedure, immediate confirmation of the biopsied target by imaging the echogenic needle track, assessment of cyst or abscess drainage, and detection of hemorrhage within minutes after biopsy. The apparatus may be especially useful in pediatric patients because it obviates the need for general anesthesia during transport to and from the CT scanner. This ultrasound-guided system does not require a craniotomy, craniectomy, or two separate burr holes.

Hyperthermia catheter implantation and therapy in the brain

1990 ◽  
Vol 72 (6) ◽  
pp. 975-979 ◽  
Author(s):  
J. Alexander Marchosky ◽  
Christopher J. Moran ◽  
Neal E. Fearnot ◽  
Charles F. Babbs
Keyword(s):  
Computerized Tomography ◽  
Malignant Gliomas ◽  
Twist Drill ◽  
Ct Scanner ◽  
Tumor Blood Flow ◽  
Content Type ◽  
Catheter Implantation ◽  
Computer Controlled ◽  
Drill Holes ◽  
The Brain

✓ For the treatment of malignant gliomas, a technique for implanting hyperthermia catheters was developed that utilized a stereotactic template and head-stabilization frame mounted on a computerized tomography (CT) scanner. Computerized tomography scans were used to measure tumor dimensions and to determine the number, implantation depths, and active heating lengths of the catheters, which were implanted through twist-drill holes while the patient was in the CT room. Heat was subsequently delivered via implanted catheters using a computer-controlled hyperthermia system, which partially compensates for heterogeneous and time-varying tumor blood flow.

Preliminary experience with Brown-Roberts-Wells (BRW) computerized tomography stereotaxic guidance system

1983 ◽  
Vol 59 (2) ◽  
pp. 217-222 ◽  
Author(s):  
M. Peter Heilbrun ◽  
Theodore S. Roberts ◽  
Michael L. J. Apuzzo ◽  
Trent H. Wells ◽  
James K. Sabshin
Keyword(s):  
Ct Scan ◽  
Computerized Tomography ◽  
Guidance System ◽  
Production Model ◽  
Ct Scanner ◽  
Content Type ◽  
Ct Scanners ◽  
Guidance Systems ◽  
Fine Print

✓ The production model of the Brown-Roberts-Wells (BRW) computerized tomography (CT) stereotaxic guidance system is described. Hardware and software modifications to the original prototype now allow the system to be used independently of the CT scanner after an initial scan with the localizing components fixed to the skull. The system is simple and efficient, can be used universally with all CT scanners, and includes a phantom simulator system for target verification. Preliminary experience with 74 patients at two institutions is described. It is concluded that CT stereotaxic guidance systems will become important tools in the neurosurgical armamentarium, as they allow accurate approach to any target identifiable on the CT scan.

First-Attempt Success Rate of Ultrasound-Guided Peripheral IV Access using a Handheld Ultrasound Machine in a Simulation Model

2021 ◽  
Vol 104 (Suppl. 1) ◽  
pp. S30-S34
Keyword(s):  
Simulation Model ◽  
Success Rate ◽  
Training Session ◽  
Confidence Score ◽  
Ultrasound Guided ◽  
Emergency Nurses ◽  
Handheld Ultrasound ◽  
Kolmogorov Smirnov ◽  
Application Data ◽  
Time Required

Background: Although peripheral Intravenous (IV) cannulation is a routine procedure performed by nurses, IV access can be difficult to achieve, particularly in emergency patients who have critical illnesses. Ultrasound is used in this procedure to increase the success rate in novice practitioners. Objective: We aimed to determine the first-attempt success rate of ultrasound-guided peripheral IV (USGPIV) performed by emergency nurses in simulation model after having undergone training in the procedure. Materials and Methods: This was prospective descriptive study. The participants consisted of 61 emergency nurses at Srinagarind Hospital Emergency Department from January to April 2020. USGPIV cannulation training was provided by an emergency physician who is also a specialist in emergency ultrasound. After training, we calculated the number of attempts and time required to successfully complete USGPIV in a simulation model. Following this, participants responded to a questionnaire to evaluate their confidence in performing the procedure, as well as its feasibility and practical application. Data were analyzed using a Kolmogorov-Smirnov test, and p<0.05 was considered to be significant. Results: Sixty-one emergency nurses were included. The first-attempt success rate of USGPIV was 85.25% (95% CI 0.761, 0.944), and the mean time required was 47.33+4.89 sec. (95% CI 37.547, 57.103). Fifty-nine participants (96.72%) completed the questionnaire. All items had a mean score of greater than 3 points, with confidence score being the highest. Conclusion: Emergency nurses with no previous experience with USGPIV were able to perform a simulated version of the procedure with a high first-attempt success rate after a short training session. Further studies should be conducted to evaluate nurses’ USGPIV competency in real patients. Keywords: Ultrasound, Peripheral IV cannulation, Emergency medicine, Emergency nurse

scholarly journals Time required to move cash through slot machines

2018 ◽  
Vol 21 (3) ◽  
pp. 376-384 ◽  
Author(s):  
Karen Kelly ◽  
Carl James Schwarz ◽  
Ricardo Gomez ◽  
Kim Marsh
Keyword(s):  
British Columbia ◽  
Slot Machines ◽  
Content Type ◽  
The Public ◽  
Average Value ◽  
The Mean ◽  
Time Required ◽  
Rest Breaks ◽  
Mean Time ◽  
Practical Implications

Purpose The purpose of this paper is to present an empirical study on the time needed to load and disburse cash using bill validators on slot machines and stand-alone cash dispensers in casinos in British Columbia under a Ticket In Ticket Out (TITO) system. Design/methodology/approach Testing took place over two days, using 18 machines. The results were extrapolated to estimate the approximate time required to process $1,000,000 with different average bill amounts in the cash mix and three different bill validator machines in common use. The average value per bill using the cash mix used by the public in the casino was $33.11 [standard error (SE) $2.11]. Findings The mean time/accepted note ranged from 4.12 to 9.65 s, depending on bill validator type. This implies that the time needed to load $1,000,000 onto credit slips using bill validators on slot machines ranges from 35 to 81 h, excluding rest breaks and other breaks. The time needed to redeem $1,000,000 is estimated to be 3 h. Practical/implications The implications of these finding for illicit actors to successfully launder large amounts of cash are discussed. Given the time needed to physically handle the cash, and other control systems currently in use in casinos in British Columbia, processing large amounts of cash using bill validators on slot machines would require a highly organized team that would find it difficult to elude detection. Originality/value The trial results provide a baseline estimate to be used going forward when investigating or proposing money laundering methodologies that include slot machines.

A Novel Introducer for Ultrasound-Guided Cryoneurolysis Administration to Improve Patient Safety an d Functionality

2020 ◽  
pp. 217-220
Author(s):  
JOhn J. Finneran IV
Keyword(s):  
Peripheral Nerve ◽  
Postoperative Analgesia ◽  
Local Anesthetic ◽  
Improve Patient Safety ◽  
Femoral Nerve ◽  
Needle Insertion ◽  
Ultrasound Guided ◽  
Needle Pass ◽  
Time Required ◽  
Local Anesthetic Injection

Background: Percutaneous cryoneurolysis provides prolonged postoperative analgesia by placing a probe adjacent to a peripheral nerve and cooling the probe tip, inducing a reversible block that lasts weeks to months. Unfortunately, freezing the nerve can produce significant pain. Consequently, local anesthetic is generally applied to the nerve prior to cryoneurolysis, which, until now, required an additional needle insertion increasing both the risks and duration of the procedure. Case Presentation: Three patients underwent ultrasound-guided percutaneous cryoneurolysis of either the sciatic and saphenous nerves or the femoral nerve. In all patients, the local anesthetic injection and cryoneurolysis were accomplished with a single needle pass using the novel probe introducer. Conclusion: This introducer allows perineural local anesthetic injection followed immediately by cryoneurolysis, thereby sparing patients a second skin puncture, lowering the risks of the procedure, and decreasing the overall time required for cryoneurolysis. Key words: Cryoablation, cryoanalgesia, peripheral nerve block, postoperative analgesia, ultrasound

Fast and numerically stable Mie solution of EM near field and absorption for stratified spheres

2022 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Olivér Csernyava ◽  
Bálint Péter Horváth ◽  
Zsolt Badics ◽  
Sándor Bilicz
Keyword(s):  
Near Field ◽  
Human Head ◽  
Approximate Model ◽  
Head Model ◽  
Wave Regime ◽  
Content Type ◽  
Precise Calculation ◽  
Linearly Polarized ◽  
Numerical Instabilities ◽  
Computational Resources

Purpose The purpose of this paper is the development of an analytic computational model for electromagnetic (EM) wave scattering from spherical objects. The main application field is the modeling of electrically large objects, where the standard numerical techniques require huge computational resources. An example is full-wave modeling of the human head in the millimeter-wave regime. Hence, an approximate model or analytical approach is used. Design/methodology/approach The Mie–Debye theorem is used for calculating the EM scattering from a layered dielectric sphere. The evaluation of the analytical expressions involved in the infinite sum has several numerical instabilities, which makes the precise calculation a challenge. The model is validated through an application example with comparing results to numerical calculations (finite element method). The human head model is used with the approximation of a two-layer sphere, where the brain tissues and the cranial bones are represented by homogeneous materials. Findings A significant improvement is introduced for the stable calculation of the Mie coefficients of a core–shell stratified sphere illuminated by a linearly polarized EM plane wave. Using this technique, a semi-analytical expression is derived for the power loss in the sphere resulting in quick and accurate calculations. Originality/value Two methods are introduced in this work with the main objective of estimating the final precision of the results. This is an important aspect for potentially unstable calculations, and the existing implementations have not included this feature so far.

scholarly journals Sustaining open innovation through a “Center of Excellence”

2019 ◽  
Vol 47 (3) ◽  
pp. 19-26 ◽  
Author(s):  
Elizabeth E. Richard ◽  
Jeffrey R. Davis ◽  
Jin H. Paik ◽  
Karim R. Lakhani
Keyword(s):  
Open Innovation ◽  
Business Strategy ◽  
Pilot Scale ◽  
Lessons Learned ◽  
Cultural Issues ◽  
Content Type ◽  
Center Of Excellence ◽  
And Performance ◽  
Time Required ◽  
The Right

Purpose This paper presents NASA’s experience using a Center of Excellence (CoE) to scale and sustain an open innovation program as an effective problem-solving tool and includes strategic management recommendations for other organizations based on lessons learned. Design/methodology/approach This paper defines four phases of implementing an open innovation program: Learn, Pilot, Scale and Sustain. It provides guidance on the time required for each phase and recommendations for how to utilize a CoE to succeed. Recommendations are based upon the experience of NASA’s Human Health and Performance Directorate, and experience at the Laboratory for Innovation Science at Harvard running hundreds of challenges with research and development organizations. Findings Lessons learned include the importance of grounding innovation initiatives in the business strategy, assessing the portfolio of work to select problems most amenable to solving via crowdsourcing methodology, framing problems that external parties can solve, thinking strategically about early wins, selecting the right platforms, developing criteria for evaluation, and advancing a culture of innovation. Establishing a CoE provides an effective infrastructure to address both technical and cultural issues. Originality/value The NASA experience spanned more than seven years from initial learnings about open innovation concepts to the successful scaling and sustaining of an open innovation program; this paper provides recommendations on how to decrease this timeline to three years.

Titanium miniplates or stainless steel wire for cranial fixation: a prospective randomized comparison

2002 ◽  
Vol 96 (2) ◽  
pp. 244-247 ◽  
Author(s):  
William C. Broaddus ◽  
Kathryn L. Holloway ◽  
Charles J. Winters ◽  
M. Ross Bullock ◽  
R. Scott Graham ◽  
...  
Keyword(s):  
Stainless Steel ◽  
Steel Wire ◽  
Stainless Steel Wire ◽  
Bone Flap ◽  
Content Type ◽  
Wire Fixation ◽  
Time Required ◽  
Titanium Miniplate ◽  
To Receive ◽  
Fine Print

Object. The authors designed a study to compare low-profile titanium miniplate fixation to that in which stainless steel wire is used. Methods. Before undergoing craniotomy, 40 patients gave informed consent and were randomized to receive either wire or miniplate fixation. After dural closure, bone flap fixation was timed. The bone flap was measured for inward or outward offset and mobility to manual pressure on its margin. Three months postoperatively the bone flap margins were graded for appearance or palpation of an offset and for the presence of burr hole depressions. Twenty-four patients were randomized to receive miniplate fixation and 16 to receive stainless steel wire fixation. The time required for wire fixation was approximately 40% longer than that for miniplates (11.8 ± 5.1 minutes compared with 8.3 ± 5 minutes, p = 0.02). The offset of bone flaps after wire fixation was significantly greater than that with miniplates (1.6 ± 1 mm compared with 0.3 ± 0.6 mm, p < 0.001), as was the mobility of the bone flap on digital pressure (1.2 ± 0.9 mm compared with 0.2 ± 0.5 mm, p < 0.001). At the 3-month follow-up review, two of 12 patients had suboptimal results after wire fixation, whereas none of 14 patients had suboptimal results after miniplate fixation. When dichotomized for excellent or less-than-excellent postoperative results, the data were significantly better for patients who underwent miniplate fixation (p < 0.05). Conclusions. Titanium miniplate cranial fixation provides more accurate and rigid reapproximation of the bone edges, with results that are significantly better on close inspection or palpation. The additional cost of miniplate fixation may thus be justified in many cases.

Central nervous system leiomyosarcoma in patients with acquired immunodeficiency syndrome

2000 ◽  
Vol 92 (4) ◽  
pp. 688-692 ◽  
Author(s):  
Ann M. Ritter ◽  
Barbara H. Amaker ◽  
R. Scott Graham ◽  
William C. Broaddus ◽  
John D. Ward
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Acquired Immunodeficiency Syndrome ◽  
Content Type ◽  
Barr Virus ◽  
The Central Nervous System ◽  
Histological Characteristics ◽  
Acquired Immunodeficiency ◽  
Epstein Barr ◽  
Immunodeficiency Syndrome

✓ Leiomyosarcomas (LMSs) of the central nervous system are extremely rare; however, they are becoming more prevalent in immunocompromised patients. The authors present the cases of two patients with acquired immunodeficiency syndrome: one with LMS of the thoracic vertebral body and the other with LMS originating from the region of the cavernous sinus. The epidemiological and histological characteristics of LMS and its association with latent Epstein—Barr virus are discussed, as well as the treatments for this neoplasm.

Long-term complications after gamma knife surgery for arteriovenous malformations

2005 ◽  
Vol 102 (Special_Supplement) ◽  
pp. 34-37 ◽  
Author(s):  
Masahiro Izawa ◽  
Motohiro Hayashi ◽  
Mikhail Chernov ◽  
Koutarou Nakaya ◽  
Taku Ochiai ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Arteriovenous Malformations ◽  
Cyst Formation ◽  
Gamma Knife Surgery ◽  
Content Type ◽  
Delayed Hemorrhage ◽  
Complete Obliteration ◽  
Risk Of Hemorrhage ◽  
Fine Print

Object. The authors analyzed of the long-term complications that occur 2 or more years after gamma knife surgery (GKS) for intracranial arteriovenous malformations (AVMs). Methods. Patients with previously untreated intracranial AVMs that were managed by GKS and followed for at least 2 years after treatment were selected for analysis (237 cases). Complete AVM obliteration was attained in 130 cases (54.9%), and incomplete obliteration in 107 cases (45.1%). Long-term complications were observed in 22 patients (9.3%). These complications included hemorrhage (eight cases), delayed cyst formation (eight cases), increase of seizure frequency (four cases), and middle cerebral artery stenosis and increased white matter signal intensity on T2-weighted magnetic resonance imaging (one case of each). The long-term complications were associated with larger nidus volume (p < 0.001) and a lobar location of the AVM (p < 0.01). Delayed hemorrhage was associated only with incomplete obliteration of the nidus (p < 0.05). Partial obliteration conveyed no benefit. Delayed cyst formation was associated with a higher maximal GKS dose (p < 0.001), larger nidus volume (p < 0.001), complete nidus obliteration (p < 0.01), and a lobar location of the AVM (p < 0.05). Conclusions. Incomplete obliteration of the nidus is the most important factor associated with delayed hemorrhagic complications. Partial obliteration does not seem to reduce the risk of hemorrhage. Complete obliteration can be complicated by delayed cyst formation, especially if high maximal treatment doses have been administered.

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