fiber optics in orthopedics

Cornelia de Lange Syndrome is a well-known congenital disease characterized by multiple malformations that make anesthetic management a challenge. Since few individuals survive the earliest stage of life, papers describing the details of anesthetic management are mainly reported in the pediatric population. These individuals who move into adulthood develop physical changes that should be taken into consideration. This article reports the case of a 34-year-old patient undergoing an orthopedic procedure. The operation was performed under general anesthesia because the patient showed severe scoliosis and joint contractures, so extraordinary difficulty in neuroaxial and peripheral techniques was expected...

Cornelia de Lange Syndrome is a well-known congenital disease characterized by multiple malformations that make anesthetic management a challenge. Since few individuals survive the earliest stage of life, papers describing the details of anesthetic management are mainly reported in the pediatric population. These individuals who move into adulthood develop physical changes that should be taken into consideration. This article reports the case of a 34-year-old patient undergoing an orthopedic procedure. The operation was performed under general anesthesia because the patient showed severe scoliosis and joint contractures, so extraordinary difficulty in neuroaxial and peripheral techniques was expected...

OBJECTIVE: To investigate the clinical value and safety of holmium: YAG laser endoureterotomy in the treatment of ureteral obstruction. METHODS: Holmium: YAG laser endoureterotomy, with the laser optic fiber 550 microm in diameter and the output power of 3.5 Watt, via ureteroscopy, was performed on 18 patients ureteral obstruction, 8 males and 10 females, aged 52.1 (34-67), 11 with the stricture in the upper segment (complete obstruction in 4 cases), 5 in the middle segment, and 2 in lower segment; and 6 cases complicated with ureteral calculus...

BACKGROUND: The native anterior cruciate ligament (ACL) does not behave as a simple bundle of fibers with constant tension but as a continuum of ligament fibers with differential length change during knee flexion/extension. Computer-assisted navigation can be used to assess length change in different fibers within the native ACL and to evaluate how different reconstruction grafts replicate the range of native ligament fiber length change behavior. HYPOTHESIS: Anterior cruciate ligament reconstruction graft size and configuration (single-vs double-bundle) are deciding factors as to how much of the native ACL fiber length change behavior is replicated...

Rotational acetabular osteotomy (RAO) has an important advantage in that surgical bony defects are reconstructed with a patients' own tissue. We propose a surgical robot for the RAO using Er:YAG laser irradiating mounted on iliac bone to operate RAO precisely and to reduce recovery and trauma. A water-cooling Er:YAG laser (30 J/cm/sup 2/, l=2.94 mum, 20 Hz, 200 msec) that used optical fiber was operated 4-8 irradiation-overlapping ratio. We kept the distance between the laser and the bone at 0.25 mm using force sensor and spring to maintain effective ablation...

Nanotechnology involves the use of materials with components, such as fibers, grains and particles, that have dimensions of less than 100 nm. While numerous advantages of nanomaterials have been elucidated for catalytic, processing, mechanical, electrical, and optical applications, few have been described for orthopedic applications. Better orthopedic biomaterials are needed since the average lifetime of a bone biomaterial is less than 15 years. This review discusses recent studies that have been conducted to determine the efficacy of nanophase materials as bone implants...

Radiofrequency current and laser energy can be delivered locally through electrode-needle or optical fiber inserted in the tissue and allows local ablation of tissues, up to a volume of 4 to 5 cm in diameter with one application or vaporizes tissue. Tumor ablation guided with medical imaging proved a high local efficacy over 90% for tumors less than 25 mm in the liver, lung, and kidney. The spinal applications of the thermal energy of RF and laser are reported in this paper. First, the tumor ablation is reviewed with malignant and benign tumors...

In some situations, patients need endotracheal intubation to maintain airway patency while they are constrained in the lateral position. In this study we compared lightwand-guided intubation of 120 randomly enrolled patients placed in the supine, right, or left lateral position. Group S patients were initially placed in the supine position, and subsequent to the artificial airway having been established they were turned to the lateral decubitus position. Group R patients were initially placed in a right decubitus position during induction and intubation...

Miniinvasive surgery together with general anesthesia, the antibiotherapy and the transplant, the argon laser, the electric and ultrasound scalpel, the mechanical sutures and imagistic techniques are "a new surgical era". The cystoscope Nietze, the Veres needle and the insufflations system with flow and pressure control, the improvement of laparoscopes, the invention of endoscopes with optical fibers, the miniaturized video camera connected to a video monitor and the fabrication of instruments of 10, 3 and 3 mm diameter permitted the rapid develop of miniinvasive surgery...

Over the past decade, orthopedic surgery has embraced an increase in the depth of cement penetration into the adjacent cancellous bone structure. The resultant interdigitation transforms this zone into a thick layer of continuous interpenetrating composite material. The failure behavior of the composite formed with a number of potential bone cements with different bonding ability was investigated. The cancellous bone-cement composites exhibit considerable resistance to crack extension, and in situ optical observation indicates that the contribution of the cancellous bone is analogous to that of a typical fiber bridging process...

Partial upper airway obstruction during spontaneous respiration with a ProSeal laryngeal mask airway can result in gastric distention.

OBJECTIVE: The objective of this study was to investigate the possible existence of a set of critical combinations among medical CO2 laser device set-ups and to compare the resigns of diameter and depth of irradiated tissue. These data are useful to the surgeon to identify a general operative protocol that allows both to forecast the beam behavior on a large variety of operative conditions accurately and to identify the related safety margins. Two methods have been addressed: the more traditional free-air beam delivery to the tissue and the more modern requirements of the minimally invasive surgery concepts, which use fiberoptic-based delivery systems for the CO2 laser beam...

PURPOSE: Difficult intubation is a major problem in anesthesia. In case of limited mouth opening only a few intubating devices are available. Our study was designed to evaluate the effectiveness and safety of a modified transillumination technique for nasotracheal intubation (NTI). METHODS: One hundred twenty-three patients needing NTI were studied, 76 in group A: NTI with no expected intubation difficulty; and 47 in group B: limited mouth opening (<20 mm). All intubations were performed with the Trachlight(TM)...

Surgical video systems (SVSs), which typically consist of a video camera attached to an optical endoscope, a video processor, a light source, and a video monitor, are now being used to perform a significant number of minimally invasive surgical procedures. SVSs offer several advantages (e.g., multiple viewer visualization of the surgical site, increased clinician comfort) over nonvideo systems and have increased the practicality and convenience of minimally invasive surgery (MIS). Currently, SVSs are used by hospitals in their general, obstetric/gynecologic, orthopedic, thoracic, and urologic procedures, as well as in other specialties for which MIS is feasible...

Twelve cadaveric shoulder arthroscopies were performed to evaluate the use of lasers as an adjunctive tool in arthroscopic shoulder surgery. The three most common lasers historically used in orthopedic surgery were examined: Holmium:YAG, Neodymium:YAG, and the CO2. The following parameters were evaluated for each laser system: (1) ease of use of the laser system and handpiece; (2) ability to excise and trim bursae, synovium, ligament, tendon, bone, and articular cartilage; and (3) ability to contract ligaments and capsule by heat transfer...

A 79 year old female was admitted to CTO Intensive Care Unit in the immediate postoperative period of orthopedic surgery. A Swan-Ganz fiber optic catheter was inserted through the right internal jugular vein but it was not possible to obtain a satisfactory tracing off pulmonary artery occlusion pressure. We experienced a remarkable trouble to withdraw the catheter in order to repeat the insertion. A chest-X-ray was performed and it showed a knot of the catheter in the right ventricle. It was possible to extract the knotted catheter through original venotomy so avoiding surgery...

With the advent of magnetic resonance fluoroscopic imaging, it is possible to obtain images at a rate which can be considered effectively real-time. Image refresh rates can be as low as 0.5 s. Such rates are fast enough to allow MR to be used for guidance of surgical instruments during micro-surgical procedures. Examples include the localization of biopsy needles within a tumor, localization of surgical tools for application of therapeutic drugs or the proper positioning of optical fibers for application of laser heat...

Videoarthroscopy is used by most orthopedic surgeons who do a significant volume of arthroscopic surgery. Constant advancement in technology and equipment requires an understanding of the various components of the videoarthroscopic system. The future will bring more simplified systems that combine the solid state camera, light source, and arthroscope. The potential to interface the digital data with computers for storage will enhance record keeping. However, no matter what new developments there are, the quality of the image will be no better than the compatibility of the entire videoarthroscopic system and how it is used by the surgeon...

Intraarticular pressure (IAP) was continuously monitored during continuous passive motion (CPM) of five normal and 11 abnormal human knees using a new fiberoptic, transducer-tipped Camino catheter. IAP varied in a consistent hysteresis pattern in the normal knees, with subatmospheric pressures recorded at intermediate angles of joint flexion. A similar pattern was recorded in the abnormal knees without cruciate ligament pathology, whereas considerable variability was noted in the knees with cruciate ligament abnormality...

A comprehensive knowledge of operating microscope, microsurgical instruments and microsutures is most essential for any beginner in this field. Magnification provided by an operation microscope is higher and variable to suit microsurgical procedures. Although zoom magnification and focussing are preferable for convenience, microscopes with manual controls can be used for clinical and experimental work. A beam splitter and camera equipment are essential accessories. Microsurgical instruments are delicate and expensive and must be bought with discretion and carefully protected...