Air in the insufflation tube may cause fatal embolizations in laparoscopic surgery: an animal study

Background

The aim of this study was to evaluate the risk of an air embolization with the volume of the insufflation tube during induction of laparoscopy. A further objective was to determine the LD₅₀ of air in young piglets.

Methods

End-tidal carbon dioxide pressure ( $ P_{{{\text{CO}}_{2} ,{\text{et}}}} $ ), pulmonary arterial pressure (P _pa), heart rate (f _c), and mean arterial pressure (P _{a carot}) were measured in 17 piglets divided into three groups: group 1 (n = 6), bolus application (CO₂ embolization, followed by air embolization, 2 mL/kg each), group 2 (n = 7), continuous air embolization (30 min, 0.2 mL/kg/min), and group 3 (n = 4), continuous CO₂ embolization (30 min, 0.4 mL/kg/min).

Results

All animals survived CO₂ embolism. Air embolization as a bolus (2 mL/kg) or with an accumulated volume of 3.1 mL/kg led to death. Decreases in $ P_{{{\text{CO}}_{2} ,{\text{et}}}} $ indicated air or massive CO₂ embolization only. There was a good correlation between $ P_{{{\text{CO}}_{2} ,{\text{et}}}} $ and P _pa in case of air embolization (r = ?0.80, p < 0.0001). In contrast, no dependency was recognized during CO₂ embolism (r = ?0.17, p = 0.2).

Conclusions

In order to minimize the lethal risk of gas embolization, the insufflation system has to be completely filled with CO₂ before connecting to the patient.     

Clinical evaluation of direct pulp capping using a calcium silicate cement—treatment outcomes over an average period of 2.3 years

Objectives

This study aims to assess the treatment outcomes of direct pulp capping with a calcium silicate cement (Biodentine) after caries excavation.

Materials and methods

A total of 245 teeth of 226 patients diagnosed to be clinical healthy or showing spontaneous pain were directly capped. The teeth were examined 0.19 to 7.4 (mean 2.3 ± 2.04) years after treatment. The following data were recorded: age and sex of the patient, type of tooth and restoration (glass ionomer cement [GIC], amalgam, composite resin, ceramic, gold) and symptoms before or after treatment. The evaluation of the treatment was carried out by sensibility and percussion testing and by the patient’s questioning. A positive sensibility test, a negative percussion test, the absence of swelling and discomfort were considered as treatment success. Survival analysis was performed using the Kaplan-Meier, log-rank, Chi-square and Fisher’s exact test, respectively.

Results

After an average period of 2.3 years, 86.0% of the teeth remained vital; the survival rate after 7.4 years was 83.4%. The treatment outcome was significantly worse for cavities restored with GIC compared to all other restorative materials (p < 0.05). All other evaluated factors had no significant influence on the success rate (p > 0.05).

Conclusion

Exposed pulps of asymptomatic vital permanent teeth and teeth with spontaneous pain before treatment can be successfully capped directly using Biodentine. A subsequent restoration with GIC does not appear to be suitable as it significantly reduces the success of the treatment.

Clinical relevance

Direct pulp capping can be done successfully with this type of calcium silicate cement.

     

RACER: dynamic use of environmental measurement data for decision making and communication

To facilitate access to and use of environmental measurement data, Risk Assessment Corporation has developed a data management system as part of its Risk Analysis, Communication, Evaluation, and Reduction process. The concepts of data consistency are not new, but many data management applications are developed around managing the entire data life cycle, rather than on using the data to reach meaningful conclusions. The RACER process is specifically focused on the efficient use of available data to promote sound decision making. The RACER data management system provides a means of understanding trends in data, comparing data to frequently referenced comparison values, and organizing environmental measurement data for use by other components of the RACER process that evaluate human health impacts. Data transfers to the system can be automated to occur frequently for facilities collecting large volumes of data to achieve a dynamic point of access to measurement data that reflects the most recently available information. Because the RACER process is designed around the most common uses of data, its utility spans a broad range of potential applications, from routine monitoring and reporting to emergency response decision making based on potential human health impacts. Because it is portable and flexible, the elements of the system can be used in any situation where there is a need to efficiently access and interpret environmental measurement data. Its output and functions are equally relevant for small datasets with hundreds of measurements or large and complex datasets with millions of measurements.     

Histological ex vivo analysis of retrieved human tantalum augmentations

Purpose

The characteristics of tantalum augment osseointegration in human ex vivo specimens from re-revision procedures are unknown and limited data in this regard is available. The purpose of this study was to investigate the osseointegration pattern into porous tantalum augmentations harvested during re-revision procedures.

Methods

Between 2007 and 2010 a total of 324 hip and knee revisions with a tantalum augmentation were performed in our institution. Out of this cohort, seven patients (2.2 %) had to be re-revised. To analyse the status of trabecular ingrowth in the retrieved cases (four hips, three knees), all specimens were analysed by contact radiography, subjected to undecalcified processing, histology, thin-section analysis and backscattered electron imaging.

Results

Trabecular and vascular ingrowth could be found along the bone-augment-interface in two of seven revised specimens, respectively. The depth of bone ingrowth reached up to 2.6 mm. However, the analysis of the remaining cases revealed no bony ingrowth into trabecular metal. Rather, large parts of the implants were embedded in cement or pores were filled with autologous bone.

Conclusions

Although the cause for the missing bony ingrowth seems to be multifactorial, some fundamental conditions, such as the provision of the greatest possible interface between the tantalum implant and the host bone, should be met and thus, bone cement and autologous bone grafts should be used with caution.     

Perioperative quality of care is modulated by process management with clinical pathways for fast-track surgery of the colon

Purpose  

Clinical pathways (CPs) are increasingly used to improve quality of care. However, evidence if such improvements are also feasible in fast-track colorectal surgery is lacking. This study evaluates effects of a CP for fast-track colonic resections with respect to process and outcome quality.