This paper presents a semi-automatic robotic system supporting a surgeon in the harvesting of the internal mammary artery (IMA) for an open chested intervention in coronary revascularisation surgery. The versatile surgical lightweight robot MIRO developed at DLR (German Aerospace Center) is used to detect and mark the path of the IMA at the inner side of the thoracic wall. The robot is equipped with a tool combining a Doppler ultrasonography (US) probe and a medical marker pen. The position of the IMA is extracted from the US-images to place the tool above the artery via visual servoing. Additionally, the robot moves the tool in direction of the artery to mark the location of the IMA on it's path. To achieve an ideal contact situation for US-imaging along the whole path the contact force between tissue and probe is controlled according to force measurements based on the internal torque sensors of the robot. The evaluation of the robotic system by an animal experiment shows that the system is capable of robustly detecting the IMA.
A family is reported in which three members had an aneurysm at the junction of the posterior cerebral artery and the carotid artery. Two patients harbonred symmetrically placed bilateral aneurysm each. The cases suggest a hereditary basis for its causation.
Two cases of infectious complications after liver biopsy are reported. Klebsiella pneumoniae and beta-hemolytic Streptococcus were cultured. In both cases the biopsy was obtained under laparoscopic control. A 28-year-old woman with liver cirrhosis died 24 hours after liver biopsy as a result of septic shock and disseminated intravascular coagulation. A 67-year-old man with hepatic fibrosis suffered from transient bacteremia and recovered uneventfully after antibiotic therapy. In these patients, there was evidence to implicate pre-existing cholangitis as factor predisposing to postbiopsy bacteremia.
Background: Epidemiological data in Haemophilia A (HA) report an improvement in haemophilia care over the last 50 years; the life expectancy of these patients now approaches that of the general population but evidence-based guidelines for the acute management and secondary prophylaxis of cardiovascular diseases in haemophilia patients are still lacking, Aims: We report the surgical and haematological strategies used in a mild haemophilia A patient who successfully underwent endovascular aortic aneurysm repair (EVAR) because very little is known about how to handle the increased risk of bleeding associated with invasive procedures and antithrombotic agents Methods: Case report: To our knowledge, about six other haemophilic patients treated with open surgery or EVAR were reported in the literature Results: A 64-year-old man with mild-moderate HA (F8:C 6.9%), without inhibitor was referred for treatment of a symptomatic infrarenal aortic aneurysm that had enlarged from 5.6 cm to 6 cm in diameter in 6 months. Among the personal antecedents: Acute Coronary Syndrome (1997), allergy to FVIII Concentrate of plasmatic origin, traumatic amputation of right lower limb and Arterial Hypertension on treatment.He are VIH positive on antiretroviral triple therapy. The patient was successfully treated with EVAR, Femoro-femoral bypass and right common iliac artery embolization with Coils (Endurant 32 * 14 mm) associated with perioperative administration of titrated doses of recombinant full length 3rd generation factor VIII concentrate (Octocog Alfa, Advateâ, Takeda Lab)(rCF8), administered on bolus The surgery was carried out under general anaesthesia and anticoagulation with bolus of unfractionated heparin(UFH)(Heparin Leoâ 5000 UI) administered inmediately before the surgery and after the perioperative administration of a bolus of aproximately 55 UI by kilogram of Advateâ to achieve a secure level of FVIII presurgery (105 %). 3 hours after the first bolus, an intraoperative control of FVIII was performed (using a chromogenic technique) and a new bolus of rCF8 was administered (aprox 20 UI by kilogram). At the end of surgery the UFH was reversed with protamine sulfate in a 1:1 ratio. To reduce the risk of hematoma, local dry weight and cold were applied after the withdrawal of the introducers. In the first 48 h post he received rCF8 to maintain minimum level of 80% and after, every 12 h/7 days (minimum level 50%) and another 7 days, every 24 h (minimum level 30%), performing antithrombotic prophylaxis (Enoxaparin sodium 40 mg / day) and concomitant antiaggregant therapy(Acetylsalicylic acid 100 mg / day, 2 months).The determination of the postoperative levels of FVIII was carried out by one stage coagulative assay (ACL Top). There were no perioperative complications and he was discharged at day 14, performing the determination of inhibitor at 15 days and 2 months after surgery, being negative (< 0.4 Bethesda units) Summary/Conclusion: This case report shows that EVAR is a relatively safe procedure in haemophilic patients by mean...
Background:Background: GvHD still remains the main cause of transplant-related morbidity and mortality. While the first line
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