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Objective: The volume and complexity of endovascular procedures are increasing. Multidetector computed tomography (CT) made precise three-dimensional (3D) planning of these procedures possible, but intraoperative imaging, even with the use of modern flat-panel detectors, is limited to two dimensions. Flat detectors, however, allow C-arm cone-beam CT. This technology can be used to generate a 3D data set that can be fused with a preoperative high-resolution CT scan, thus generating a live 3D roadmap. We hypothesized that use of a novel image fusion software, VesselNavigator (Philips Healthcare, Best, The Netherlands), facilitates precise and expeditious procedures and therefore reduces radiation exposure and contrast agent dose., Methods: A retrospective review of patients undergoing standard aortobi-iliac endovascular aneurysm repair at our institution between January 2011 and April 2014 was performed. Conventional imaging was compared with VesselNavigator-assisted imaging, and a matched analysis based on body mass index (BMI) was performed because of the dependence of radiation dose on body habitus. Outcome parameters were procedure time, fluoroscopy time, radiation, and contrast agent dose., Results: A total of 75 patients were identified. After matching based on BMI, control and VesselNavigator groups each had 16 patients with BMI of 27.0 ± 3.6 kg/m(2) and 27.0 ± 3.6 kg/m(2), respectively (mean ± standard deviation). R(2) was 6.37 × 10(-7). Radiation dose measured as air kerma was lower with VesselNavigator (1067 ± 470.4 mGy vs 1768 ± 696.2 mGy; P = .004). Fluoroscopy time was shorter (18.4 ± 6.8 minutes vs 26.8 ± 10.0 minutes; P = .01) and contrast agent dose was lower (37.4 ± 21.3 mL vs 77.3 ± 23.0 mL; P < .001) with VesselNavigator compared with control. Procedure time was also shorter with VesselNavigator (80.4 ± 21.2 minutes vs 110.0 ± 29.1 minutes; P = .005)., Conclusions: Image fusion using VesselNavigator enhances the functionality of conventional fluoroscopy in standard endovascular aneurysm repair. It reduces radiation exposure to patients and providers. It also limits the amount of contrast agent and shortens the overall procedure length. The benefit of this technology is demonstrated on this typically straightforward procedure but may be even more useful for complex procedures., (Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

A 72-year-old man was admitted with one blade of a huge pair of shears in his left thorax. His hemodynamics deteriorated due to life-threatening vascular lesions. An urgent thoracotomy revealed several injuries to the intercostal vessels and left apical inferior lung lobe. The blade tip was stuck in the posterior chest wall, 2 cm adjacent to the descending aorta. The blade was removed, the lung was sutured, and the patient made a good recovery.

We describe a scheme of molecular tagging velocimetry in air in which nitric oxide (NO) molecules are created out of O2 and N2 molecules in the focus of a strong laser beam. The NO molecules are visualized a while later by laser-induced fluorescence. The precision of the molecular tagging velocimetry of gas flows is affected by the gradual blurring of the written patterns through molecular diffusion. In the case of turbulent flows, molecular diffusion poses a fundamental limit on the resolution of the smallest scales in the flow. We study the diffusion of written patterns in detail for our tagging scheme which, at short (micros) delay times is slightly anomalous due to local heating by absorption of laser radiation. We show that our experiments agree with a simple convection-diffusion model that allows us to estimate the temperature rise upon writing. Molecular tagging can be a highly nonlinear process, which affects the art of writing. We find that our tagging scheme is (only) quadratic in the intensity of the writing laser.

The aim of this study was to determine whether compliance with infection control measures for the care of patients during and after cardiothoracic surgery could be improved by using 'plan-do-study-act' (PDSA) improvement cycles in a 715-bed university hospital. The endpoints of these cycles were indices of correct procedure based on infection control standards. The intervention consisted of instruction and training of nursing and medical staff on the use of PDSA cycles, feedback of the baseline measurements, and the use of posters in the proximity of the operating room (OR). At follow-up, overall compliance only improved in the room used by the perfusionists and the OR. After the follow-up period, monitoring revealed a drop in compliance in the OR, but improved compliance during vascular catheter care of patients with prolonged stay in the intensive care unit (ICU), and during wound care of patients on the nursing ward. The last series of monitoring showed that compliance with general infection control measures in the OR had improved again, and that compliance had remained satisfactory on the ward and in the ICU, with the exception of patients recently transferred to the ICU from the OR. The results show that by using PDSA cycles, compliance with infection control measures can improve significantly. However, repeated monitoring is necessary to ensure continued compliance.

Objective: Postoperative wound infections generally cause considerable extra morbidity, mortality and costs. As nowadays length of hospitalization shortens, post-discharge surveillance is important to get reliable information on the prevalence of postoperative wound infections. In this study, the prevalences of sternal wound (SWI) and donor site infections (DSI) during hospitalization as well as, 30 and 90 days after cardiac surgery were studied paying special attention to the contribution of post-discharge surveillance., Methods: A total of 1885 patients who underwent cardiac surgery were included in the study and were followed for the prevalence of SWI or DSI up to 90 days postoperatively. Infection data during hospitalization were collected using medical records, bacteriological results and systematic observations of infection control nurses. After discharge from the hospital, data were collected with the help of the out-patient clinic and the family physician., Results: After cardiac surgery, SWI and DSI were diagnosed in 4.7 and 1.5% of patients during hospitalization, in 6.8 and 4.6% at 30 days postoperatively, and in 9.0 and 7.3% of patients at 90 days postoperatively. Of the 90-days postoperative infections rates almost half of SWI and 80% of DSI were diagnosed post-discharge, a result predominantly achieved by the active participation of the family physicians., Conclusions: After 30 and 90 days follow-up of patients after cardiac surgery, additional sternal wound and donor site infections were diagnosed compared with the in-hospital infection rate. Post-discharge surveillance is essential for a reliable assessment of surgical wound infections.