- Email: [email protected]
News in ORbit
NEWS IN ORbit
SURGERY REARRANGES BABY'S HEART A six-week old baby boy had two pioneer heart operations to correct four birth defects. The success of the operation should encourage surgery on otherwise hopeless cases. At birth, the baby appeared normal, but a few days later his breathing became labored and his skin turned blue. Cardiac and pediatric specialist, Dr. Lynfield, of New York University Medical Center, realized the baby was in heart failure, probably caused by a transposition of the great vessels leading from the heart and that surgery might be able to save the baby. Two days of tests at the intensive care unit at Beth Israel Hospital confirmed these observations and revealed further complications. The pulmonary artery and the aorta were transposed from their normal positions: The pulmonary artery normally extending from the right ventricle and heading for the lungs to get oxygenated blood, was, in this case, extending from the left ventricle. The aorta, normally stemming from the left ventricle, in this case stemmed from the right ventricle. Additionally, the aorta was obstructed by a condition known as preductal coarctation. The patent ductus, a large connection between the aorta and pulmonary artery, failed to close up at birth. The defects caused five times the normal amount of blood to be pumped into the lungs and to cope with this
16
enormous volume the heart was overexerted. A team of twelve surgeons opened the blocked aorta, cut the ductus and placed a band on the pulmonary artery, which reduced the excessive flow of blood to the lungs. In the second operation three days later a large opening was created between the upper heart chambers. This resulted in a better distribution of blood between the two sides of the circulatory system. Both operations relieved the blood flow to the lungs, assuring an adequate amount of oxygenated blood to the body. Complications during the surgery included an irregular heart beat, collapse of a lung, intravenous feeding, and high acid levels in the blood, which all had to be corrected over a 16-day period in the intensive care unit. (New York Times)
TITANIUM USED IN SURGICAL IMPLANTS Prostheses must adapt to the body's environment ; materials must be compatible with contiguous tissues of the body. One big problem with surgical implants is to determine what materials to make them from. The metal titanium has many characteristics which make it significantly useful for surgical implants. It has excellent strength, is extremely resistant to corrosion in body environments, and is Continued on page 19
AORN Journal
Continued from page I 6
adaptable to sterilization by any method. The metal is being used for an aortic heart valve that can be positioned by the surgeon without sutures. The device, a MagovernCromie valve, requires a special insertion tool for positioning. It is then held permanently in place by a series of interdigitating needles. The needles are affixed into the surrounding tissue simultaneously by the insertion tool. Other components of the valve include a Silastic ball in a titanium cage, a teflon ventricular base and a knitted dacron cuff. Implants utilizing titanium and its alloys are hip nails and screws, hip prostheses, and plates of various configurations. Research has produced a knee prosthesis for dogs. It will provide data for application to the human body. The device weighs 5 ounces and compares favorably to a 9 ounce stainless steel device. (U.S.I. Chemical News) GRANTS FOR POST-RN STUDY In the April, 1967, Journal is a listing of scholarships, grants and loans available to registered nurses. Here are some additional grants which the Nurses’ Educational Funds, Inc., has announced:
1) The American Journal of Nursing Company announced eight new scholarships of $1,000 for registered nurses working toward their baccalaureate degree, and five fellowships of $6,000 for nurses working for their doctorate degree.
2) Three $1,000 scholarships for registered nurses specializing in rehabilitation nursing have been established by the Paralyzed Veterans of America, Inc., of the National Paraplegia Foundation and World Veterans Federation. Be sure that you get your applications for these and other NEF awards to the NEF office by February 1 of the academic year. For more information write: Nurses’ Educational Funds, 10 Columbus Circle, N. Y. 10019.
August 1967
GAS JET CLEANS CORONARY ARTERIES A team of Brooklyn surgeons led by Dr. Philip Sawyer reports a successful operation to remove obstructions from the coronary artery. A 44-year-old female patient, the first to undergo the operation, had suffered two heart attacks, and X-rays revealed that her right coronary artery was blocked by fatty deposits along its wall. During the 3$$ hour operation, a heart-lung machine maintained circulation when the heart was stopped for about 35 minutes. Also, a cooling system was used to reduce body temperature, lower metabolism and the amount of blood required by the brain. The blocked right coronary artery was exposed and surgeons inserted a fine hypodermic needle attached to a carbon dioxide cylinder. Quick jets of gas loosened the atherosclerotic deposits and then an incision in the artery wall facilitated removal of fatty material and the blood clot with a forceps. (Newsweek ) HYPERBARIC UNIT PRESENTS TOXICITY PROBLEM Patients who are enclosed in a hyperbaric chamber, administered 100 per cent oxygen, and subjected to conditions of increased atmospheric pressure have had desired therapy for a number of maladies. However, the use of oxygen at elevated pressures for therapeutic purposes presents a complicating problem of toxicity. I n Horizons, a publication of the Columbia University College of Pharmaceutical Sciences, Dr. Spiro P. Loucas states: “The indiscriminate use of hyperbaric oxygenation can give rise to disturbances of the central nervous system manifested in convulsive seizures . . . substernal distress and pulmonary atelectasis can occur. The threshold to each of these toxic states is vague.” Dr. Loucas is an advisory committee member of hyperbaric Continued on, page 21
19
Continued from page 19
oxygenation at Mt. Sinai Hospital, N. Y. In working with gases, the axiom applies that with increasing partial pressures, gases tend to exhibit toxic manifestations. Two observations are characteristic of complicating factors states Dr. Loucas: a lag period is evident before the symptoms of toxicity appear ; and, the toxic effects are usually reversed by a return to atmospheric pressure. To control onset of convulsive symptoms when prolonged exposure time is needed, anticonvulsant and barbiturate agents are used, but have not shown much promise. There is a question as to whether these agents have a beneficial effect on underlying disturbances. Hyperbaric oxygenation is finding greater application in treatment of carbon monoxide poisoning, and high oxygen exposures have met with considerable success in treatment of anaerobic infections. It is the choice treatment of Clostridium welchii (gas gangrene) infections. Also, great interest with this type of therapy has occurred relating to surgical procedures of coronary occlusion and other forms of ischemic disease. Studies are in progress at Mt. Sinai Hospital to determine toxicity thresholds under hyperbaric conditions. A means of detecting the onset of deleterious effects of exposure needs to be perfected. Also, more basic pharmacological and biochemical research is important. (Horizons) OBSTETRIC TECHNICIAN’S COURSE
A 30-week course at Albert Einstein College of Medicine, N. Y., will train nurse’s aides for service as obstetric technicians in city hospitals. This new category of worker in city hospitals did not exist before the program was started about two years ago by Dr. J. J. Smith, associate professor of clinical gynecology and obstetrics at the medical school and director of that service at Lincoln Hospital, where the training is supervised. A class of 24
dugust 1967
nurse’s aides selected from eight city hospitals is now training at Lincoln. Upon completing the course, aides will qualify for more skilled duties in maternity wards and in labor, delivery, and operating rooms, supplementing nurses in those areas. The first class of nine women was graduated on April 15, 1966, and since then, 13 women have taken the course. (Medical Tribune) “G-SUIT” FOR SHOCK THERAPY An inflatable pressure suit of vinyl has been developed for treatment of shock victims and persons with dangerously low blood pressure. The garment is adapted from the G-suit worn by pilots to prevent blackout during high speed aerial flight and maneuvers. Inflatable by mouth, the suit envelops a victim in steady pressure from the chest down. Dr. William J. Gardner, a brain surgeon who developed the suit, used it to restore blood pressure during surgery. One accidental discovery occurred while using the suit after surgery in premature childbirth. The patient had been bleeding profusely. The suit was used postoperatively to raise the patient’s blood pressure. When it was fitted, to everyone’s surprise the bleeding stopped. It seems that it can stop hemorrhaging by pressing sutures together in damaged blood vessels. After this discovery, the suit helped to save ten patients who were hemorrhaging and in shock. The Army has purchased 100 suits to test in Vietnam. It is expected that its success will make the suit an important tool in ambulances and hospital emergency rooms.
(Life) PHOTO PROCESS
SHARPENS X-RAYS As a result of the space photo computer technique, research is now being done to apply this method to medical X-rays in an effort to bring out photo detail. Dr. Leo Rigler of the Continued on Fage 23
21
Continued f r o m page 21
University of California at Los Angeles remarked in Medical Tribune, (March 20,1967) that chest X-rays show only one-tenth of what is actually present. The photo enhancement process was originally developed to remove distortions in photographs of the moon taken by Ranger and Surveyor spacecraft. Through a computer process the intensity of an electric beam is modulated as it exposes film by a line to line scan. Encouraging results have been obtained from enhancement of photographs of the retina and X-ray films of the chest and skull. The computer filter proved effective in sharpening outlines of blood vessels and details of the cell structure of the mastoid bone.
PHS GRANT FOR AUXILIARY VENTRICLE More than $2,000,000 is being invested by the Public Health Service in a five-year program aimed at perfecting the mechanical auxiliary ventricle being developed by Dr. Adrian Kantrowitz and co-workers at the Maimonides Medical Center, Brooklyn, N. Y. About four or five trials of the “booster heart” will be made this year to develop criteria for patients most likely to benefit from the mechanical ventricle and for maximum clinical monitoring of those patients who will receive them. Depending on promising results, clinical testing will be initiated along with an increase in research staff and facilities at Maimonides. Among the new personnel needed will be research associates in surgery, internal medicine, cardiology, engineering and biomedical instrumentation, and an increase in support to about $450,000 during the current year will be necessary. The mechanical ventricle was developed to reduce work load of the left ventricle in failing hearts and was implanted in two patients last year. Although neither survived, their deaths were due to unrelated causes. (See the lead article in July issue by Dr. Kantrowitz
August 1967
and Mary Ellen O’Leary, R.N., entitled, “An Auxiliary Ventricle For the Failing Heart.”Ed.)
(Medical Tribune) “CLEAN SURGERY”-ACCURATE ? Postoperative wound infection rate may not have reached an irreducible minimum as has been thought. The rate of between two and six per cent in cases of so called “clean surgery” has remained for the last two decades. This rate may not be entirely the result of unpreventable bacterial contamination. It could be partly related to host reaction to such contamination. It is believed that by building a patient’s defenses strong enough to cope with the small numbers of bacteria found in the modern operating room environment, wound infection can be lessened. In accidental wounds with dirt and other contaminants it is standard practice to debride and follow this with copious saline irrigation of the wound. If flushing is good for accidentally contaminated wounds, it would appear that wounds contaminated by exposure to air during surgery would also benefit. Bacteria such as found on exposed incision surfaces would be readily accessible to a bactericidal agent and it might be possible to completely sterilize a wound prior to closure if the agent were delivered in overwhelming concentration. Dr. Heusinkveld from Lewiston, Idaho, told Medical Tribune, (March 4, 1967) that he was able to keep postoperative wound infections down to 0.35 per cent in a total of 848 cases. In his method wounds are irrigated with saline prior to closure. After the pleura or peritoneum is closed a second flush is applied and the wound edges scrubbed with a sponge. A mixture of 1,000,000 U of Penicillin in 5 cc of saline is instilled in the wound and left while the remainder of the closure is completed. An occlusive dressing remains in place for 48 hours after which time the wound is exposed to the air. Continued on page 24
23
Continued from page 23
LOCATING NEEDLE FRAGMENTS IN KNEE When a child accidentally gets a needle fragment in his knee it often becomes embedded. It is easier to locate a fragment which penetrated the knee joint if the roentgenograms are taken with the joint in the surgical position and perhaps the position at the moment of injury. What usually happens is that the child is kneeling on the floor, with the joint in near full flexion, and then in
fragments, leaving one or more of them in the knee. To eliminate potential infection, prompt surgical removal is advisable. Rusting of the steel may cause discoloration if embedded for several days. Minute inspection is necessary at surgery if the fragment is buried beneath the cartilage surface. Dr. Robert H. Ramsey and Dr. Floyd G. Goodman made these discoveries upon review of 21 cases of sewing needle fragments embedded in the knee joint area. They found that unsuccessful attempts at surgical removal and prolonged operative period resulted because location of the fragments was misidentified and unsuspected. (Modern Medicine)
SEWING SPOOLS FOR SURGERY Dr. J. T. Richards and Dr. H. B. Othersen,
tape that may be attached to the abdominal skin with adhesive tape. To prevent retraction of the tube, a few inches of adhesive tape are wound around the catheter distal to the spool. The gauze pad, slit and placed on the abdomen around the tube, can be changed without disturbing the assembly. (Modern Medicine)
SURGICAL SOAPS COMPARED Two surgical soaps have been studied for effective antibacterial action and conclusions
chlorophene preparation. Dr. Virgil H. Crowder, Jr., spokesman for the other three coauthors of the study, said cultures of surgeons’ hands, patients’ operative fields, and the walls of the incision following first incision stroke consistently indicated the best bacterial prevention resulted from the use of PVP-iodine soap. As for bacterial recovery rates, from surgeons’ hands there was none with PVPiodine and 28 per cent after hexachlorophene. From the operative field bacterial recovery was 10 per cent from PVP-iodine soap and 47 per cent from the hexachlorophene group, and from the incision, figures were 45 per cent and 72 per cent, with PVPiodine soap the most effective. (Hospital Topics)
After a Stamm gastrostomy is performed, a wooden sewing spool of appropriate size is slit, fitted together around the exposed por-
EYE DISEASES STUDIED A five-year program to apply space-age technology to the study and treatment of eye diseases is underway at Johns Hopkins University. The aims of the research team of scientists and surgeons, financed by the National Institutes of Health are: 1) to produce a lowvolt laser device that will disclose before surgery whether cataract removal will restore vision, 2) to develop a microsurgical instrument to scale down a surgeon’s finger movements 40 to 1OO times for delicate operations,
tion of the tube, and held together with twill
Continued on page 27
Jr., report that a gastrostomy tube may be fixated with an ordinary wooden spool for long-term feeding. This prevents the tube from pivoting, and eventually enlarging the wound allowing gastric contents to leak out. The result of leakage would be the formation of granulation tissue and gastric mucosa adhering to the edges; or a gastric fistula.
24
AORN Journal
Continued from page 24
and 3 ) to devise electronic equipment to detect the earliest symptoms of eye disorders without touching the eye. The causes of blindness are being studied throughout U. S. hospitals and universities. Fifty-nine per cent of blindness in the country afflicting those 65 and over is due to deteriorating blood systems and tissues, which make eyes vulnerable to diseases. Infection from common cold sores as well as diabetes, German measles, and syphilis affect sight. Another major cause of blindness is detachment of the retina caused by a blow to the eye or weak spots in the eye wall. When tiny holes are torn in the retina, fluid can flow behind it and float it away from its blood supply. Laser and other light beams are in use to scar the sensitive tissues sealing them back where the break has occurred. Also, silicone pads stitched behind the eye push blood vessels against a detached retina to renourish it. Other successful methods to reattach retinas and to prevent ruptures where weak spots have occurred in the eye’s wall are facilitated by grafts of preserved sclera from bequeathed eyes. Shortening operating time and minimizing tissue handling will increase rate of successful corneal transplants. Experiments are underway with instruments which cut a “button” from a donor cornea and stitch it in a corresponding “button” hole, minimizing operating time. Plastic implants are being perfected to temporarily restore vision for several years. Also, experiments with artificial corneas of gelatin substances from animal skins are being attempted. Some scientists are saving eyes from removal due to tumors. They use a hook-shaped instrument that reaches behind the eye and spurts liquid oxygen into malignant tumors, destroying them by cyrosurgery. Intensified light beams have also been used to burn certain small tumors in their early stages. Uvei-
August 1967
tis, believed to cause 20 per cent of blindnesb, is being treated by laser. Operations to remove cataracts, which cloud the lens, are restoring sight to many. The lens will stick to the frosted tip of the cryoprobe and is easily lifted, and with it the cataract. (Dr. Ballen’s article in this Journal discusses eye surgery.) Doctors are working with measuring devices that spot eyes likely to develop glaucoma, which causes blindness to one out of seven cases. The key to this disease is to spot symptoms and then to control the internal pressure buildup with eye drops and drugs. Surgery is also helpful. Other tools for eye surgery are being developed. Low frequency sound waves allow six-thousandths of an inch strokes to be made without exerting pressure on eye tissues. Measuring oxygen levels in the arteries of premature infants will prevent blindness. Too much oxygen can cause blood vessels of the retina to be destroyed. Electrical activities of the eye and brain are being recorded to further study vision. Although all these new developments are rapidly advancing our knowledge of the eye, the biggest obstacle is that there are not enough donor eyes available for study. (The Modern Hospital) CARDEXFORYOUROR? How about a wall-mounted cardex for your OR? At Jefferson Medical College, Philadelphia, a wall-mounted cardex proved valuable to the ER staff in providing immediate access to procedures and policies. This system makes it easy to keep information up-to-date since the cards can be removed when changes are necessary. Mounted in a prominent spot, could such a system be useful in your OR? An excellent article on this subject entitled “A Visual Control System for Scheduling of Surgery” by Lucy Jo Atkinson and Ellen Braze11 can be found in the March-April, 1965, AORN Journal. (AORN of Chicago Newsletter)
27
SURGERY REARRANGES BABY'S HEART A six-week old baby boy had two pioneer heart operations to correct four birth defects. The success of the operation should encourage surgery on otherwise hopeless cases. At birth, the baby appeared normal, but a few days later his breathing became labored and his skin turned blue. Cardiac and pediatric specialist, Dr. Lynfield, of New York University Medical Center, realized the baby was in heart failure, probably caused by a transposition of the great vessels leading from the heart and that surgery might be able to save the baby. Two days of tests at the intensive care unit at Beth Israel Hospital confirmed these observations and revealed further complications. The pulmonary artery and the aorta were transposed from their normal positions: The pulmonary artery normally extending from the right ventricle and heading for the lungs to get oxygenated blood, was, in this case, extending from the left ventricle. The aorta, normally stemming from the left ventricle, in this case stemmed from the right ventricle. Additionally, the aorta was obstructed by a condition known as preductal coarctation. The patent ductus, a large connection between the aorta and pulmonary artery, failed to close up at birth. The defects caused five times the normal amount of blood to be pumped into the lungs and to cope with this
16
enormous volume the heart was overexerted. A team of twelve surgeons opened the blocked aorta, cut the ductus and placed a band on the pulmonary artery, which reduced the excessive flow of blood to the lungs. In the second operation three days later a large opening was created between the upper heart chambers. This resulted in a better distribution of blood between the two sides of the circulatory system. Both operations relieved the blood flow to the lungs, assuring an adequate amount of oxygenated blood to the body. Complications during the surgery included an irregular heart beat, collapse of a lung, intravenous feeding, and high acid levels in the blood, which all had to be corrected over a 16-day period in the intensive care unit. (New York Times)
TITANIUM USED IN SURGICAL IMPLANTS Prostheses must adapt to the body's environment ; materials must be compatible with contiguous tissues of the body. One big problem with surgical implants is to determine what materials to make them from. The metal titanium has many characteristics which make it significantly useful for surgical implants. It has excellent strength, is extremely resistant to corrosion in body environments, and is Continued on page 19
AORN Journal
Continued from page I 6
adaptable to sterilization by any method. The metal is being used for an aortic heart valve that can be positioned by the surgeon without sutures. The device, a MagovernCromie valve, requires a special insertion tool for positioning. It is then held permanently in place by a series of interdigitating needles. The needles are affixed into the surrounding tissue simultaneously by the insertion tool. Other components of the valve include a Silastic ball in a titanium cage, a teflon ventricular base and a knitted dacron cuff. Implants utilizing titanium and its alloys are hip nails and screws, hip prostheses, and plates of various configurations. Research has produced a knee prosthesis for dogs. It will provide data for application to the human body. The device weighs 5 ounces and compares favorably to a 9 ounce stainless steel device. (U.S.I. Chemical News) GRANTS FOR POST-RN STUDY In the April, 1967, Journal is a listing of scholarships, grants and loans available to registered nurses. Here are some additional grants which the Nurses’ Educational Funds, Inc., has announced:
1) The American Journal of Nursing Company announced eight new scholarships of $1,000 for registered nurses working toward their baccalaureate degree, and five fellowships of $6,000 for nurses working for their doctorate degree.
2) Three $1,000 scholarships for registered nurses specializing in rehabilitation nursing have been established by the Paralyzed Veterans of America, Inc., of the National Paraplegia Foundation and World Veterans Federation. Be sure that you get your applications for these and other NEF awards to the NEF office by February 1 of the academic year. For more information write: Nurses’ Educational Funds, 10 Columbus Circle, N. Y. 10019.
August 1967
GAS JET CLEANS CORONARY ARTERIES A team of Brooklyn surgeons led by Dr. Philip Sawyer reports a successful operation to remove obstructions from the coronary artery. A 44-year-old female patient, the first to undergo the operation, had suffered two heart attacks, and X-rays revealed that her right coronary artery was blocked by fatty deposits along its wall. During the 3$$ hour operation, a heart-lung machine maintained circulation when the heart was stopped for about 35 minutes. Also, a cooling system was used to reduce body temperature, lower metabolism and the amount of blood required by the brain. The blocked right coronary artery was exposed and surgeons inserted a fine hypodermic needle attached to a carbon dioxide cylinder. Quick jets of gas loosened the atherosclerotic deposits and then an incision in the artery wall facilitated removal of fatty material and the blood clot with a forceps. (Newsweek ) HYPERBARIC UNIT PRESENTS TOXICITY PROBLEM Patients who are enclosed in a hyperbaric chamber, administered 100 per cent oxygen, and subjected to conditions of increased atmospheric pressure have had desired therapy for a number of maladies. However, the use of oxygen at elevated pressures for therapeutic purposes presents a complicating problem of toxicity. I n Horizons, a publication of the Columbia University College of Pharmaceutical Sciences, Dr. Spiro P. Loucas states: “The indiscriminate use of hyperbaric oxygenation can give rise to disturbances of the central nervous system manifested in convulsive seizures . . . substernal distress and pulmonary atelectasis can occur. The threshold to each of these toxic states is vague.” Dr. Loucas is an advisory committee member of hyperbaric Continued on, page 21
19
Continued from page 19
oxygenation at Mt. Sinai Hospital, N. Y. In working with gases, the axiom applies that with increasing partial pressures, gases tend to exhibit toxic manifestations. Two observations are characteristic of complicating factors states Dr. Loucas: a lag period is evident before the symptoms of toxicity appear ; and, the toxic effects are usually reversed by a return to atmospheric pressure. To control onset of convulsive symptoms when prolonged exposure time is needed, anticonvulsant and barbiturate agents are used, but have not shown much promise. There is a question as to whether these agents have a beneficial effect on underlying disturbances. Hyperbaric oxygenation is finding greater application in treatment of carbon monoxide poisoning, and high oxygen exposures have met with considerable success in treatment of anaerobic infections. It is the choice treatment of Clostridium welchii (gas gangrene) infections. Also, great interest with this type of therapy has occurred relating to surgical procedures of coronary occlusion and other forms of ischemic disease. Studies are in progress at Mt. Sinai Hospital to determine toxicity thresholds under hyperbaric conditions. A means of detecting the onset of deleterious effects of exposure needs to be perfected. Also, more basic pharmacological and biochemical research is important. (Horizons) OBSTETRIC TECHNICIAN’S COURSE
A 30-week course at Albert Einstein College of Medicine, N. Y., will train nurse’s aides for service as obstetric technicians in city hospitals. This new category of worker in city hospitals did not exist before the program was started about two years ago by Dr. J. J. Smith, associate professor of clinical gynecology and obstetrics at the medical school and director of that service at Lincoln Hospital, where the training is supervised. A class of 24
dugust 1967
nurse’s aides selected from eight city hospitals is now training at Lincoln. Upon completing the course, aides will qualify for more skilled duties in maternity wards and in labor, delivery, and operating rooms, supplementing nurses in those areas. The first class of nine women was graduated on April 15, 1966, and since then, 13 women have taken the course. (Medical Tribune) “G-SUIT” FOR SHOCK THERAPY An inflatable pressure suit of vinyl has been developed for treatment of shock victims and persons with dangerously low blood pressure. The garment is adapted from the G-suit worn by pilots to prevent blackout during high speed aerial flight and maneuvers. Inflatable by mouth, the suit envelops a victim in steady pressure from the chest down. Dr. William J. Gardner, a brain surgeon who developed the suit, used it to restore blood pressure during surgery. One accidental discovery occurred while using the suit after surgery in premature childbirth. The patient had been bleeding profusely. The suit was used postoperatively to raise the patient’s blood pressure. When it was fitted, to everyone’s surprise the bleeding stopped. It seems that it can stop hemorrhaging by pressing sutures together in damaged blood vessels. After this discovery, the suit helped to save ten patients who were hemorrhaging and in shock. The Army has purchased 100 suits to test in Vietnam. It is expected that its success will make the suit an important tool in ambulances and hospital emergency rooms.
(Life) PHOTO PROCESS
SHARPENS X-RAYS As a result of the space photo computer technique, research is now being done to apply this method to medical X-rays in an effort to bring out photo detail. Dr. Leo Rigler of the Continued on Fage 23
21
Continued f r o m page 21
University of California at Los Angeles remarked in Medical Tribune, (March 20,1967) that chest X-rays show only one-tenth of what is actually present. The photo enhancement process was originally developed to remove distortions in photographs of the moon taken by Ranger and Surveyor spacecraft. Through a computer process the intensity of an electric beam is modulated as it exposes film by a line to line scan. Encouraging results have been obtained from enhancement of photographs of the retina and X-ray films of the chest and skull. The computer filter proved effective in sharpening outlines of blood vessels and details of the cell structure of the mastoid bone.
PHS GRANT FOR AUXILIARY VENTRICLE More than $2,000,000 is being invested by the Public Health Service in a five-year program aimed at perfecting the mechanical auxiliary ventricle being developed by Dr. Adrian Kantrowitz and co-workers at the Maimonides Medical Center, Brooklyn, N. Y. About four or five trials of the “booster heart” will be made this year to develop criteria for patients most likely to benefit from the mechanical ventricle and for maximum clinical monitoring of those patients who will receive them. Depending on promising results, clinical testing will be initiated along with an increase in research staff and facilities at Maimonides. Among the new personnel needed will be research associates in surgery, internal medicine, cardiology, engineering and biomedical instrumentation, and an increase in support to about $450,000 during the current year will be necessary. The mechanical ventricle was developed to reduce work load of the left ventricle in failing hearts and was implanted in two patients last year. Although neither survived, their deaths were due to unrelated causes. (See the lead article in July issue by Dr. Kantrowitz
August 1967
and Mary Ellen O’Leary, R.N., entitled, “An Auxiliary Ventricle For the Failing Heart.”Ed.)
(Medical Tribune) “CLEAN SURGERY”-ACCURATE ? Postoperative wound infection rate may not have reached an irreducible minimum as has been thought. The rate of between two and six per cent in cases of so called “clean surgery” has remained for the last two decades. This rate may not be entirely the result of unpreventable bacterial contamination. It could be partly related to host reaction to such contamination. It is believed that by building a patient’s defenses strong enough to cope with the small numbers of bacteria found in the modern operating room environment, wound infection can be lessened. In accidental wounds with dirt and other contaminants it is standard practice to debride and follow this with copious saline irrigation of the wound. If flushing is good for accidentally contaminated wounds, it would appear that wounds contaminated by exposure to air during surgery would also benefit. Bacteria such as found on exposed incision surfaces would be readily accessible to a bactericidal agent and it might be possible to completely sterilize a wound prior to closure if the agent were delivered in overwhelming concentration. Dr. Heusinkveld from Lewiston, Idaho, told Medical Tribune, (March 4, 1967) that he was able to keep postoperative wound infections down to 0.35 per cent in a total of 848 cases. In his method wounds are irrigated with saline prior to closure. After the pleura or peritoneum is closed a second flush is applied and the wound edges scrubbed with a sponge. A mixture of 1,000,000 U of Penicillin in 5 cc of saline is instilled in the wound and left while the remainder of the closure is completed. An occlusive dressing remains in place for 48 hours after which time the wound is exposed to the air. Continued on page 24
23
Continued from page 23
LOCATING NEEDLE FRAGMENTS IN KNEE When a child accidentally gets a needle fragment in his knee it often becomes embedded. It is easier to locate a fragment which penetrated the knee joint if the roentgenograms are taken with the joint in the surgical position and perhaps the position at the moment of injury. What usually happens is that the child is kneeling on the floor, with the joint in near full flexion, and then in
fragments, leaving one or more of them in the knee. To eliminate potential infection, prompt surgical removal is advisable. Rusting of the steel may cause discoloration if embedded for several days. Minute inspection is necessary at surgery if the fragment is buried beneath the cartilage surface. Dr. Robert H. Ramsey and Dr. Floyd G. Goodman made these discoveries upon review of 21 cases of sewing needle fragments embedded in the knee joint area. They found that unsuccessful attempts at surgical removal and prolonged operative period resulted because location of the fragments was misidentified and unsuspected. (Modern Medicine)
SEWING SPOOLS FOR SURGERY Dr. J. T. Richards and Dr. H. B. Othersen,
tape that may be attached to the abdominal skin with adhesive tape. To prevent retraction of the tube, a few inches of adhesive tape are wound around the catheter distal to the spool. The gauze pad, slit and placed on the abdomen around the tube, can be changed without disturbing the assembly. (Modern Medicine)
SURGICAL SOAPS COMPARED Two surgical soaps have been studied for effective antibacterial action and conclusions
chlorophene preparation. Dr. Virgil H. Crowder, Jr., spokesman for the other three coauthors of the study, said cultures of surgeons’ hands, patients’ operative fields, and the walls of the incision following first incision stroke consistently indicated the best bacterial prevention resulted from the use of PVP-iodine soap. As for bacterial recovery rates, from surgeons’ hands there was none with PVPiodine and 28 per cent after hexachlorophene. From the operative field bacterial recovery was 10 per cent from PVP-iodine soap and 47 per cent from the hexachlorophene group, and from the incision, figures were 45 per cent and 72 per cent, with PVPiodine soap the most effective. (Hospital Topics)
After a Stamm gastrostomy is performed, a wooden sewing spool of appropriate size is slit, fitted together around the exposed por-
EYE DISEASES STUDIED A five-year program to apply space-age technology to the study and treatment of eye diseases is underway at Johns Hopkins University. The aims of the research team of scientists and surgeons, financed by the National Institutes of Health are: 1) to produce a lowvolt laser device that will disclose before surgery whether cataract removal will restore vision, 2) to develop a microsurgical instrument to scale down a surgeon’s finger movements 40 to 1OO times for delicate operations,
tion of the tube, and held together with twill
Continued on page 27
Jr., report that a gastrostomy tube may be fixated with an ordinary wooden spool for long-term feeding. This prevents the tube from pivoting, and eventually enlarging the wound allowing gastric contents to leak out. The result of leakage would be the formation of granulation tissue and gastric mucosa adhering to the edges; or a gastric fistula.
24
AORN Journal
Continued from page 24
and 3 ) to devise electronic equipment to detect the earliest symptoms of eye disorders without touching the eye. The causes of blindness are being studied throughout U. S. hospitals and universities. Fifty-nine per cent of blindness in the country afflicting those 65 and over is due to deteriorating blood systems and tissues, which make eyes vulnerable to diseases. Infection from common cold sores as well as diabetes, German measles, and syphilis affect sight. Another major cause of blindness is detachment of the retina caused by a blow to the eye or weak spots in the eye wall. When tiny holes are torn in the retina, fluid can flow behind it and float it away from its blood supply. Laser and other light beams are in use to scar the sensitive tissues sealing them back where the break has occurred. Also, silicone pads stitched behind the eye push blood vessels against a detached retina to renourish it. Other successful methods to reattach retinas and to prevent ruptures where weak spots have occurred in the eye’s wall are facilitated by grafts of preserved sclera from bequeathed eyes. Shortening operating time and minimizing tissue handling will increase rate of successful corneal transplants. Experiments are underway with instruments which cut a “button” from a donor cornea and stitch it in a corresponding “button” hole, minimizing operating time. Plastic implants are being perfected to temporarily restore vision for several years. Also, experiments with artificial corneas of gelatin substances from animal skins are being attempted. Some scientists are saving eyes from removal due to tumors. They use a hook-shaped instrument that reaches behind the eye and spurts liquid oxygen into malignant tumors, destroying them by cyrosurgery. Intensified light beams have also been used to burn certain small tumors in their early stages. Uvei-
August 1967
tis, believed to cause 20 per cent of blindnesb, is being treated by laser. Operations to remove cataracts, which cloud the lens, are restoring sight to many. The lens will stick to the frosted tip of the cryoprobe and is easily lifted, and with it the cataract. (Dr. Ballen’s article in this Journal discusses eye surgery.) Doctors are working with measuring devices that spot eyes likely to develop glaucoma, which causes blindness to one out of seven cases. The key to this disease is to spot symptoms and then to control the internal pressure buildup with eye drops and drugs. Surgery is also helpful. Other tools for eye surgery are being developed. Low frequency sound waves allow six-thousandths of an inch strokes to be made without exerting pressure on eye tissues. Measuring oxygen levels in the arteries of premature infants will prevent blindness. Too much oxygen can cause blood vessels of the retina to be destroyed. Electrical activities of the eye and brain are being recorded to further study vision. Although all these new developments are rapidly advancing our knowledge of the eye, the biggest obstacle is that there are not enough donor eyes available for study. (The Modern Hospital) CARDEXFORYOUROR? How about a wall-mounted cardex for your OR? At Jefferson Medical College, Philadelphia, a wall-mounted cardex proved valuable to the ER staff in providing immediate access to procedures and policies. This system makes it easy to keep information up-to-date since the cards can be removed when changes are necessary. Mounted in a prominent spot, could such a system be useful in your OR? An excellent article on this subject entitled “A Visual Control System for Scheduling of Surgery” by Lucy Jo Atkinson and Ellen Braze11 can be found in the March-April, 1965, AORN Journal. (AORN of Chicago Newsletter)
27