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Microsurgery: Free Tissue Transfer and Replantation
MICROSURGERY: FREE TISSUE TRANSFER AND REPLANTATION John R Griffin MD and James F Thornton MD HISTORY In 1964 Nakayama and associates15 reported In the late 1890s and early 1900s surgeons began what is most likely the first clinical series of free- approximating blood vessels, both in laboratory ani- tissue microsurgical transfers. The authors brought mals and human patients, without the aid of magni- vascularized intestinal segments to the neck for cer- fication.1,2 In 1902 Alexis Carrel3 described the vical esophageal reconstruction in 21 patients. The technique of triangulation for blood vessel anasto- intestinal segments were attached by direct microvas- mosis and advocated end-to-side anastomosis for cular anastomoses in vessels 3–4mm diam. Sixteen blood vessels of disparate size. Nylen4 first used a patients had a functional esophagus on follow-up of monocular operating microscope for human ear- at least 1y. drum surgery in 1921. Soon after, his chief, Two separate articles in the mid-1960s described Holmgren, used a stereoscopic microscope for the successful experimental replantation of rabbit otolaryngologic procedures.5 ears and rhesus monkey digits.16,17 Komatsu and 18 In 1960 Jacobson and coworkers,6 working with Tamai used a surgical microscope to do the first laboratory animals, reported microsurgical anasto- successful replantation of a completely amputated moses with 100% patency in carotid arteries as digit in 1968. That same year Krizek and associ- 19 small as 1.4mm diameter. In 1965 Jacobson7 was ates reported the first successful series of experi- able to suture vessels 1mm diam with 100% patency mental free-flap transfers in a dog model. -
Pseudoischemic Electrocardiogram in Myasthenia Gravis with Thymoma Published Online in Wiley Interscience
Address for correspondence: Nicola Mumoli, MD CaseShort Communication Livorno Hospital Department of Internal Medicine Viale Alfieri 36 Pseudoischemic Electrocardiogram in 57100 Livorno, Italy Myasthenia Gravis with Thymoma: [email protected] Reversibility After Thymectomy Patrizio Chiavistelli, MD, Marco Cei, MD, Giovanni Carmignani, MD, Carlo Bartolomei, MD Nicola Mumoli, MD Department of Internal Medicine, Livorno Hospital, Livorno, Italy Abnormal ST T-wave changes can be found at presentation in various noncoronary disorders; misinterpretation of these patterns as ischemic heart disease can lead to erroneous diagnosis and treatment. Here we present a case of myasthenia gravis (MG) with thymoma, in which the resting electrocardiogram (ECG) led to a misleading diagnosis of myocardial ischemia. After thymectomy, the ECG resumed a normal pattern. Myasthenia gravis is not usually considered in the differential diagnosis of conditions associated with an abnormal ECG. The combination of dysphagia, dyspnoea, ECG changes, and creatine kinase (CK) elevations may easily bring to mind an erroneous and possibly deleterious diagnosis of myocardial ischemia. Introduction did not seek medical attention. At the beginning of the The resting 12-lead electrocardiogram (ECG) remains at current year, he reported a flu-like illness, with spontaneous the center of the diagnostic pathways of acute coronary recovery, but shortly afterward he experienced dyspnea, syndromes (ACSs), either with1 or without ST segment dysphagia, and weight loss (37 kg). One month before elevation,2 because it serves as an invaluable tool for admission, he underwent fiberoptic endoscopy of the nose, both diagnosis and risk stratification. Nevertheless, as is pharynx, and larynx because of dysphonia, without any universally accepted, the predictive value of any diagnostic evidence of an active disease. -
Studies of Thymic Function with Emphasis on the Role of the Thymus in Oncogenesist
[CANCER RESEARCH 26 Part I, 551-574, April 1966] Studies of Thymic Function with Emphasis on the Role of the Thymus in Oncogenesist LLOYDW. LAW National Cancer Institute, Bethesda, Maryland This presentation will be concerned with 2 general topics: organ to other sites occurs with a selective seeding in spleen (a) our present knowledge of thymic structure and function, lymph nodes, and other lymphoid organs. but particularly the latter, as revealed by the results of recent For a more detailed discussion of the ontogeny of the thymus experiments in several species of animals following early thymic and its microscopic anatomy, the reader is referred to the studies ablation, and (b) consideration of the precise role of the thymus in of Smith (97) and of Ruth et al. (92). the initiation and suppression of neoplastic growths. Pertaining to Thymic Structure and Function Origin and Early Structure of the Thymus In most species the thymus is located in the upper anterior The thymus is a compound organ consisting of 3 quite different part of the chest. Exceptions are the chicken and guinea pig. cell systems: (a) lymphoid cells, (b) reticulum cells, and (c) The absolute size varies from species to species but the absolute e[)ithehal cells. The latter 2 may be referred to as the epithelial size of thymic lobules appears to be remarkably uniform in the reticulum cell complex. The thymus in mammals arises as various species, suggesting that there may be a critical limit for paired structures from the endoderm of the 3rd and 4th branchial the size of a thymic lobule. -
Analysis of the Role of Thyroidectomy and Thymectomy in the Surgical Treatment of Secondary Hyperparathyroidism
Am J Otolaryngol 40 (2019) 67–69 Contents lists available at ScienceDirect Am J Otolaryngol journal homepage: www.elsevier.com/locate/amjoto Analysis of the role of thyroidectomy and thymectomy in the surgical ☆ treatment of secondary hyperparathyroidism T Mateus R. Soares, Graziela V. Cavalcanti, Ricardo Iwakura, Leandro J. Lucca, Elen A. Romão, ⁎ Luiz C. Conti de Freitas Division of Head and Neck Surgery, Department of Ophthalmology, Otolaryngology, Head and Neck Surgery, Ribeirao Preto Medical School, University of Sao Paulo, Brazil ARTICLE INFO ABSTRACT Keywords: Purpose: Parathyroidectomy can be subtotal or total with an autograft for the treatment of renal hyperpar- Parathyroidectomy athyroidism. In both cases, it may be extended with bilateral thymectomy and total or partial thyroidectomy. Hyperparathyroidism Thymectomy may be recommended in combination with parathyroidectomy in order to prevent mediastinal Thymectomy recurrence. Also, the occurrence of thyroid disease observed in patients with hyperparathyroidism is poorly Thyroidectomy understood and the incidence of cancer is controversial. The aim of the present study was to report the ex- perience of a single center in the surgical treatment of renal hyperparathyroidism and to analyse the role of thyroid and thymus surgery in association with parathyroidectomy. Materials and methods: We analysed parathyroid surgery data, considering patient demographics, such as age and gender, and surgical procedure data, such as type of hyperparathyroidism, associated thyroid or thymus surgery, surgical duration and mediastinal recurrence. Histopathological results of thyroid and thymus samples were also analysed. Results: Medical records of 109 patients who underwent parathyroidectomy for secondary hyperparathyroidism were reviewed. On average, thymectomy did not have impact on time of parathyroidectomy (p = 0.62) even when thyroidectomy was included (p = 0.91). -
Code Procedure Cpt Price University Physicians Group
UNIVERSITY PHYSICIANS GROUP (UPG) PRICES OF PROVIDER SERVICES CODE PROCEDURE MOD CPT PRICE 0001A IMM ADMN SARSCOV2 30MCG/0.3ML DIL RECON 1ST DOSE 0001A $40.00 0002A IMM ADMN SARSCOV2 30MCG/0.3ML DIL RECON 2ND DOSE 0002A $40.00 0011A IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE 0011A $40.00 0012A IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE 0012A $40.00 0021A IMM ADMN SARSCOV2 5X1010 VP/0.5 ML 1ST DOSE 0021A $40.00 0022A IMM ADMN SARSCOV2 5X1010 VP/0.5 ML 2ND DOSE 0022A $40.00 0031A IMM ADMN SARSCOV2 AD26 5X10^10 VP/0.5 ML 1 DOSE 0031A $40.00 0042T CEREBRAL PERFUS ANALYSIS, CT W/CONTRAST 0042T $954.00 0054T BONE SURGERY USING COMPUTER ASSIST, FLURO GUIDED 0054T $640.00 0055T BONE SURGERY USING COMPUTER ASSIST, CT/ MRI GUIDED 0055T $1,188.00 0071T U/S LEIOMYOMATA ABLATE <200 CC 0071T $2,500.00 0075T 0075T PR TCAT PLMT XTRC VRT CRTD STENT RS&I PRQ 1ST VSL 26 26 $2,208.00 0126T CAROTID INT-MEDIA THICKNESS EVAL FOR ATHERSCLER 0126T $55.00 0159T 0159T COMPUTER AIDED BREAST MRI 26 26 $314.00 PR RECTAL TUMOR EXCISION, TRANSANAL ENDOSCOPIC 0184T MICROSURGICAL, FULL THICK 0184T $2,315.00 0191T PR ANT SEGMENT INSERTION DRAINAGE W/O RESERVOIR INT 0191T $2,396.00 01967 ANESTH, NEURAXIAL LABOR, PLAN VAG DEL 01967 $2,500.00 01996 PR DAILY MGMT,EPIDUR/SUBARACH CONT DRUG ADM 01996 $285.00 PR PERQ SAC AGMNTJ UNI W/WO BALO/MCHNL DEV 1/> 0200T NDL 0200T $5,106.00 PR PERQ SAC AGMNTJ BI W/WO BALO/MCHNL DEV 2/> 0201T NDLS 0201T $9,446.00 PR INJECT PLATELET RICH PLASMA W/IMG 0232T HARVEST/PREPARATOIN 0232T $1,509.00 0234T PR TRANSLUMINAL PERIPHERAL ATHERECTOMY, RENAL -
Cellular and Humoral Immune Alterations in Thymectomized Patients for Thymoma
Cellular and humoral immune alterations in thymectomized patients for thymoma Maurizio Lalle, Mauro Minellli, Paola Tarantini, Mirella Marino, Virna Cerasoli, Francesco Facciolo, Cesare Iani, Mauro Antimi To cite this version: Maurizio Lalle, Mauro Minellli, Paola Tarantini, Mirella Marino, Virna Cerasoli, et al.. Cellular and humoral immune alterations in thymectomized patients for thymoma. Annals of Hematology, Springer Verlag, 2009, 88 (9), pp.847-853. 10.1007/s00277-008-0693-3. hal-00535026 HAL Id: hal-00535026 https://hal.archives-ouvertes.fr/hal-00535026 Submitted on 11 Nov 2010 HAL is a multi-disciplinary open access L’archive ouverte pluridisciplinaire HAL, est archive for the deposit and dissemination of sci- destinée au dépôt et à la diffusion de documents entific research documents, whether they are pub- scientifiques de niveau recherche, publiés ou non, lished or not. The documents may come from émanant des établissements d’enseignement et de teaching and research institutions in France or recherche français ou étrangers, des laboratoires abroad, or from public or private research centers. publics ou privés. Ann Hematol (2009) 88:847–853 DOI 10.1007/s00277-008-0693-3 ORIGINAL ARTICLE Cellular and humoral immune alterations in thymectomized patients for thymoma Maurizio Lalle & Mauro Minellli & Paola Tarantini & Mirella Marino & Virna Cerasoli & Francesco Facciolo & Cesare Iani & Mauro Antimi Received: 1 September 2008 /Accepted: 23 December 2008 /Published online: 23 January 2009 # Springer-Verlag 2009 Abstract The aim of this study was to analyze the impact studies, a longer surveillance and a cooperative approach, of thymectomy on kinetics of the immune reconstitution in due to the rarity of the disease, are necessary to define thymoma patients. -
Icd-9-Cm (2010)
ICD-9-CM (2010) PROCEDURE CODE LONG DESCRIPTION SHORT DESCRIPTION 0001 Therapeutic ultrasound of vessels of head and neck Ther ult head & neck ves 0002 Therapeutic ultrasound of heart Ther ultrasound of heart 0003 Therapeutic ultrasound of peripheral vascular vessels Ther ult peripheral ves 0009 Other therapeutic ultrasound Other therapeutic ultsnd 0010 Implantation of chemotherapeutic agent Implant chemothera agent 0011 Infusion of drotrecogin alfa (activated) Infus drotrecogin alfa 0012 Administration of inhaled nitric oxide Adm inhal nitric oxide 0013 Injection or infusion of nesiritide Inject/infus nesiritide 0014 Injection or infusion of oxazolidinone class of antibiotics Injection oxazolidinone 0015 High-dose infusion interleukin-2 [IL-2] High-dose infusion IL-2 0016 Pressurized treatment of venous bypass graft [conduit] with pharmaceutical substance Pressurized treat graft 0017 Infusion of vasopressor agent Infusion of vasopressor 0018 Infusion of immunosuppressive antibody therapy Infus immunosup antibody 0019 Disruption of blood brain barrier via infusion [BBBD] BBBD via infusion 0021 Intravascular imaging of extracranial cerebral vessels IVUS extracran cereb ves 0022 Intravascular imaging of intrathoracic vessels IVUS intrathoracic ves 0023 Intravascular imaging of peripheral vessels IVUS peripheral vessels 0024 Intravascular imaging of coronary vessels IVUS coronary vessels 0025 Intravascular imaging of renal vessels IVUS renal vessels 0028 Intravascular imaging, other specified vessel(s) Intravascul imaging NEC 0029 Intravascular -
1 Annex 2. AHRQ ICD-9 Procedure Codes 0044 PROC-VESSEL
Annex 2. AHRQ ICD-9 Procedure Codes 0044 PROC-VESSEL BIFURCATION OCT06- 0201 LINEAR CRANIECTOMY 0050 IMPL CRT PACEMAKER SYS 0202 ELEVATE SKULL FX FRAGMNT 0051 IMPL CRT DEFIBRILLAT SYS 0203 SKULL FLAP FORMATION 0052 IMP/REP LEAD LF VEN SYS 0204 BONE GRAFT TO SKULL 0053 IMP/REP CRT PACEMAKR GEN 0205 SKULL PLATE INSERTION 0054 IMP/REP CRT DEFIB GENAT 0206 CRANIAL OSTEOPLASTY NEC 0056 INS/REP IMPL SENSOR LEAD OCT06- 0207 SKULL PLATE REMOVAL 0057 IMP/REP SUBCUE CARD DEV OCT06- 0211 SIMPLE SUTURE OF DURA 0061 PERC ANGIO PRECEREB VES (OCT 04) 0212 BRAIN MENINGE REPAIR NEC 0062 PERC ANGIO INTRACRAN VES (OCT 04) 0213 MENINGE VESSEL LIGATION 0066 PTCA OR CORONARY ATHER OCT05- 0214 CHOROID PLEXECTOMY 0070 REV HIP REPL-ACETAB/FEM OCT05- 022 VENTRICULOSTOMY 0071 REV HIP REPL-ACETAB COMP OCT05- 0231 VENTRICL SHUNT-HEAD/NECK 0072 REV HIP REPL-FEM COMP OCT05- 0232 VENTRI SHUNT-CIRCULA SYS 0073 REV HIP REPL-LINER/HEAD OCT05- 0233 VENTRICL SHUNT-THORAX 0074 HIP REPL SURF-METAL/POLY OCT05- 0234 VENTRICL SHUNT-ABDOMEN 0075 HIP REP SURF-METAL/METAL OCT05- 0235 VENTRI SHUNT-UNINARY SYS 0076 HIP REP SURF-CERMC/CERMC OCT05- 0239 OTHER VENTRICULAR SHUNT 0077 HIP REPL SURF-CERMC/POLY OCT06- 0242 REPLACE VENTRICLE SHUNT 0080 REV KNEE REPLACEMT-TOTAL OCT05- 0243 REMOVE VENTRICLE SHUNT 0081 REV KNEE REPL-TIBIA COMP OCT05- 0291 LYSIS CORTICAL ADHESION 0082 REV KNEE REPL-FEMUR COMP OCT05- 0292 BRAIN REPAIR 0083 REV KNEE REPLACE-PATELLA OCT05- 0293 IMPLANT BRAIN STIMULATOR 0084 REV KNEE REPL-TIBIA LIN OCT05- 0294 INSERT/REPLAC SKULL TONG 0085 RESRF HIPTOTAL-ACET/FEM -
Ipo) List for Cy 2021 (N=266)
TABLE 31: PROPOSED MUSCULOSKELETAL-RELATED SERVICE REMOVALS FROM THE INPATIENT ONLY (IPO) LIST FOR CY 2021 (N=266) CY CY 2020 Long Descriptor Related Proposed Proposed 2020 Services CY 2021 CY 2021 CPT OPPS OPPS APC Code Status Assignment Indicator 0095T Removal of total disc arthroplasty 22856 N/A (artificial disc), anterior approach, each additional interspace, cervical (list separately in addition to code for primary procedure) 0098T Revision including replacement 22858 N/A of total disc arthroplasty (artificial disc), anterior approach, each additional interspace, cervical (list separately in addition to code for primary procedure) 0163T Total disc arthroplasty (artificial 22858 N/A disc), anterior approach, including discectomy to prepare interspace (other than for decompression), each additional interspace, lumbar (list separately in addition to code for primary procedure) 0164T Removal of total disc 22856 N/A arthroplasty, (artificial disc), anterior approach, each additional interspace, lumbar (list separately in addition to code for primary procedure) 0165T Revision including replacement 22858 N/A of total disc arthroplasty (artificial disc), anterior approach, each additional interspace, lumbar (list separately in addition to code for primary procedure) 0202T Posterior vertebral joint(s) 63030 J1 5115 arthroplasty (for example, facet joint[s] replacement), including facetectomy, laminectomy, foraminotomy, and vertebral column fixation, injection of bone cement, when performed, including fluoroscopy, single level, lumbar spine -
Patient Care Curriculum: Hand Surgery Version 1.2 (October 2010)
Patient Care Curriculum: Hand Surgery Version 1.2 (October 2010) Table of Contents TITLE 1 TABLE OF CONTENTS 2 GENERAL TOPICS 3 a. Anatomy/ Embryology b. Imaging c. Interpersonal Communication Skills d. Practice Based Learning e. Professionalism f. System Based Practice DEFINITIONS 3 SPECIFIC TOPICS 1. Amputations/ Finger tip injuries 4 2. Anesthesia, Pain Management 6 3. Arthritis 7 4. Burns 10 5. Combined Hand Injuries 11 6. Compartment Syndromes 12 7. Congenital Conditions 13 8. Contractures, Spasticity, Stiffness, Weakness 14 9. Dupuytren’s 15 10. Fractures/ dislocations/ nonunions/ malunions 17 11. Infections/Bites 31 12. Injection/Extravasation 33 13. Instability 34 14. Medical Conditions 38 15. Osteonecrosis 40 16. Peripheral Nerve 42 17. Psychological Aspects of Upper Extremity Conditions 46 18. Soft Tissue Defects 47 19. Tendon: Atraumatic conditions (tenosynovitis) 49 20. Tendon: Traumatic Conditions 52 21. Trauma/Critical Care 54 22. Tumors 55 23. Vascular Conditions 58 Sources 60 2 GENERAL TOPICS a. Anatomy/ Embryology b. Imaging c. Interpersonal Communication Skills d. Practice Based Learning: Evidence-Based Medicine e. Professionalism Medico-Legal Considerations f. System Based Practice Practice Management Rehabilitation The Public Medical System (Medicare, Medicaid, VA) DEFINITIONS DISEASES/CONDITIONS * BROAD - A graduate should be able to care for all aspects of disease and provide comprehensive management (ie carpal tunnel syndrome). * FOCUSED - A graduate should be able to make the diagnosis, provide initial management/stabilization, but will not be expected to be able to provide comprehensive management (ie traumatic segmental defect of the median nerve). OPERATIONS/PROCEDURES * ESSENTIAL -COMMON - Frequently performed\operations in hand surgery; specific procedure competency is required by end of training and should be attainable primarily by case volume (ie carpal tunnel release). -
Unthsc Unthsc
Institutional Animal Care and Use Committee Title: Analgesics and Anesthesia in Laboratory Animals at UNTHSC UNTHSC Document #: 035 Version #: 02 Approved by IACUC Date: August 22, 2017 A. BACKGROUND INFORMATION a. In general, procedures which cause pain in humans should be expected to cause pain in animals. b. Appropriate analgesics must be used unless withholding such agents is scientifically justified in the animal use protocol. B. RESPONSIBILITIES a. It is the responsibility of the Principal Investigator (PI): i. To list appropriate analgesics when performing potentially painful procedures on animals. The PI must consult with the Attending Veterinarian for information on which analgesic(s) to use if the PI is unsure. ii. To procure the analgesics listed on an approved protocol unless arrangements are made with DLAM (Department of Laboratory Animal Medicine) ahead of time. Some analgesics are controlled substances and will require a DEA license. It is the responsibility of the PI to have this license. b. It is the responsibility of the Principal Investigator and other research personnel who will administer analgesics to have completed the applicable CITI training module. c. It is the responsibility of the Principal Investigator or designated lab staff and/or students to administer the analgesics listed in the approved protocol unless arrangements are made ahead of time for DLAM staff to do so. d. It is the responsibility of IACUC to assure that this SOP is followed. C. PROCEDURES a. Determining which procedures require analgesia and which ones may be useful, several factors should be considered: i. The invasiveness of the procedure that was performed: 1. -
Procedure Codes Payable As an Inpatient Service When Delivered In
INDIANA HEALTH COVER A G E PROGRAMS PROVIDER CO D E S E T S Procedure codes payable as an inpatient service when delivered in an inpatient setting for stays of less than 24 hours for DOS on or after July 1, 2014 Procedure Description Code 11005 Debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing soft tissue infection; abdominal wall, with or without fascial closure 11008 Removal of prosthetic material or mesh, abdominal wall for infection (eg, for chronic or recurrent mesh infection or necrotizing soft tissue infection) (list separately in addition to code for primary procedure) 19361 Breast reconstruction with latissimus dorsi flap, without prosthetic implant 21343 Open treatment of depressed frontal sinus fracture 21422 Treatment of palatal or alveolar ridge fractures (Lefort I type); open treatment 22532 Arthrodesis, lateral extracavitary technique, including minimal diskectomy to prepare interspace (other than for decompression); thoracic 22558 Arthrodesis, anterior interbody technique; lumbar, with bone graft 22585 Arthrodesis, ant or antitrl, ea additional interspace (list sep in add to single lvl arthrodesis) 22842 Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments (list separately in addition to code for primary procedure) 27025 Ober-yount fasciotomy, combined with spica cast, pins in tibia, wedging the cast, etc; unilateral 27450 Osteotomy, femur, shaft or supracondylar, with fixation; unilateral 27472 Repair, nonunion