A sports headlight retrofitted on magnifying loupes: A simple and cheap method for daily use

Medical professionals such as doctors, nurses and paramedics often use headlight to examine or to perform surgical intervention in the patients. However, there are concerns related to its use such as comfort for the user, mobility and asepsis for the cable, availability in the departments plus cost effectiveness. The concept of a retrofitted 1-watt sports headlight (adjusted on magnifying loupes) would give quick access to a light source, be available and reliable at any place, save vital funds and would be environmentally friendly as the battery can be replaced. The same concept can be applied to pre-hospital emergency care and disaster medicine as well. BACKGROUND Headlights with fibre optic cables have being used for two decades as an adjunct to the operating theatre lighting. The cable-powered headlights pose, to our experience, some limitations for the operating team: Smooth personnel circulation around the operating field is hindered by repeated unplugging and re-plugging of the cable when surgeon and assistants change sides. Protocols for draping and asepsis have to accommodate the cumbersome cable and the light source and in addition are time consuming and arising issues of flexibility. The weight of the headlight and cable may cause health issues for the bearer (head ache, low back pain) [1]. Portable surgical headlights have also been available for the last decade for a not negligible cost. They are powered by a battery pack, attached to the torso/waist and connected to the headlight by a shorter cable. They are priced at hundreds of pounds. METHOD As an alternative to cumbersome cables and expensive ‘ad hoc’ designs, we use a retrofitted 1-watt sports headlight with a weight of 100 grams. We acquired that for $ 14.99 (approximately £10) from an outdoor specialist retailer (Petzl America, Clearfield, Utah, USA). The headlight is powered by three 1.5 Volt AAA batteries and provides 60 lumen of luminous flux (Fig.1). We have wrapped the elastic bands of the headlight around the corresponding horizontal (axial circumferential) and sagittal elements of the headband, where the magnifying loupes are mounted (Keeler Ltd., Clewer Hill Road, Windsor SL4 4AA). The headlight can be aimed by tilting the housing (Fig.1, 2). DISCUSSION The luminous flux from our headlight according to our experience in cardiothoracic surgery is adequate for a variety of procedures: femoral and axillary arterial access, harvesting internal thoracic (mammary) arteries, open pulmonary resections, valve surgery. Being fully portable without cable, light source or pouches, it is especially handy outside the operating suite (ITU, A&E, wards) for emergency re-explorations for bleeding, secondary wound closures, application of vacuum therapy dressings, trauma, for ECMO work etc. Finally, we have had no evidence of thermal injury, as has being reported from strong xenon beams [2]. This simple affordable headlight system can be easily adapted to the needs of the entire spectrum of surgical specialties, especially those using magnifying loupes. Therefore, can be part of basic life support kits for use in prehospital emergency care, disaster and military medicine [3]. The device has the following advantages: 1. ‘‘Two-in-one’’ function of Loupes and Torch. 2. Battery can be changed (so no need to throw away the item) and is environmentally friendly 3. No need for asepsis 4. Cost effective 5. Availability everywhere In conclusion, we believe this is a practical medical device

Tumour Thrombi in the Suprahepatic Inferior Vena Cava: The Cardiothoracic Surgeons’ View

Background. Retroperitoneal tumours propagate intrathoracic caval tumour thrombi (ICTT) of which we consider two subgroups: ICTT-III (extracardiac) and ICTT-IV (intracardiac). Methods. Case series review. Results. 29 series with 784 patients, 453 with extracardiac and 331 with intracardiac ICTT. Average age was 59 years. 98% of the tumours were RCC, 1% adrenal and Wilms’ tumours, and 1% transitional cell carcinomas. The prevalent incision was rooftop with or without sternotomy. Mortality was 10% (5% for ICTT-III, 15% for ICTT-IV). Morbidity was 56% (36% for ICTT-III, 64% for ICTT-IV) and reoperation for bleeding was the commonest complication (14%). Mean Blood loss was 2.6 litres for ICTT-III and 3.7 litres for ICTT-IV. Mean blood product use was 2.4 litres for ICTT-III and 3.5 litres for ICTT-IV. Operative and anaesthetic times exceeded 5 hours. Hospital stay averaged 13 days. Variations in perioperative care included preoperative embolisation, perioperative transoesophageal echo, surgical incisions, and extracorporeal circulation. Brief Summary. Surgery for ICTT has high transfusion, operating/anaesthetic time, and in-hospital stay requirements, and intracardiac ICTT also attract higher risk. Preoperative tumour embolisation is controversial. The cardiothoracic team offers proactive optimisation of blood loss and preemptive management of intracardiac thrombus impaction: we should always be involved in the management the ICTT

Evolving dimensions in medical case reporting

Medical case reports (MCRs) have been undervalued in the literature to date. It seems that while case series emphasize what is probable, case reports describe what is possible and what can go wrong. MCRs transfer medical knowledge and act as educational tools. We outline evolving aspects of the MCR in current practice

Contegra conduit for reconstruction of the right ventricular outflow tract: a review of published early and mid-time results

<p>Abstract</p> <p>Objective</p> <p>The valved conduit Contegra (bovine jugular vein) has being implanted for more than 7 years in the right ventricular outflow tract and it is noted that the available reports have been mixed. The aim of this study is to review the reported evidence in the literature.</p> <p>Methods</p> <p>Search of the relevant literature for the primary endpoints of operative mortality and morbidity and secondary endpoints of follow-up haemodynamic performance including severe stenosis, regurgitation and need for reintervention are presented.</p> <p>Results</p> <p>We selected and analysed 17 series including 767 patients. Commonest indication was Fallot's tetralogy. Operative mortality was 2.6%. Operative morbidity was 13.9%. In follow-up, the incidence of intraconduit stenosis was 10.9% (incidence of stenosis for the 12 millimetre conduit was 83.3% in one series) and that of at least moderate regurgitation was 6.3%.</p> <p>The aspirin users had a stenosis incidence of 10.5% compared to the non-users had a stenosis incidence of 9.6%.</p> <p>Conclusion</p> <p>A dissent on the performance of the Contegra is discussed, while results are satisfactory in the majority of studies apart for the smallest conduits (12 and 14 millimetre), suggesting an association to compromised run-off. The role of aspirin as antithrombotic modulator remains controversial.</p

Why Are Computational Neuroscience and Systems Biology So Separate?

Despite similar computational approaches, there is surprisingly little interaction between the computational neuroscience and the systems biology research communities. In this review I reconstruct the history of the two disciplines and show that this may explain why they grew up apart. The separation is a pity, as both fields can learn quite a bit from each other. Several examples are given, covering sociological, software technical, and methodological aspects. Systems biology is a better organized community which is very effective at sharing resources, while computational neuroscience has more experience in multiscale modeling and the analysis of information processing by biological systems. Finally, I speculate about how the relationship between the two fields may evolve in the near future

Does body mass index affect mortality in coronary surgery?

Introduction: The Body Mass Index (BMI) quantifies nutritional status and classifies humans as underweight, of normal weight, overweight, mildly obese, moderately obese or morbidly obese. Obesity is the excessive accumulation of fat, defined as BMI higher than 30 kg/m2. Obesity is widely accepted to complicate anaesthesia and surgery, being a risk factor for mediastinitis after coronary artery bypass grafting (CABG). We sought the evidence on operative mortality of CABG between standard BMI groups. Materials and Methodology: A simple literature review of papers presenting the mortality of CABG by BMI group: Underweight (BMI ≤ 18.49 kg/m2), normal weight (BMI 18.5–24.9 kg/m2), overweight (BMI 25.0–29.9 kg/m2), mild obesity (BMI 30.0–34.9 kg/m2), moderate obesity (BMI 35.0–39.9 kg/m2), or morbid obesity (BMI ≥ 40.0 kg/m2). Results: We identified 18 relevant studies with 1,027,711 patients in total. Their variability in size of samples and choice of BMI groups precluded us from attempting inferential statistics. The overall cumulative mortality was 2.7%. Underweight patients had by far the highest mortality (6.6%). Overweight patients had the lowest group mortality (2.1%). The group mortality for morbidly obese patients was 3.44 %. Discussion: Patients with extreme BMI’s undergoing CABG (underweight ones more than morbidly obese) suffer increased crude mortality. This simple observation indicates that under nutrition and morbid obesity need be further explored as risk factors for coronary surgery