Technical Notes Research Articles

Keynote for fast publishing by writing Technical note

Writing-up of technical information is consuming time and efforts, however the exponential grow of innovations and finding should be relevantly shared by publications. Technical note (also known as innovation or technical development in some journals) is among short scientific article published by medical journals and sometime engineering journals. It is produced for describing a new technic, procedure, or development relevant for medical system. Sometimes, technical note describes the modification of an existing technics. This article presents a simple guide on writing Technical Notes and includes basic arguments as definition, appellations, and structure. 

Identificación de síntomas de enfermedades compatibles con el síndrome del edificio enfermo en una empresa industrial en Esmeraldas, con el cuestionario NTP 380 del INSHT

El síndrome del edificio enfermo se manifiesta con diferentes síntomas que aquejan a los trabajadores que tienen más de 6 meses en un área donde existe circulación de aire artificial. Este estudio pretende evidenciar las enfermedades que pueden generarse a consecuencia del síndrome de edificio enfermo en 65 trabajadores que pertenecen al área administrativa de una empresa industrial, para esto se realizó un estudio de corte transversal y cuantitativo con el cuestionario de Notas Técnicas de Prevención 380 del Instituto Nacional de Seguridad e Higiene en el Trabajo de España, y se correlacionó con la información de ausentismo y morbilidad laboral desde el periodo de enero 2017 hasta junio 2018, en relación al número de síntomas positivos obtenidos para los 65 empleado tomados como población de estudio, se comprobó que 57 de ellos presentaron 7 o más síntomas positivos mientras que sólo 8 trabajadores presentaron menos de 7 síntomas positivos.

Flame Spread and Smoke & Toxicity Testing Interpretations for Plastic Pipes - Technical Notes

Lightweight composite materials are increasingly used in the ship industry as a substitute to their heavier steel alternatives. These materials are often inherently flammable and require an assessment of the fire risk associated with their flame spread and smoke & toxicity in order to enable their safe usage. However, for plastic pipes there are contradictions within the IMO (International Maritime Organisation) guidelines which lead to different interpretations and different implementations. The goal of this work is to evaluate whether smoke and toxicity is adequately assessed for products currently approved for use and commercially available on the market. Testing according to standardised means given in the IMO code shows that the materials fail both flame spread and smoke & toxicity testing. This proves that there are different interpretations and illustrates the need for clarity in this area to enable safe and consistent use of these materials.

The ABC's of Spinal Decompression: Pearls and Technical Notes

The foundation of spine surgery centers on the proper identification, decompression, and stabilization of bony and neural elements. We describe easily reproducible and reliable methods for optimal decompression and release of neural structures to alleviate symptoms and improve patients' quality of life. Multiple spinal decompression techniques were described in procedures for which the goal of surgery was decompression alone or decompression and fusion. Eight fundamental techniques were described: inverted U-cut, J-cut, T-cut, L-cut, Z-cut, I-track cuts, C-cut, and O-cut. These foundational cuts may be combined, as needed, to develop an individually tailored approach to the patient's pathology. After properly identifying the anatomic structures, each of these techniques provides a consistent, reproducible, and efficient means to decompress the spine under various circumstances. These techniques provide surgical trainees with a framework for approaching surgical decompression.

Radial Artery Fascial Flow-Through Free Flap for Complex Cerebral Revascularization: Technical Notes and Long-Term Neurologic and Radiographic Outcomes.

Surgical innovation is critical for the management of challenging cerebrovascular pathology. Flow-through free flaps are versatile composite grafts that combine viable tissue with a revascularization source. Neurosurgical experience with these flaps is limited. To provide an in-depth technical description of the radial artery fascial (and fasciocutaneous) flow-through free flap (RAFF and RAFCF, respectively) for complex cerebral revascularizations. An Institutional Review Board-approved, prospective database was retrospectively reviewed to identify patients that underwent extracranial-to-intracranial cerebral bypass with a RAFF or RAFCF. Patient demographics, underlying pathology, surgical treatment, complications, and outcomes were recorded. A total of 4 patients were treated with RAFFs or RAFCFs (average age 40 ± 8.8 yr). Two patients with progressive moyamoya disease involving multiple vascular territories with predominantly anterior cerebral artery (ACA) symptoms and flow alterations underwent combined direct ACA and indirect middle cerebral artery (MCA) bypass with a RAFF. The third patient with moyamoya disease and concomitant proximal fusiform aneurysms requiring internal carotid artery sacrifice underwent dual direct ACA and MCA bypass and indirect MCA revascularization with posterior tibial artery and RAFF grafts. The fourth patient with a large MCA bifurcation aneurysm and recurrent wound complications underwent a direct MCA bypass and complex wound reconstruction using a RAFCF. Good neurologic outcomes (Glasgow Outcomes Scale score ≥4 at discharge) were achieved in all patients. There were no perioperative surgical complications, and graft patency was confirmed on long-term follow-up. The RAFF and RAFCF are versatile grafts for complex cerebral revascularizations.

Using Absorbable Gelatin Sponge to Facilitate Sinus Membrane Elevation during Open Sinus Lift: Technical Notes and Case Series

Ridge atrophy accompanied by the pneumatization of maxillary sinus in the maxillary posterior region may lead to inadequate bone height, thereby precluding implant placement. Therefore, it may be mandatory to perform a sinus membrane elevation procedure and augmentation in the bone. The present study aimed to introduce a novel modification method for sinus floor elevation using a gelatin sponge (Gelatamp, COLTENE ROEKO, India) in order for better visualization, hemostasis, and conservative maxillary sinus membrane dissection with the low risk of complications. Implant placement was performed in a case series of 28 patients with hyperpneumatized sinus or a moderately resorbed posterior maxillary alveolus. According to the findings, implant placement caused no complications in the patients. Furthermore, none of the patients experienced infections, sinusitis or graft and implant failure clinically and radiographically at the three- and six-month follow-up. Therefore, it could be concluded that gelatamp-assisted sinus lift is a simple, safe, noninvasive, and innovative technique for sinus membrane elevation. In addition, it is predictable and efficient, especially in the cases where piezoelectric surgery armamentarium is not available.

Activation of Dispute Resolution under UNCITRAL Technical Notes on Online Dispute Resolution

To reduce the number of e-commerce disputes is very difficult because the risks involved in e-commerce transaction are fairly various and serious. However, effort has been made to make users allow easier access to ODR to give the ways to resolve those disputes at a quicker and cheaper way, that is, Online Dispute Resolution. UNCITRAL finalized and adopted the Technical Notes on Online Dispute Resolution at its forty-ninth session in 2016. The Technical Notes on Online Dispute Resolution are non-binding, and take the form of a descriptive document, reflecting elements of an online dispute resolution process. Under the Technical Notes, the process of an ODR proceeding consists of three stages: negotiation, facilitated settlement, and a third (final) stage. ODR platform can provide an accessible method of resolving disputes for the large number of parties for whom traditional courts are now too expensive. ODR platform provides a modern and cost effective process to resolve e-commerce disputes to the parties’ best interest. ODR platform is a platform that is sophisticated and best designed to maximise the opportunities for e-commerce dispute resolution and minimise the access to justice. The purpose of this paper is to contribute to the activation of ODR platform by studying three stages of ODR process such as negotiation, facilitated settlement, and a third (final) stage.

Sphenopalatine Ganglion Block and Radiofrequency Ablation: Technical Notes and Efficacy.

Background: Sphenopalatine ganglion (SPG) blockade or lesioning can offer significant pain relief for cluster headaches (CHs) and a variety of other pain syndromes involving the head and face. Methods: We reviewed the literature on the efficacy of SPG block and radiofrequency ablation (RFA) using PubMed and Google Scholar. Results: The infrazygomatic technique can be used to directly access the SPG for injection of local anesthetic or lesioning using RFA. Important technical points to achieve these procedures are described. SPG blockade efficacy is supported by randomized controlled studies but SPG RFA is not. Conclusion: Targeting the SPG is a promising treatment option for refractory CHs. RFA and neuromodulation have the potential to offer long-term significant pain relief, but more randomized studies are needed to demonstrate their efficacy.

Technical Notes and Result of Stereotactic Evacuation of Hematoma in Spontaneous Supratentorial Intracerebral Hematoma

Primary intracerebral hematoma constitutes about 10-15% of all strokes and is associated with high mortality and severe disability. Surgical treatment of intracerebral hemorrhage is quite controversial. It is believed that minimal invasive stereotactic surgery may reduce hematoma volume and decrease secondary neurotoxicity. The technical note of stereotactic surgery has been illustrated. A retrospective study from March 2016 to March 2018 has been conducted and all patients who underwent stereotactic evacuation of hematoma were included in this study. Baseline characteristics of patients and outcome in terms of Glasgow Coma Scale (GCS) and Modified Rankin Scale (mRS) have been shown. We have found significant improvement in GCS postoperatively, however mRS did not improve immediately but was significantly better in three months follow up period.

Technical and Methodical Notes on the Lensless Holographic Microscopy Applications for Helminthology and Zooparasitology. Case I: Spectrozonal/Multispectral Analysis of Ascaris Lumbricoides based on Coherent and Incoherent Light Sensor Platforms

Technical and Methodical Notes on the Lensless Holographic Microscopy Applications for Helminthology and Zooparasitology. Case I: Spectrozonal/Multispectral Analysis of Ascaris Lumbricoides based on Coherent and Incoherent Light Sensor Platforms

Intraoperative Spinal Navigation for the Removal of Intradural Tumors: Technical Notes.

In recent years, spinal surgery has incorporated the many advantages of navigation techniques to facilitate the placement of pedicle screws during osteosynthesis, mainly for degenerative diseases. However, spinal intradural tumors are not clearly visible by intraoperative fluoroscopy or computed tomography scans, thereby making navigation necessary. To evaluate the use of spinal navigation for the removal of intradural and spinal cord tumors using spinal magnetic resonance imaging (MRI) merged with intraoperative 3-dimensional (3-D) fluoro images. After fixing the patient reference frame on the spinous process, the 3-D fluoro images were obtained in the surgical room. Using this image as the reference, the preoperative volumetric MRI images and intraoperative 3-D fluoro images were merged using automated software or manually. From January to July 2016, we performed 10 navigated procedures for intradural spinal tumors by merging MRI and 3-D fluoro images. Nine patients had an intradural extramedullary tumor, 6 had neurinomas, and 3 had meningiomas; 1 patient had an intramedullary spinal cord metastasis. The surgically demonstrated benefits of spinal navigation for the removal of intradural tumors include the decreased risk of surgery at the wrong spinal level, a minimal length of skin incision and muscle strip, and a reduction in bone removal extension. Furthermore, this technique offers the advantage of opening the dura as much as is necessary and, in the case of intrinsic spinal cord tumors, it allows the tumor to be centered. Otherwise, this would not be visible, thus enabling the precise level and the posterior midline sulcus to be determined when performing a mielotomy.

Percutaneous Endoscopic Cervical Discectomy and Osteophytes Removal Via an Anterior Transforaminal Approach for Radiculopathy: Technical Notes and Review

BACKGROUND: Cervical radiculopathy can be treated by anterior endoscopic approach to access its target pathology decompressing spinal nerve roots without fusion. The transforaminal anterior percutaneous endoscopic cervical discectomy approach is easy way to transverse process and decompress and remove osteophytes. It preserves spinal motion, stability and reduces risk of vertebral injury. METHODS: A case selected had neck pain radiating toward right arm for 2 month but severe pain from 20 days, neck deformities, head tilted toward right side. Neurological examination showed decreased sensation, weakness over right sided trapezius, biceps and triceps muscles. Eaton sign and Spurling sign were positive. Preoperative dynamic X-ray showed degenerative changes, osteophtyes at C3-4, C5-6, CT -intervertebral foraminal stenosis at C3-4 and C5-6 level, MRI -disc protrusion severely compressing spinal cord at C3/4 level. We operated at most significant level as first successful newer approach for cervical radiculopathy with osteophytes removal, decompression and discectomy by PECD anterolateral (transforaminal approach) under general anesthesia. RESULTS: Blood loss 100 mL. Hospital Stay 3 days. Operative time was 80 minute. There was marked improvement of preoperative VAS score from 7/10 to 3/10. After surgery drain was fixed for 24 hour to collect some residual fluids and avoid hematomas. There were no significant post operative events or surgery-related complication. CONCLUSION: Under percutaneous endoscopic system is easy to visualize proper minute structure, drill, dissect and lessen the chance of iatrogenic injury, decrease risk of vertebral arteries. Anterior transformaminal endoscopic surgical approach can be further developed and trained for treatment of cervical radiculopathy in large population.

Fluorescein-Guided Surgery for Pediatric Brainstem Gliomas: Preliminary Study and Technical Notes

Introduction Brainstem gliomas (BsG) account for 10 to 15% of pediatric brain tumors. Surgery is the preferred treatment for focal and exophytic lesions. Sodium fluorescein has been proven safe and effective in resection of malignant brain tumors. Objective The objective was to o analyze the safety and effectiveness of this approach, to evaluate intraoperative fluorescein imaging, and to measure the safety of chosen dose for pediatric patients. Methods Twelve cases were enrolled between March 2014 and September 2016 in Beijing Tiantan Hospital. All of the patients received 2.5 mg/kg of sodium fluorescein before opening the dura; the intraoperative fluorescence enhancement was observed, and the degree of satisfaction and consistency with the neuronavigation were evaluated. Results With a mean age of 7.5 years, there were eight cases located within the pontine, three in the medullary oblongata, and one in the tectal plate. Histological results were astrocytoma, glioblastoma, oligodendroglioma, and pilocytic astrocytoma. Under the fluorescein module of the microscope, the tumors were recognizable enough to help surgeons to discriminate the lesion from non-fluorescent tissue, with a consistency of 83% with the neuronavigation. Total removal was accomplished in nine cases, while the mean percentage of resection of the other cases was 93.7%. The Karnofsky performance score (KPS) showed no significant differences between pre-operation and discharge, but there was a difference between pre-operation and 6-month follow-up. Conclusion The fluorescein-guided surgery is useful for demarcating the tumor margin and works well with other navigation and monitoring devices. A safe dose of sodium fluorescein (2.5 mg/kg) was proven effective for children.

Surgical treatment of preschool childhood spinal thoracic tuberculosis: two case reports and technical note

AbstractBackground: The development of paraplegia and kyphosis are two important problems related to spinal tuberculosis (Pott’s disease) in children. The current study aims to present two pediatric Pott’s disease, point out the progression of this disease in children, surgical options and surgical outcomes.Materials and methods: Two cases of childhood Pott’s disease were referred to our department with progressive neurological deficits (both of children were experienced bilateral weakness in lower extremities; grade C according to Frankel scale) during short periods (less than one month per each). Both cases’ MRIs are demonstrated abscesses in thoracic spine. Both patients are treated surgically. We discussed in this study the technical notes in both cases, especially in 2- year-old child.Results: Both cases were treated surgically after decompressing nerve roots and thecal sac posterior instrumentation was applied. Microbiological examination of both samples revealed on M.Tuberculosis. Orthoses are applied three months after operations. Antituberculosis medication protocol was applied. Preoperative paraparesis had recovered completely and muscle strengths all returned to normal in both children. There is no loss of correction during the follow-up periods.Conclusion: Spinal tuberculosis is a dynamic disease that may lead to severe deformities in childhood. Especially in cases where two or more vertebrae are affected, early surgical treatment is essential to prevent severe kyphosis. Surgical intervention accompanied with antituberculosis medications protocol is essential to cure treatment in pediatric population. In children aged ≤6 years and more than one vertebrae were affected, fıbula can be used to allow growth of the child vertebral column.

Percutaneous Endoscopic Cervical Discectomy and Osteophytes Removal Via an Anterior Transforaminal Approach for Radiculopathy: Technical Notes and Review

BACKGROUND: Cervical radiculopathy can be treated by anterior endoscopic approach to access its target pathology decompressing spinal nerve roots without fusion. The transforaminal anterior percutaneous endoscopic cervical discectomy approach is easy way to transverse process and decompress and remove osteophytes. It preserves spinal motion, stability and reduces risk of vertebral injury. METHODS: A case selected had neck pain radiating toward right arm for 2 month but severe pain from 20 days, neck deformities, head tilted toward right side. Neurological examination showed decreased sensation, weakness over right sided trapezius, biceps and triceps muscles. Eaton sign and Spurling sign were positive. Preoperative dynamic X-ray showed degenerative changes, osteophtyes at C3-4, C5-6, CT -intervertebral foraminal stenosis at C3-4 and C5-6 level, MRI -disc protrusion severely compressing spinal cord at C3/4 level. We operated at most significant level as first successful newer approach for cervical radiculopathy with osteophytes removal, decompression and discectomy by PECD anterolateral (transforaminal approach) under general anesthesia. RESULTS: Blood loss 100 mL. Hospital Stay 3 days. Operative time was 80 minute. There was marked improvement of preoperative VAS score from 7/10 to 3/10. After surgery drain was fixed for 24 hour to collect some residual fluids and avoid hematomas. There were no significant post operative events or surgery-related complication. CONCLUSION: Under percutaneous endoscopic system is easy to visualize proper minute structure, drill, dissect and lessen the chance of iatrogenic injury, decrease risk of vertebral arteries. Anterior transformaminal endoscopic surgical approach can be further developed and trained for treatment of cervical radiculopathy in large population.

Technical Notes for Prevention of Troubles in STA-MCA Bypass

Technical Notes for Prevention of Troubles in STA-MCA Bypass

In Reply: Endoscopic and Gravity-Assisted Resection of Medial Temporo-occipital Lesions Through a Supracerebellar Transtentorial Approach: Technical Notes With Case Illustrations.

BACKGROUND Traditional approaches to medial temporo-occipital intra-axial brain tumors carry the risk of visual or language deficits related to brain retraction or transgression of deep fiber tracts. To reduce these risks, the microscopic supracerebellar transtentorial approach with the patient in the sitting position has been previously described for lesions in relative proximity to the tentorium. OBJECTIVE We describe this approach performed with endoscopic tumor resection to allow better visualization and a more ergonomic operating position. METHODS Four consecutive patients harboring a medial temporo-occipital lesion are reported. All were operated on while in the sitting position using frameless navigation and a supracerebellar transtentorial approach. Tumor resection was performed by 2 surgeons with endoscopic visualization. RESULTS Pathologies included intraparenchymal metastatic melanoma, cavernous hemangioma, and ganglioglioma, as well as an intraventricular metastatic tumor. The distance from the tentorium to the lesion ranged from 1 to 4 mm. Gross total resection was achieved in 3 of the 4 patients. The patient with a metastatic melanoma had an intentional near-total resection given the tumor encasing a branch of the posterior cerebral artery. The patient with the intraventricular tumor sustained a small but symptomatic infarct of the lateral geniculate region, resulting in a visual field deficit. CONCLUSION This small series suggests that the endoscopic supracerebellar transtentorial approach with the patient in the sitting position can be a safe and effective approach for removing medial temporo-occipital lesions. It allows excellent tumor visualization, eliminates the need for brain retraction, minimizes parenchymal transgression, and improves surgical ergonomics. Significant experience in endoscopy and excellent neuroanesthesia support are recommended before undertaking this approach.

The use of Scientific Evidence to Support Judicial Decisions

Seeking the Judiciary is an alternative to get access to medicines in Brazil. In attempt to regulate this process, the National Justice Council published in 2010 the Recommendation n. 31 advising the Courts of Justice (CJ) to sign technical support agreements in order to instantiate the judicial decisions through Technical Notes (TN) and Quick Technical Responses (QTR) wording. This study analyzed the conformity between the TN and QTR recommendations and the judicial decisions related to lawsuits against Minas Gerais State, Brazil, from 2014 to 2016. At the end, the financial resource that would be saved if magistrates had denied all technically not advised medicines was estimated. The TN and QTR from Minas Gerais CJ’s website were analyzed: 124 TN and their respective lawsuits involving 156 medicines; 341 QTR and their legal actions encompassing 810 drugs. The annual purchase price of medicines not advised by the TN and QTR was estimated. For TN: 20% conformity between favorable to the drug dispensation judicial decision and TN; 3% of TN were in favor of it, but judicial decision was against it; 21% agreement between unfavorable to the drug dispensation judicial decision and TN. In 56% of the cases, the magistrate approved the medicine request despite the TN recommendation against it. For QTR: 38% conformity between favorable to the drug dispensation judicial decision and QTR; 14% agreement between unfavorable to the drug dispensation judicial decision and QTR. In 48% of the cases, the QTR were against it, but the judge approved the drug request. The estimated cost to purchase the not technically advised medicines was USD 1359245.89. The conformity between judicial decisions and TN and QTR recommendations was low. It’s necessary to evaluate if the use of technical advises is the way to solve the “Health Judicialization” in Brazil.

Breakage of the Tail Portion of the Lag Screw during Removal of Proximal Femoral Zimmer Natural Nail: Report of Two Cases with Technical Notes

Proximal femoral cephalomedullary nailing is one of the treatments of choice for intertrochanteric fracture. Zimmer Natural Nail® (ZNN; Zimmer) is one of the alternatives. We report two cases of broken tail portion of the ZNN lag screw during the removal procedure. This may be the first reported cases in scientific literature with this pattern of failure. We report these cases to highlight one of the possible problems that could occur during removal of this implant which can possibly prolong the operation time significantly if the required device is not prepared.

Technical Notes on Volume Averaging in Porous Media I: How to Choose a Spatial Averaging Operator for Periodic and Quasiperiodic Structures

This paper is a first of a series aiming at revisiting technical aspects of the volume averaging theory. Here, we discuss the choice of the spatial averaging operator for periodic and quasiperiodic structures. We show that spatial averaging must be defined in terms of a convolution and analyze the properties of a variety of kernels, with a particular focus on the smoothness of average fields, the ability to attenuate geometrical fluctuations, Taylor series expansions, averaging of periodic fields and resilience to perturbations of periodicity. We conclude with a set of recommendations regarding kernels to use in the volume averaging theory.